Positive Predictive Value and Breast Cancer Histology by the Method of Detection Across a Multistate Health Care Enterprise

Abstract Objective To compare the pathology outcomes of image-guided breast biopsies across a multistate health care enterprise by the method of detection (MOD), including the positive predictive value (PPV3) and histological types. Methods Biopsies from October 31, 2017, to July 6, 2023, across 18 imaging sites in 4 states were extracted. Radiologists prospectively assigned MODs, including symptomatic presentations (self-examination, clinical examination) and imaging modalities (mammogram, tomosynthesis, US, MRI, contrast-enhanced mammogram, molecular breast imaging, other imaging). For each MOD, the rates of malignancy and cancer subtypes were calculated. Univariate and multivariate logistic regression analyses were performed. Results In 26 932 biopsies on 22 582 patients (mean age 57.6 years ± 14.2 [SD]; 22 416 women), 6068 (81.1%) cancers were detected by screening, and 1144 (15.3%) were detected by symptoms. Symptomatic presentation MODs had a higher PPV3 (43.0% vs 25.6%; P Conclusion Compared with breast cancers detected after symptomatic presentations, those identified via image-based screening were smaller and less often invasive, confirming the value of screening in early detection. Positive predictive value and the rate of invasive carcinoma varied in parallel across MODs.