Biopsy-proven stromal fibrosis: what is the appropriate management approach?
Bibliographic record
Abstract
Background: Stromal fibrosis is a common benign finding in breast biopsies that can mimic carcinoma and occasionally coexist with malignancy. The key clinical question is whether biopsy-proven stromal fibrosis without atypia warrants surgical excision or can be safely managed with imaging surveillance. The purpose is to assess the upgrade rate of biopsy-proven stromal fibrosis without associated atypia and determine the most appropriate management approach for these patients. Methods: A retrospective review of imaging-guided breast biopsies performed between 2014 and 2019 in a tertiary center was conducted under research ethics board (REB) approval. Patients with biopsy-proven stromal fibrosis without atypia were identified. The upgrade rate to malignancy and the imaging characteristics of upgraded cases following surgical excision were recorded. Final diagnoses were confirmed by surgical histopathology or, in cases without surgery, by an uneventful clinical and radiological follow-up of at least 2 years. Predictors of malignancy were evaluated using one-way analysis of variance (ANOVA) for normally distributed variables or the Kruskal-Wallis test for non-normally distributed variables. Categorical variables are compared in three groups by the Chi-squared test. Results: Among 9,814 consecutive imaging-guided breast biopsies performed during the study period, 334 cases (4.8%) in 334 patients met the inclusion criteria, comprising the study cohort. The median patient age was 52 years. Of these, 4 cases (1.2%) were upgraded to malignancy within 2 years of follow-up. Older age (>50 years) was significantly associated with an upgrade to malignancy (P<0.001), and a personal history of breast cancer showed a trend toward increased upgrade risk (P=0.07). No other clinical or imaging features were linked to the malignancy upgrade. Conclusions: The upgrade rate for biopsy-proven stromal fibrosis without atypia is low (1.2%), supporting a diagnostic follow-up approach for 2 years under Breast Imaging Reporting and Data System (BI-RADS) 3 guidelines (<2% risk of malignancy). These findings underscore that careful radiologic-pathologic correlation can safely guide surveillance while reducing unnecessary surgical interventions.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.004 | 0.004 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".