Prospective evaluation of a composite scoring system for mammographically detected cytologically assessed impalpable XXXX .

@entity1 @entity1558 @entity5
The aim of all breast screening programmes is a reduction in deaths from the disease. It is hoped that this can be achieved with minimal intervention in the @entity1 cohort who do not have @entity5 . In this study we have assessed the efficacy of a combination of mammographic and cytological scoring systems in the evaluation of 208 @entity1 with screen-detected non-palpable @entity1558 . All mammograms were scored 1-5 and those with a score of 3 or more required needle localization. A cytology score of 1 to 5 was generated for each @entity1 according to a similar system and an aggregate score for each @entity1 was achieved by the addition of the mammographic and cytology score. Ninety-three of the 208 @entity1 had malignancy--the positive predictive value for mammography alone in this series was 45%. All 58 @entity1 who had an aggregate score of 8 or greater had @entity5 . The 60 @entity1 who had an aggregate score of 4 had benign disease on excision biopsy. We suggest that a 'wait and repeat mammogram' approach is appropriate in @entity1 with grade 3 mammography and benign (grade 1) cytology. @entity1 with an intermediate aggregate score of 5-7 should have an excision biopsy and those with an aggregate score of 8 could have definitive surgery rather than excision biopsy. Application of this aggregate scoring technique would enhance the delivery of more appropriate surgery to a majority of @entity1 with screen-detected @entity1558 .
