A survey of current UK practice regarding the biopsy of clinically and radiologically benign breast masses in young women

A survey of current UK practice regarding the biopsy of clinically and radiologically benign breast masses in young women
L.J. Hamilton, E.J. Cornford, A.J. Maxwell
Clinical Radiology 2011 66;8:738-741

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Aim: To determine current practice in the UK of needle sampling of clinically and radiologically benign breast masses in young women.

A questionnaire regarding needle sampling practice in young women with clinically and radiologically benign breast masses was sent to 481 members of the Royal College of Radiologists Breast Group. This included questions on whether a written protocol is in place to allow avoidance of biopsy, and if so, the clinical and radiological criteria used.

Responses were available for analysis from 80 units. Forty-two (53%) units had no written policy in place, whilst 38 (47%) adhered to a written policy. Of those with a policy, an age criterion for safe avoidance of biopsy was present in 36 out of the 38 units (95%). The age limit used ranged from <25 years to <35 years. Twenty-seven (71%) written policies included clinical criteria but only four (10%) policies included a size criterion. Radiological criteria were present in all policies and the majority (74%) adhered to full Stavros criteria. Seven units (18%) used a revised form of the Stavros criteria and three units used their own criteria.
Conclusion

There is little concordance between symptomatic breast clinics regarding the criteria for avoidance of breast biopsy in this young patient group. Given the very low incidence of breast carcinoma in women less than 25 years old it is considered safe and feasible to adopt a standardized protocol across the UK and avoid the often-unnecessary benign biopsies in these patients

Image-guided breast biopsy: state-of-the-art

Image-guided breast biopsy: state-of-the-art
E.A.M. O'Flynn, A.R.M. Wilson, M.J. Michell
Clin Rad 65;4:259-270

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Review of breast biopsy by the King's team

Ultrasound diagnosis of fibroadenoma — is biopsy always necessary?

G.E.C. Smith and P. Burrows
followed by commentary by Barbara Dall
Clinical Radiology Volume 63, Issue 5, May 2008, Pages 511-515

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The majority of patients in the 25 years and under age group have benign breast pathology, most commonly fibroadenoma. Modern ultrasound is a reliable technique to diagnose fibroadenoma in the hands of experienced breast radiologists. Therefore, in this age group, it is proposed that a palpable lump that has the ultrasound characteristics entirely consistent with a fibroadenoma need not be biopsied unless there is overriding clinical concern. The patients should be reassured, discharged, and advised to return for further evaluation only if they detect a change in the palpable abnormality

A project is also being co-ordinated by Robin Wilson, surveying the data from UK breast screening centres. May be presented at the RCRBG annual meeting this November