Prevalence of Imaging-Detected Silent Female Breast Cancer in Autopsy Specimens: A Study Using Image-Guided Biopsies

Area of Science:

• Forensic pathology
• Radiology
• Oncology

Background:

• Evaluating prevalence of imaging-detected silent breast cancer in females.
• Hypothesis: incidence of imaging-detected silent breast cancer exceeds true disease incidence.
• Investigating if breast imaging identifies silent breast cancers found in serial histology.

Purpose of the Study:

• Determine if breast imaging overdiagnoses silent breast cancer.
• Assess the utility of imaging in detecting occult breast malignancies.
• Compare imaging findings with histological analysis in a post-mortem setting.

Main Methods:

• Conducted 217 medicolegal autopsies on fresh Portuguese cadavers (July 2016-Dec 2019).
• Excluded cases younger than 40, autopsy >48 hours post-mortem, major breast injury, or known cancer.
• Performed bilateral mastectomies followed by mammography, ultrasonography, and targeted excisional biopsies.

Main Results:

• Eight cases indicated for excisional biopsy based on imaging; no breast cancer found.
• 43.6% of samples showed benign breast alterations; 1.84% had low-suspicion alterations.
• Physical examination missed 37.5% of biopsied breast changes, indicating high false-negative rates.

Conclusions:

• The initial hypothesis that imaging-detected silent breast cancer is more prevalent than true incidence was rejected.
• Mammography did not demonstrate overdiagnosis of breast cancer in this cohort.
• Objective breast examination is unreliable as a screening method due to significant false-negative rates.