Positive Predictive Value of Biopsy of Palpable Masses Following Mastectomy

Brennan SB, D’Alessio D, Kaplan J, Edelweiss M, Heerdt A and Morris E

Department of Breast Imaging, Memorial Sloan Kettering Cancer Center, NY 10604, USA

^*Correspondance to: Sandra Brennan 

 PDF  Full Text DOI: 10.25107/2474-1647.1580

Abstract

Objective: Determine the positive predictive value (PPV) of biopsy of palpable masses following mastectomy (MX). Determine if there are patient characteristics, tumor or imaging features more predictive of cancer.Materials and
Methods: IRB-approved retrospective review of 16396 breast ultrasounds June 2008 - December 2015 identified patients with MX presenting with palpable masses. Medical records and imaging studies were reviewed. Statistical analysis was performed with Fisher’s exact test. 95% confidence intervals (CI) were calculated.Results: 117 patients presented with palpable masses on the MX side. 101/117 patients who had a palpable mass on physical examination had a true sonographic mass to correlate with the clinical findings. 91/101 (90%) underwent biopsy: 19/91 (21%, 95% CI; 13-31) biopsies were malignant. 72/91 (79%) were benign. All 19 cancers were on the original cancer side. Recurrences ranged from 0.4 to 4.5 cm maximum diameter, mean 1.3 cm. Prophylactic versus therapeutic mastectomy was very statistically significant (p=0.01). The use of tamoxifen or an AI was also statistically significant (p=0.04) Patient age (p=1.0), radiation therapy (p=1.05), chemotherapy (p=0.2) immediate breast reconstruction (p=0.2) or implant versus flap (p=0.2) had a statistically significant association with finding cancer on biopsy. Lesion shape (irregular versus oval/round) was highly statistically significant (p=0.0003) as was nonparallel orientation on ultrasound (p=0.008). Circumscribed versus non-circumscribed margins was also statistically significant (p=0.008).Conclusion: The PPV of biopsy of palpable masses on the side of MX was 21% (95% CI; 13-31). All recurrences were on the original cancer side and this was very statistically significant.

Keywords

Breast; Mastectomy; Biopsy; Fine-Needle; Cytology; Recurrence

Cite the article

J, Edelweiss M, Heerdt A, Morris E. Positive Predictive Value of Biopsy of Palpable Masses Following Mastectomy. Clin Surg. 2017; 2: 1580.