The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

BackgroundHistopathological B3 lesions after minimal invasive breast biopsy (VABB) are a particular challenge for the clinician, as there are currently no binding recommendations regarding the subsequent procedure.PurposeTo analyze all B3 lesions, diagnosed at VABB and captured in the national central Swiss MIBB database and to provide a data basis for further management in this subgroup of patients.Material and MethodsAll 9,153 stereotactically, sonographically, or magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsies, performed in Switzerland between 2009 and 2011, captured in a central database, were evaluated. The rate of B3 lesions and the definitive pathological findings in patients who underwent surgical resection were analyzed.ResultsThe B3 rate was 17.0% (1532 of 9000 biopsies with B classification). Among the 521 lesions with a definitive postoperative diagnosis, the malignancy rate (invasive carcinoma or DCIS) was 21.5%. In patients with atypical ductal hyperplasia, papillary lesions, flat epithelial atypia, lobular neoplasia, and radial scar diagnosed by VABB, the malignancy rates were 25.9%, 3.1%, 18.3%, 26.4%, and 11.1%, respectively.ConclusionB3 lesions, comprising 17%, of all analyzed biopsies, were common and the proportion of malignancies in those lesions undergoing subsequent surgical excision was high (21.5%).

ObjectivesTo analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB.MethodsWe performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided.ResultsMRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35).ConclusionMRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings.Key points• Three vacuum-assisted breast biopsy (VAB) procedures were compared.• Technical success rates were high for all three VAB procedures.• Medical complications were relatively low using all three VAB procedures.• The use of MRI-guided vacuum-assisted breast biopsy is growing.

ZusammenfassungEs wird über die chirurgischen Behandlungsergebnisse bei 120 Fällen von Pleuraempyemen berichtet. Verf. bevorzugen die offene Drainagebehandlung, da sie ohne Erhöhung der intraoperativen und/oder Hospitalmortalität eine Reihe von Spät-komplikationen (wie die Thorakoplastik) vermeidet, die der geschlossenen Drainage anhaften. Results of Surgical Treatment of Pleural EmpyemaThis is a report on 120 cases of surgically treated pleural empyema. The authors prefer an open drainage which avoids secondary complications (like thoracoplasty) inherent to the closed method without increase of intraoperative and/or hospital mortality.Das Pleuraempyem ist seit der Einführung der Antibiotika seltener geworden. Trotzdem bleiben manche Fragen hinsichtlich der Therapie offen. Die vorliegende Arbeit betont bewußt die Vorteile der offenen gegenüber der geschlossenen Drainage.Heruntergeladen von: NYU. Urheberrechtlich geschützt.

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