Minimal Invasive Biopsy Results of ”Uncertain Malignant Potential” in Digital Mammography Screening: High Prevalence but also High Predictive Value for Malignancy

Weigel, Stefanie; Decker, Thomas; Korsching, Eberhard; Biesheuvel, Cornelis; Wöstmann, A.; Böcker, W.; Hungermann, D.; Roterberg, K.; Tio, Joke; Heindel, Walter

doi:10.1055/s-0031-1273330

Cited by 23 publications

(17 citation statements)

References 18 publications

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“…Regarding certain B3 lesions, our findings confirm that operative resection is necessary: Particularly ADH show a malignancy rate of 50%. This result is in agreement with a reported malignancy rate of 32 to 59% in mammographic screening [ 11 , 17 – 19 ]. The final diagnosis of ADH cannot be made in minimal-invasive biopsy, because here the determination of extensiveness of the lesion is not possible, which is however one of the three main criteria defining ADH [ 19 , 20 ].…”

Section: Discussionsupporting

confidence: 93%

“…This result is in agreement with a reported malignancy rate of 32 to 59% in mammographic screening [ 11 , 17 – 19 ]. The final diagnosis of ADH cannot be made in minimal-invasive biopsy, because here the determination of extensiveness of the lesion is not possible, which is however one of the three main criteria defining ADH [ 19 , 20 ]. The European Working Group for Breast Screening Pathology therefore recommends to use the term “atypical epithelial proliferation of ductal type” (AEPDT) instead of ADH in diagnostics of minimal-invasive biopsy [ 2 ].…”

Section: Discussionsupporting

confidence: 93%

“…In observational studies, an association of FEA with lobular neoplasia, ADH, low-grade DCIS, invasive G1 carcinoma and tubular carcinoma is indicated [ 21 ]. In approximately one third of subsequent resections, an additional lesion of the low-grade pathway is found [ 17 , 19 , 22 ]. Though, interpretation of these studies is limited because of lacking radiologic-pathologic correlation in several cases and because of different indications for surgical excision.…”

Section: Discussionmentioning

confidence: 99%

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Malignancy rates of B3-lesions in breast magnetic resonance imaging – do all lesions have to be excised?

Preibsch¹,

Wanner²,

Staebler

et al. 2018

BMC Med Imaging

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BackgroundApproximately 10% of all MRI-guided vacuum-assisted breast biopsies (MR-VAB) are histologically classified as B3 lesions. In most of these cases surgical excision is recommended. The aim of our study was to evaluate the malignancy rates of different B3 lesions which are visible on MRI to allow a lesion-adapted recommendation of further procedure.MethodsRetrospective analysis of 572 consecutive MR-VAB was performed. Inclusion criteria were a representative (=successful) MR-VAB, histologic diagnosis of a B3 lesion and either the existence of a definite histology after surgical excision or proof of stability or regression of the lesion on follow-up MRI. Malignancy rates were evaluated for different histologies of B3 lesions. Lesion size and lesion morphology (mass/non-mass enhancement) on MRI were correlated with malignancy.ResultsOf all MR-VAB 43 lesions fulfilled the inclusion criteria. The malignancy rate of those B3 lesions was 23.3% (10/43). The highest malignancy rate was found in atypical ductal hyperplasia (ADH) lesions (50.0%; 4/8), 33.3% (2/6) in flat epithelial atypia (FEA), 28.6% (2/7) in lobular intraepithelial neoplasia (LIN) and 12.5% (2/16) in papillary lesions (PL). All 6 complex sclerosing lesions were benign. Mass findings were significantly more frequently malignant (31.3%, 10/32; p < 0.05) than non-mass findings (0/11). Small lesions measuring 5–10 mm were most often malignant (35.0%; 7/20). All large lesions (> 20 mm) were not malignant (0/10). Intermediate sized lesions (11–20 mm) turned out to be malignant in 23.1% (3/13).ConclusionsThe malignancy rate of B3 lesions which were diagnosed after MR-VAB was 23.3%. ADH, FEA and LIN showed considerable malignancy rates (50%, 33% and 29%) and should therefore undergo surgical excision. None of the cases, which were diagnosed as radial scars, non-mass enhancement or larger lesions (> 20 mm) were malignant. Here, a follow-up MRI seems to be advisable to avoid unnecessary operations.Trial registrationRetrospective study design, waived by the IRB.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Malignancy rates of B3-lesions in breast magnetic resonance imaging – do all lesions have to be excised?

Preibsch¹,

Wanner²,

Staebler

et al. 2018

BMC Med Imaging

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show abstract

“…A total of 14% (n=300) of the lesions were B3-lesions (lesions of uncertain malignant potential) and 95 patients were (14) 3 (3) PPV, positive predictive value; LIN, lobular intraepithelial neoplasia; ADH, atypical ductal hyperplasia; PL, papillary lesion; FEA, flat epithelial atypia; RS, radial scar; PT, phyllodes tumor. (4,(9)(10)(11)(12). In our trial, ADH was the biggest subgroup of the B3-lesions, with 31%; similar observations have been made by other authors (5).…”

Section: Discussionsupporting

confidence: 90%

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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“…We compared data from participants from the DR photoncounting mammography unit with those from the rest of the screening areas included, which is hereafter labeled as "statewide." Cancers detected with the DR photon-counting system between January 2009 and June 2010 (n = 89), as well as between January 2009 and August 2009 (n = 37), were reported previously in a different context (10,11).…”

Section: Calculation Of Mean Glandular Dosesupporting

confidence: 57%

Digital Mammography Screening with Photon-counting Technique: Can a High Diagnostic Performance Be Realized at Low Mean Glandular Dose?

Weigel

Berkemeyer²,

Girnus³

et al. 2014

Radiology

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Minimal Invasive Biopsy Results of ”Uncertain Malignant Potential” in Digital Mammography Screening: High Prevalence but also High Predictive Value for Malignancy

Cited by 23 publications

References 18 publications

Malignancy rates of B3-lesions in breast magnetic resonance imaging – do all lesions have to be excised?

Malignancy rates of B3-lesions in breast magnetic resonance imaging – do all lesions have to be excised?

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

Digital Mammography Screening with Photon-counting Technique: Can a High Diagnostic Performance Be Realized at Low Mean Glandular Dose?

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