Management, Upgrade Rates, and Radiologic Surveillance of Screen-Detected High-Risk Breast Lesions.

Authors

Eline L van der Veer, Adriana M J Bluekens, Angela M P Coolen, Willem Vreuls, Adri C Voogd, Lucien E M Duijm

Published in

Radiology. Imaging cancer. Volume 8. Issue 6. Pages e260010.

Abstract

Purpose To evaluate the prevalence, upgrade rate, and radiologic surveillance management of high-risk lesions (HRLs) detected at screening mammography in a Dutch breast cancer screening population. Materials and Methods This retrospective analysis of a prospectively maintained database included patients recalled from the Dutch breast cancer screening program between January 2009 and July 2019. Incidence rates, diagnostic work-up, radiologic surveillance, and upgrades to (pre)malignancy after surgical excision and during radiologic surveillance were evaluated. Results Among 17 809 recalled patients, 514 patients with a mean age of 58 years ± 8.1 (SD) were diagnosed with an HRL. The incidence rate of HRLs was 0.83 per 1000 screens and 2.89 per 100 recalls. The majority of HRLs consisted of papillary lesions (34.4% [177 of 514]) and atypical ductal hyperplasia (ADH) (31.1% [160 of 514]). Surgical excision was performed in 233 cases (45.3%), resulting in 58 HRLs (24.9%) being upgraded to (pre)malignancy. Invasive tumors were mainly found in papillary lesions with atypia and ADH. Of patients diagnosed with an HRL, 324 (63.0%) had an indication for radiologic surveillance. Of these, 257 (79.3%) underwent surveillance, with 109 (42.4%) completing the recommended 5-year surveillance trajectory. During surveillance, 26 patients (10.1%) developed a (pre)malignancy. Invasive tumors were more frequently identified among HRLs upgraded during surveillance than among HRLs upgraded after surgical excision (17 of 26 [65%] vs 16 of 58 [28%]; P = .001). HRLs upgraded to invasive cancer were more likely to be triple-negative compared with screen-detected cancers (9.1% [3 of 33] vs 6.6% [215 of 3277]; P < .001). Conclusion Overall, 16.3% (84 of 514) of screen-detected HRLs were associated with a diagnosis of (pre)malignancy after surgical excision or during radiologic surveillance. Completion of the recommended 5-year surveillance trajectory was achieved in fewer than half of patients undergoing surveillance. Keywords: Breast Mammography, MR-Imaging, Ultrasound, Biopsy/Needle Aspiration, Screening Supplemental material is available for this article. © RSNA, 2026.

PMID:
42853044
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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