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Prospective Multicenter Study Validate a Prediction Model for Surgery Uptake Among Women with Atypical Breast Lesions

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Diagnosis of atypical breast lesions (ABLs) leads to unnecessary surgery in 75–90% of women. We have previously developed a model including age, complete radiological target excision after biopsy, and focus size that predicts the probability of cancer at surgery. The present study aimed to validate this model in a prospective multicenter setting. –

Methods

Women with a recently diagnosed ABL on image-guided biopsy were recruited in 18 centers, before wire-guided localized excisional lumpectomy. Primary outcome was the negative predictive value (NPV) of the model.

Results

The NOMAT model could be used in 287 of the 300 patients included (195 with ADH). At surgery, 12 invasive (all grade 1), and 43 in situ carcinomas were identified (all ABL: 55/287, 19%; ADH only: 49/195, 25%). The area under the receiving operating characteristics curve of the model was 0.64 (95% CI 0.58–0.69) for all ABL, and 0.63 for ADH only (95% CI 0.56–0.70). For the pre-specified threshold of 20% predicted probability of cancer, NPV was 82% (77–87%) for all ABL, and 77% (95% CI 71–83%) for patients with ADH. At a 10% threshold, NPV was 89% (84–94%) for all ABL, and 85% (95% CI 78-–92%) for the ADH. At this threshold, 58% of the whole ABL population (and 54% of ADH patients) could have avoided surgery with only 2 missed invasive cancers.

Conclusion

The NOMAT model could be useful to avoid unnecessary surgery among women with ABL, including for patients with ADH.

Clinical Trial registration: NCT02523612.

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Acknowledgement

We thank all the women who kindly accepted to participate in this study. We thank the research teams of all participating centers, and Nathalie Bouvet for data management. We thank the French National Cancer Institute for funding this trial.

Funding

This trial was supported by a French National Grant after expert reviews (PHRC National Cancer 2014 Reference INCA RECF2719).

Author information

Authors and Affiliations

  1. AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France

    Catherine Uzan MD, PhD

  2. Sorbonne University, INSERM UMR_S_938, “Cancer Biology and Therapeutics”, Centre de Recherche Saint-Antoine (CRSA), Paris, France

    Catherine Uzan MD, PhD

  3. Institut Universitaire de Cancérologie (IUC), Paris, France

    Catherine Uzan MD, PhD

  4. Gustave Roussy, Villejuif, France

    Chafika Mazouni MD, PhD, Caroline Rossoni MSc, Corinne Balleyguier MD, PhD, Natacha Joyon MD, PhD, Magali Lacroix Triki MD, PhD, Suzette Delaloge MD, PhD & Stefan Michiels MD, PhD

  5. Radiology Center, Centre Eugène Marquis, CHU Rennes, Rennes, France

    Brigitte De Korvin MD

  6. Institut Bergonié, Bordeaux, France

    Christine Tunon de Lara MD

  7. Institut Paoli Calmettes, Marseille, France

    Monique Cohen MD

  8. Hôpital Tenon, Sorbonne University, Paris, France

    Nathalie Chabbert MD, PhD & Sonia Zilberman MD

  9. Centre Jean Perrin, Clermont-Ferrand, France

    Veronique Boussion MD

  10. Institut Curie, Université Paris-Sciences Lettres, INSERM U934, Département de Médecine Diagnostique et Théranostique, Paris, France

    Anne Vincent Salomon MD, PhD

  11. University of Paris, Hôpital Saint Louis, APHP, Paris, France

    Marc Espie MD

  12. Centre Georges François Leclerc, Dijon, France

    Charles Coutant MD, PhD

  13. Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France

    Frederic Marchal MD, PhD

  14. Service de Biostatistique et d’Épidémiologie, Gustave Roussy, Villejuif, France

    Flore Salviat MD

  15. CESP INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France

    Flore Salviat MD

  16. Centre Oscar Lambret, Lille, France

    Loic Boulanger MD

  17. Institut Cancérologique de l’ouest, Saint-Herblain, France

    Isabelle Doutriaux-Dumoulin MD

  18. Institut Claudius Regaud-Oncopole, Toulouse, France

    Eva Jouve MD

  19. Les Hôpitaux universitaires de Strasbourg, Strasbourg, France

    Carole Mathelin MD, PhD

  20. Hôpital de la Croix-Rousse, Lyon, France

    Pierre de Saint hilaire MD

  21. CHU Dupuytren, Limoges, France

    Joelle Mollard MD

Authors
  1. Catherine Uzan MD, PhD
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  2. Chafika Mazouni MD, PhD
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  3. Caroline Rossoni MSc
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  5. Christine Tunon de Lara MD
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  10. Anne Vincent Salomon MD, PhD
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  11. Marc Espie MD
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  12. Charles Coutant MD, PhD
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  14. Flore Salviat MD
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  15. Loic Boulanger MD
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  16. Isabelle Doutriaux-Dumoulin MD
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  17. Eva Jouve MD
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  18. Carole Mathelin MD, PhD
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  19. Pierre de Saint hilaire MD
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  20. Joelle Mollard MD
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  21. Corinne Balleyguier MD, PhD
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  22. Natacha Joyon MD, PhD
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  23. Magali Lacroix Triki MD, PhD
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  24. Suzette Delaloge MD, PhD
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  25. Stefan Michiels MD, PhD
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Corresponding author

Correspondence to Catherine Uzan MD, PhD.

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Disclosures

SD. reports grants and non-financial support from Roche/Genentech; grants and nonfinancial support from Pfizer; grants and nonfinancial support from Puma; grants and non-financial support from AstraZeneca; grants and non-financial support from Novartis; grants from Amgen.

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Uzan, C., Mazouni, C., Rossoni, C. et al. Prospective Multicenter Study Validate a Prediction Model for Surgery Uptake Among Women with Atypical Breast Lesions. Ann Surg Oncol 28, 2138–2145 (2021). https://doi.org/10.1245/s10434-020-09107-z

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  • DOI: https://doi.org/10.1245/s10434-020-09107-z

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