Jacky Luiten

Summary and summary in Dutch | 117 8 in 2015 ‐ 2016. But reversely, the rate of secondary excision biopsies, which initially decreased from 1.0 per 1000 screens in 1997 ‐ 1998 to 0.3 per 1000 in 2005 ‐ 2006, was found to increased again to 0.6 per 1000 in 2015 ‐ 2016 ( p =0.003). Of all secondary excision biopsies, 61.0% had a benign pathology outcome, and this proportion increased from 40.4% to 70.2% over the years. Since the vast majority of currently performed excision biopsies reveals a benign pathology result, the use of secondary excision biopsy should be considered carefully. Since the introduction of digital mammography SCNB is performed more often, probably because digital mammography has a higher sensitivity for the detection of small lesions and microcalcifications compared to SFM. 5 Pathologic examination of these small lesions has given rise to a new pathologic classification of so called ‘high ‐ risk’ lesions. High ‐ risk lesions are defined as being not identical to normal breast tissue, but not fulfilling criteria of either invasive breast cancer or precursor stadia also referred to as DCIS. Examples are flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in ‐ situ, papillary lesions and radial scars. Optimal management of these high ‐ risk lesions found at SCNB is controversial due to its rather unknown natural behavior. 6 ‐ 9 Chapter 4 analyzes the incidence, management and outcome of high ‐ risk breast lesions during the years 2011 ‐ 2016. Despite a rather stable proportion of recalled women who underwent SCNB, the proportion of high ‐ risk lesions at (S)CNB results gradually increased from 3.2% in 2011 to 9.5% in 2016 ( p <0.001). Subsequently, the excision rate for high ‐ risk lesions per 1000 screens increased from 0.25 to 0.70 ( p <0.001). Since the proportion of surgical excisions showing in ‐ situ or invasive breast cancer did not increase (overall 29%), a growing number of screened women who underwent invasive surgical excision had a benign outcome. The introduction of digital screening mammography resulted in a higher specificity and sensitivity for small lesions, including a better discrimination of fine microcalcifications. 10 However, the information on trends in the detection of suspicious microcalcifications at mammography screening and the yield of these lesions after recall is limited. Therefore, in chapter 5 we analyzed these trends during 20 years of mammography screening. A fivefold increase in the recall for suspicious microcalcifications from 0.1% in 1997 ‐ 1998 to 0.5% in 2015 ‐ 2016 ( p <0.001) was found. The recalls yielding DCIS increased from 0.3 per 1000 screens to 1.1 per 1000 screens respectively ( p <0.001), resulting in a decrease in the positive predictive value for recall for suspicious microcalcifications from 51% to 33% ( p <0.001).