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Background The purpose of this study was to determine the validity of the ultrasound features as well as patient characteristics assigned to B3 (uncertain malignant potential) breast lesions before vacuum-assisted excision biopsy (VAEB). Methods This study population consisted of 2245 women with breast-nodular abnormalities, which were conducted ultrasound-guided VAEB (US-VAEB). Patient’s clinical and anamnestic data and lesion-related ultrasonic feature variables of B3 captured before US-VAEB were compared with those of benign or malignant cases, using histopathological results as a benchmark. Results The proportions of benign, B3 and malignant breast lesions diagnosed post-US-VAEB were 88.5, 8.2 and 3.4% respectively. B3 high frequent occurred in BI-RADS-US grade 3 (7.7%), grade 4a (11.0%) and grade 4b (9.1%). The overall malignancy underestimation rate of B3 was 4.4% (8/183). Malignant lesions were found mostly in the range of BI-RADS grade 4b (27.3%), grade 4c (33.3%) and grade 5 (100%). Multivariate binary logistic regression analyses (B3 vs benign) showed that non-menopausal patients (95% CI 1.628–8.616, P = 0.002), single (95% CI 1.370–2.650, P = 0.000) or vascularity (95% CI 1.745–4.150, P = 0.000) nodules in ultrasonic features were significant risk factors for B3 occurrences. In addition, patients elder than 50 years (95% CI 3.178–19.816, P = 0.000), unclear margin (95% CI 3.571–14.119, P = 0.000) or suspicious calcification (95% CI 4.010–30.733, P = 0.000) lesions were significantly associated with higher risks of malignant potentials for B3 cases (malignant vs B3). Conclusion The results of this study indicate that ultrasound findings and patients’ characteristics might provide valuable information for distinguishing B3 lesions from benign breast abnormalities before VAEB, and help to reduce malignancy underestimation of B3.

Background: The purpose of this study was to determine the validity of the ultrasound features as well as patient characteristics assigned to B3 (uncertain malignant potential) breast lesions before vacuum-assisted excision biopsy (VAEB).Methods: This study population consisted of 2245 women with breast-nodular abnormalities, which were conducted ultrasound-guided VAEB (US-VAEB). Patient’s clinical and anamnestic data and lesion-related ultrasonic feature variables of B3 were compared with those of benign or malignant cases, using histopathological results as a benchmark. Results: The proportions of benign, B3 and malignant breast lesions were 88.5%, 8.2% and 3.4% respectively. B3 high frequent occurred in BI-RADS-US grade 3 (7.7%), grade 4 (9.3%), grade 4a (11.3%) and grade 4b (9.1%). The overall malignancy underestimation rate of B3 cases was 4.4% (8/183). The more common malignancy underestimation of B3 subtypes were PL/ADH 50% (1/2), ADH 23.1% (3/13), and CSL/RS 16.7% (1/6). And the highly frequent recurrence rates of B3 subtypes were ADH 10% (1/10), PL 4.9% (4/82), and PT 8.6% (6/70). Multivariate binary logistic regression analyses (B3 vs benign) showed that non-menopausal patients (95% CI 1.628-8.616, P = 0.002), single (95% CI 1.370-2.650, P = 0.000) or abundant blood supply (95% CI 1.745-4.150, P = 0.000) nodules via ultrasound examination were significant risk factors for B3 occurrences. Moreover, patients elder than 50 years (95% CI 3.178-19.816, P = 0.000), unclear margin (95% CI 3.571-14.119, P = 0.000) or microcalcification (95% CI 4.010-30.733, P = 0.000) nodules were significantly associated with higher risks of malignant potentials (B3 vs malignant).Conclusion: The results of this study indicate that ultrasound findings and patients’ characteristics could provide valuable information for distinguishing B3 cases from benign or malignant cases before VAEB.

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