B3 breast lesions determined by vacuum-assisted biopsy: how to reduce the frequency of benign excision biopsies

Tonegutti, M; Girardi, V.; Ciatto, Stefano; Manfrin, Erminia; Bonetti, Franco

doi:10.1007/s11547-010-0585-1

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…The overall risk for malignancy of B3-lesions was 22% in our study; in 23 cases, postsurgical histological examination revealed a malignancy. Other studies reported an incidence of 8-35% (4)(5)(6)13,(18)(19)(20). The highest malignancy rate regarding the subgroup of the B3-lesions was found for ADH, with a PPV of 0.31.…”

Section: Discussionmentioning

confidence: 99%

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

Hoffmann

Stamatis

Bittner

et al. 2016

Molecular and Clinical Oncology

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Abstract. The use of mammography screening, followed by needle core biopsy (NCB), is associated with an increasing amount of invasive procedures. A considerable amount of specimens must be classified as lesions with uncertain malignant potential (B3-lesion). In these cases, an open biopsy is indicated for further diagnosis. We evaluated patients with B3-lesions to determine the risk of malignancy corresponding to the histopathological NCB results and the type of radiological lesion identified. A total of 95 patients participating in the German mammography screening program with a B3-lesion following NCB (104 B3-lesions in total) were included in our analysis. We analyzed the correlation between the initial histopathological findings from the NCB specimen and cancer risk. We further analyzed the correlations of malignant results with the type of mammographic lesion. In 23 cases (22%), histopathological examination following excision revealed a malignant lesion, including invasive and in situ carcinoma. The positive predictive value of the subgroups of B3-lesions ranged between 0.11 and 0.31; the B3-lesion associated with the highest cancer risk was the atypical ductal hyperplasia; however, no significant difference was observed between the B3-lesion subgroups (P=0.309) regarding the risk of malignancy. Comparing the different types of mammographic findings, such as radiological mass or microcalcifications, there was no significant difference in the risk for malignancy (P=0.379). The different types of B3-lesions did not exhibit differences in the risk for malignancy, and the morphological type of mammographic lesion does not appear to be correlated with cancer risk; therefore, our results underline the need for open biopsy in patients with B3-lesions following NCB.

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Section: Discussionmentioning

confidence: 99%

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

Hoffmann

Stamatis

Bittner

et al. 2016

Molecular and Clinical Oncology

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“…Management of B3 lesions provides a challenge to the multidisciplinary team as diagnostic surgical excision is no longer the only available treatment . Our study analyses our personal series of patients with only US‐detected lesions with a B3 diagnosis at US‐CNB with the aim of identifying parameters associated with an increased risk of malignancy underestimation and to develop a predictive scoring system useful in common practice to choose the right management in US‐detected B3 lesions, considering clinical, radiologic, and pathologic data.…”

Section: Discussionmentioning

confidence: 99%

“…B3 lesions are a relatively small proportion of all CNBs, ranging from 4% to 14%, but they are considered a significant problem because of the risk of malignancy underestimation, which ranges from 20% to 35%, due to diagnostic or sampling errors . For this reason, most of them are referred to surgery to examine the entire lesion and to establish the definitive diagnosis, thus resulting in a relatively great number of benign excision biopsies …”

Section: Introductionmentioning

confidence: 99%

A new risk stratification score for the management of ultrasound-detected B3 breast lesions

et al. 2018

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To develop a predictive scoring system for ultrasound-detected B3 lesions at ultrasound-guided core needle biopsy (US-CNB). A total of 2724 consecutive US-CNBs performed in our Institution (January 2011 to December 2014) were retrospectively reviewed. Inclusion criteria were as follows: (a) histopathological examination of the entire lesion or (b) availability of radiologic follow-up (FUP) ≥24 months. Patient- and lesion-related variables-patients' age, lesion consistency, lesion size, vascularization, BI-RADS category, and US-CNB result-were analyzed. Positive predictive values (PPVs) for malignancy were calculated correlating US-CNB results with excision histology or FUP. A scoring system for underlying malignancy was developed using risk factors weighting. A total of 102 B3 lesions were included: 27 atypical ductal hyperplasia (26.5%), 5 lobular intraepithelial neoplasia (4.9%), 32 radial scar (31.4%), 37 papillary lesions (36.3%), and 1 fibroepithelial lesion (0.9%). Surgery was performed on 71/102 (69.6%) lesions, and 22/71 were malignant; the remaining 31/102 lesions (30.4%) were unchanged at FUP. The overall PPV for malignancy was 21.6%. Patients' age (odds ratio [OR] = 3.63, P = 0.008), lesion consistency (OR = 5.96, P = 0.001), BI-RADS category (OR = 17.52, P < 0.001), and CNB result (OR = 3.6, P = 0.008) were associated with a higher risk of malignancy underestimation and selected as risk factors in the score definition. Two risk groups were identified: low (0-2 points) and high risk (3-5 points), with significantly different risk of malignancy underestimation (8.0% vs 59.3%, P < 0.001). The proposed score helps to predict the risk of malignancy underestimation and choose the management of B3 lesions at US-CNB.

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“…No residual carcinoma was found in the 6 patients with malignant lesions. In their series, Tonegutti et al 7 showed that the presence or absence of atypia proved to be the reliable criterion for prompting or avoiding surgery in cases with a vacuumassisted core biopsy finding of a B3 lesion. Su et al 8 also confirmed that vacuum‐assisted core biopsy is highly reliable and may avoid diagnostic open surgery in most patients with benign lesions.…”

Section: Resultsmentioning

confidence: 99%

Sonographically Guided Vacuum-Assisted Breast Biopsy for Complete Excision of Presumed Benign Breast Lesions

Feng

Wan

et al. 2012

Journal of Ultrasound in Medicine

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B3 breast lesions determined by vacuum-assisted biopsy: how to reduce the frequency of benign excision biopsies

Abstract: On the basis of our experience, the presence or absence of atypia in our series proved to be the reliable criterion to prompt or avoid surgery in cases with a VAB finding of B3 lesion. This criterion may therefore be adopted in practice to more accurately select patients for surgery.

Cited by 11 publications

References 31 publications

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

A new risk stratification score for the management of ultrasound-detected B3 breast lesions

Sonographically Guided Vacuum-Assisted Breast Biopsy for Complete Excision of Presumed Benign Breast Lesions

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