Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management

Saladin, Camilla; Haueisen, H.; Kampmann, G; Oehlschlegel, Christian; Seifert, Burkhardt; Rageth, L; Rageth, Christoph; Stadlmann, Sylvia; Ra, Kubik-Huch

doi:10.1177/0284185115610931

Cited by 47 publications

(41 citation statements)

References 23 publications

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“…Data series report a risk of malignancy between 10% and 35% : Our finding of 8.05% mildly differs from the literature.…”

Section: Subtypes Prevalence and Malignancy Rate In Cnb And Vabb Groupcontrasting

confidence: 98%

“…In recent years, B3 rate increased to 11%‐17% : We report a rate of 16.4%, in line with literature (Table ).…”

Section: Subtypes Prevalence and Malignancy Rate In Cnb And Vabb Groupsupporting

confidence: 91%

“…Literature data report a B3-rate of 11%-17%, with a risk of malignancy between 10% and 22%. [3][4][5][6]8 In our region, screening data show a higher incidence of B3 (17.5%). 2 The aim of this study was to analyze the rate of B3-lesions and the risk of malignancy in patients who underwent surgical excision in our department.…”

mentioning

confidence: 48%

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B3‐lesions of the breast: Risk of malignancy after vacuum‐assisted breast biopsy versus core needle biopsy diagnosis

et al. 2019

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“…Data series report a risk of malignancy between 10% and 35% : Our finding of 8.05% mildly differs from the literature.…”

Section: Subtypes Prevalence and Malignancy Rate In Cnb And Vabb Groupcontrasting

confidence: 98%

“…In recent years, B3 rate increased to 11%‐17% : We report a rate of 16.4%, in line with literature (Table ).…”

Section: Subtypes Prevalence and Malignancy Rate In Cnb And Vabb Groupsupporting

confidence: 91%

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B3‐lesions of the breast: Risk of malignancy after vacuum‐assisted breast biopsy versus core needle biopsy diagnosis

et al. 2019

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“…Institutional differences in excision rates underscore the lack of consensus. [22][23][24] The wide range of published upgrade rates to ductal carcinoma in situ and/or invasive mammary carcinoma on excision partly contributes to the problem. Here we present the most comprehensive literature review of reported upgrade rates for atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia, and radial scar, along with a summary of the key findings from our statistical analysis with management recommendations (Tables 5-8).…”

Section: Discussionmentioning

confidence: 99%

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

2016

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Optimal management of high-risk breast lesions detected by mammogram yielding atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia on core needle biopsy is controversial. This is a single-institution retrospective review of 5750 core needle biopsy cases seen over 14.5 years, including 249 (4.3%), 72 (1.3%), 50 (0.9%), 37 (0.6%), and 54 (0.9%) cases of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia, respectively. Patient age, radiologic characteristics, needle gauge, and excision diagnoses were recorded. Of 462 high-risk cases analyzed, 333 (72%) underwent excision. Upgrade rate to ductal carcinoma in situ, pleomorphic carcinoma in situ, or invasive mammary carcinoma was 18% for atypical ductal hyperplasia, 11% for flat epithelial atypia, 9% for atypical lobular hyperplasia, 28% for lobular carcinoma in situ, and 16% for radial scar. Carcinoma diagnosed on excision was more likely to be in situ than invasive, and if invasive, more likely to be low grade than high grade. Overall, cases that were benign (vs high risk or carcinoma) on excision were less likely to have residual calcifications after biopsy (17% vs 27%, P=0.013), and more likely to have a smaller mass size (<1 cm) (82% vs 50%, P=0.001). On subgroup analysis, atypical ductal hyperplasia cases that were benign (vs high risk or carcinoma) on excision were more likely to have smaller mass size (<1 cm) (P=0.025). Lobular neoplasia diagnosed incidentally (vs targeted) on core needle biopsy was less likely to upgrade on excision (5% vs 39%, P=0.002). A comprehensive literature review was performed, identifying 116 studies reporting high-risk lesion upgrade rates, and our upgrade rates were similar to those of more recent larger studies. Careful radiological-pathological correlation is needed to identify high-risk lesion subgroups that may not need excision.

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“…The counter argument is that the associated coexisting disease is relatively indolent and could be managed with surveillance. 8–10,16,17,19 In addition, the intrinsic biologic risk for future breast cancer is considerably lower for FEA than for ADH. 38 …”

Section: Discussionmentioning

confidence: 99%

Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens

et al. 2017

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Objectives Flat epithelial atypia (FEA) is a relatively new diagnostic term with uncertain clinical significance for surgical management. Any implied risk of invasive breast cancer associated with FEA is contingent upon diagnostic reproducibility, yet little is known regarding its use. Materials and Methods Pathologists in the Breast Pathology Study interpreted one of four 60-case test sets, one slide per case, constructed from 240 breast biopsy specimens. An electronic data form with standardized diagnostic categories was used; participants were instructed to indicate all diagnoses present. We assessed participants’ use of FEA as a diagnostic term within: 1) each test set; 2) 72 cases classified by reference as benign without FEA; and 3) six cases classified by reference as FEA. 115 pathologists participated, providing 6,900 total independent assessments. Results Notation of FEA ranged from 0% to 35% of the cases interpreted, with most pathologists noting FEA on 4 or more test cases. At least one participant noted FEA in 34 of the 72 benign non-FEA cases. For the 6 reference FEA cases, participant agreement with the case reference FEA diagnosis ranged from 17% to 52%; diagnoses noted by participating pathologists for these FEA cases included columnar cell hyperplasia, usual ductal hyperplasia, atypical lobular hyperplasia, and atypical ductal hyperplasia. Conclusions We observed wide variation in the diagnosis of FEA among U.S. pathologists. This suggests that perceptions of diagnostic criteria and any implied risk associated with FEA may also vary. Surgical excision following a core biopsy diagnosis of FEA should be reconsidered and studied further.

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Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management

Cited by 47 publications

References 23 publications

B3‐lesions of the breast: Risk of malignancy after vacuum‐assisted breast biopsy versus core needle biopsy diagnosis

B3‐lesions of the breast: Risk of malignancy after vacuum‐assisted breast biopsy versus core needle biopsy diagnosis

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens

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