Results of the First Mammography Screening Projects in Germany from a Histopathological Viewpoint

Background: The aim of this study was to review the role of the pathologist in mammography screening. Patients and Methods: The first German mammography screening project was undertaken in Bremen in June 2001. Women between the ages of 50 and 69 were offered mammographic assessment. Suspicious findings were followed up by a stereotactic core biopsy or vacuum-assisted core biopsy. The tissue was examined at the Department of Pathology in Bremen as well as at the Section of Breast Pathology at the University Münster. Each case was discussed in a multidisciplinary board. The core biopsies were classified according to the 5-point scale of the internationial guidelines. Results: Biopsies were obtained from 402 women within the first 2 years of the screening project. Of these, 47% were assigned to group B5 (malignant), 44% were categorized in group B2 (benign) while 1% was classified in group B1 (regular breast tissue, unsatisfactory) and 8% were assigned to the group B3/B4 (lesion of uncertain malignant potential / suspicious for malignancy). The discrepancies in 10% of the cases centered on papillary lesions, flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH). Conclusion: In clearly defined lesions the agreement of the histological findings of independent pathologists is very high. In unclear lesions it should be raised. In addition, close cooperation between clinicians, radiologists and pathologists is critical.