Asymptomatic Complicated Cysts in Postmenopausal Women: Is Tissue Sampling Unnecessarily High?

RATIONALE AND OBJECTIVES: To determine the malignancy rate of complicated cysts in postmenopausal women and to discuss appropriate (Breast Imaging Reporting and Data System assessment and recommendation. MATERIALS AND METHODS: This study was approved by our institutional review board and informed consent was waived. One hundred fourteen postmenopausal patients with 183 complicated cysts as defined by the newest Breast Imaging Reporting and Data System edition were identified retrospectively between January 2013 and December 2015 (to allow for 2 years follow-up period). One hundred eight complicated cysts were assessed as probably benign and 75 as suspicious. Prospective review of all images and pathology was performed and patient's age, breast density, risk factors, use of hormone replacement therapy, and family history of breast cancer were recorded. A total of 30 symptomatic patients and lesions not meeting criteria for complicated cysts were excluded from our cohort. Benignity was determined by aspiration, biopsy, resolution, recategorization to a simple cyst, or adequate follow-up. RESULTS: None of our complicated cysts proved malignant. Fifteen of 108 probably benign complicated cysts were aspirated yielding benign fluid in 10 and 5 were biopsied yielding benign pathology (only 2 with atypical cells). Twenty-nine of 75 complicated cysts categorized as suspicious were aspirated and fluid was discarded in 25 and 4 sent for cytology yielding benign pathology. The other 41 complicated cysts thought to be suspicious were biopsied with benign pathology (only 1 atypical). CONCLUSION: This study supports the use of a probably benign assessment of asymptomatic complicated cysts irrespective of age. The sensitivity for malignancy was 100% in our cohort.

Clinical Performance of Synthesized Two-dimensional Mammography Combined with Tomosynthesis in a Large Screening Population.

Purpose To compare the clinical performance of synthesized two-dimensional (s2D) mammography combined with digital breast tomosynthesis (DBT) with that of full-field digital mammography (FFDM) alone and FFDM combined with DBT in a large community-based screening population by analyzing recall rate, positive predictive value, and cancer detection rate. Materials and Methods This was a retrospective study approved by the institutional review board and was HIPAA compliant with waiver of informed consent. A total of 78 810 screening mammograms from October 11, 2011, to June 30, 2016, were retrospectively collected. Of these, 32 076 were FFDM, 30 561 were DBT-FFDM, and 16 173 were DBT-s2D mammograms. Diagnostic performance of FFDM, DBT-FFDM, and DBT-s2D mammography was compared. Statistical significance was determined by using the Pearson χ2 test and was expressed as odds ratios and related confidence intervals determined by means of logistic regression analysis with pairwise comparisons. Results Recall rates were significantly lower with DBT-s2D mammography (4.3%, 687 of 16 173) when compared with DBT-FFDM (5.8%, 1785 of 30 561; odds ratio, 0.72; 95% confidence interval: 0.65, 0.78; P < .0001) and when compared with FFDM alone (8.7%, 2799 of 32 076; odds ratio, 0.46; 95% confidence interval: 0.43, 0.51). The cancer detection rate was similar among FFDM alone (5.3 of 1000 screening examinations), DBT-FFDM (6.4 of 1000 screening examinations), and DBT-s2D mammography (6.1 of 1000 screening examinations) with no significant difference (FFDM vs DBT-FFDM, P = .08; FFDM vs DBT-s2D, P = .27). The percentage of invasive cancers detected was significantly higher with DBT-s2D mammography (76.5%) than with DBT-FFDM (61.3%, P = .01), and positive predictive values with DBT-s2D mammography (40.8%) were significantly higher than those with DBT-FFDM (28.5%, P < .0001). Conclusion Screening with DBT-s2D mammography in a large community-based practice improved recall rate and positive predictive values without loss of cancer detection rate when compared with DBT-FFDM and FFDM alone. © RSNA, 2017.