Zusammenfassung
Ziel: Aus der Abklärungsdiagnostik des digitalen Mammografie-Screenings wurden die Rate,
das histologische Spektrum und der positive Vorhersagewert (PPV) hinsichtlich Malignität
von Brustläsionen minimalinvasiver Biopsien „unklaren malignen Potenzials (B3)” untersucht.
Material und Methoden: Konsekutive Untersuchungen von 37 178 Teilnehmerinnen einer digitalen Einheit des
deutschen Screeningprogramms wurden eingeschlossen. Ergebnisse: Die B 3-Rate war 15,1 % (148 / 979). Es lagen folgende Häufigkeiten der B 3-Subtypen
vor: atypische epitheliale Proliferationen vom duktalen Typ (AEPDT) 35,1 % (52 / 148),
radiäre Narben (RS) 28,4 % (42 / 148), papilläre Läsionen (PAP) 20,3 % (30 / 148),
Carcinoma lobulare in situ 8,8 % (13 / 148), flache epitheliale Atypien 5,4 % (8 / 148),
mukozelenartige Läsionen 2,0 % (3 / 148). Der PPV für Malignität in der sekundären
chirurgischen Exzision betrug insgesamt 0,28 (25 / 91); dabei ist der PPV 0,40 (19 / 47)
für die AEPDT, 0,20 (5 / 25) für die RS, 0,08 (1 / 12) für PAP. Schlussfolgerung: Trotz einer höheren B 3-Rate von Brustläsionen mit „unklarem malignem Potenzial”
minimalinvasiver Biopsien im digitalen Mammografie-Screening ist die Rate benigner
chirurgischer Exzisionen im Vergleich zum analogen Screening nicht unverhältnismäßig
erhöht. In Kombination mit einem konsequenten interdisziplinären Management resultiert
eine erhöhte Brustkrebsentdeckungsrate pro Screeningteilnehmerin mit offener Biopsie.
Abstract
Purpose: To evaluate the rate, the histological spectrum and the positive predictive value
(PPV) for malignancy of minimally invasive biopsies with ”uncertain malignant potential
(B3)” in digital mammography screening. Methods and Materials: Consecutive data of 37 178 participants of one digital unit of the German screening
program were included. Results: The B 3 rate was 15.1 % (148 / 979). The frequencies of lesion subtypes were as follows:
atypical epithelial proliferation of ductal type (AEPDT) 35.1 % (52 / 148), radial
scar (RS) 28.4 % (42 / 148), papillary lesions (PAP) 20.3 % (30 / 148), lobular carcinoma
in situ 8.8 % (13 / 148), flat epithelial atypia 5.4 % (8 / 148), and mucocele-like
lesions 2.0 % (3 / 148). The PPV for malignancy in surgical excisions was overall
0.28 (25 / 91); in detail 0.40 (19 / 47) for AEPDT, 0.20 (5 / 25) for RS, 0.08 (1 / 12)
for PAP. Conclusion: Despite a higher B 3 rate of minimally invasive biopsies with ”uncertain malignant
potential” in digital screening, the benign surgical biopsy rate is not disproportionally
increased compared with analog screening programs. Together with defined management
protocols, this results in an increased cancer detection rate per screening participant
with surgical excision.
Key words
breast - biopsy - mammography screening - digital mammography - histology - predictive
value
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Dr. Stefanie Weigel
Institut für Klinische Radiologie, Universitätsklinikum Münster
Albert-Schweitzer-Straße 33
48129 Münster
Germany
Telefon: ++ 49/2 51/8 34 56 50
Fax: ++ 49/2 51/8 34 56 60
eMail: weigels@uni-muenster.de