B3 lesion upgrade rates in a tertiary Australian breast centre: a 8‐year experience (2012–2019)

Abstract

Background: B3 breast lesions identified on core needle biopsy have uncertain malignant potential. Traditional management of these lesions has been surgical excision, but there is growing interest in less invasive and more cost-effective alternatives such as vacuumassisted excisional biopsy (VAEB). Determining the rate of malignant upgrade for B3 lesions is important as it may identify low-risk lesions where VAEB could be considered. Methods: A retrospective study was conducted of women undergoing an elective excisional biopsy for a B3 lesion identified on core needle biopsy at a tertiary Australian breast centre. The pre-operative biopsy diagnosis and subsequent excisional biopsy diagnosis were used to calculate the proportion of cases where the diagnosis was upgraded to malignancy. Results: A total of 299 eligible patients were identified. Pre-operative diagnosis of papillary lesion with atypia was associated with the highest upgrade rate (50%, n = 12). The next highest upgrade rates occurred in those with flat epithelial atypia (37.50%, n = 8); atypical ductal hyperplasia (24.71%, n = 85); lobular carcinoma in situ (LCIS)/atypical lobular hyperplasia with calcification (17.65%, n = 17); and papillary lesion without atypia (4.72%, n = 106). Patients with radial scar (n = 51), classical LCIS without calcification (n = 7) and mucocoele-like lesion (n = 8) had a 0% upgrade rate. Conclusion: VAEB may be appropriate for low malignant risk lesions such as papillary lesion without atypia, mucocoele-like lesion and radial scar lesion without atypia. Opensurgical-excisional biopsy remains appropriate for high upgrade lesions such as atypical ductal hyperplasia, papillary lesion with atypia, flat epithelial atypia and classical LCIS with calcification. Long-term prospective randomized multicentre studies and continuing multidisciplinary approach is recommended for future clinical implementation.

The value of imaging combined with clinicopathological features in the diagnosis of high-risk breast lesions

“…Mayer et al found that the upgrade rate of B3b lesions by biopsy was higher, and it was more meaningful to perform surgery ( 18 ). Our results are consistent with previous reports that the likelihood of upgrade in HR-II was significantly reduced ( 17 - 19 ), suggesting that the evaluation of AH components could be useful in guiding the follow-up management of HRLs. Because the upgrade rates of HR-I and HR-II are very different, it is important to select the correct follow-up management.…”

“…Second, we added features of breast parenchyma and found that BPE was an independent factor in predicting upgrade. Third, previous studies have proved that HRLs with AH are more likely to upgrade (17)(18)(19). To better determine the need for surgery, we further analyzed the factors that predicted the upgrade of HR-I and HR-II.…”

“…High-risk lesion upgrade was defined as the presence of DCIS or invasive ductal carcinoma components at subsequent surgery based on histopathology ( 16 ). Based on their risk of upgrade reported in the literature ( 17 - 19 ), the lesions were categorized in order of severity as high-risk I (HR-I) (ADH, ALH, atypical papilloma, and sclerosing adenosis with atypical hyperplasia) and high-risk II (HR-II) (sclerosing adenosis, benign papilloma, mucocele-like lesions, and FEA). Although FEA is accompanied by atypical hyperplasia (AH), as the literature reports ( 3 ), the upgrade rate of FEA is much lower than that of other AH, so FEA was classified as HR-II.…”

Outcomes of atypical (B3) core biopsy lesions diagnosed across BreastScreen NSW, Australia

“…In this study, the overall upgrade rate to malignancy for B3 lesions was 26.4% for BreastScreen NSW, Australia. This is consistent with the upgrade rates reported in the literature which ranged from 10 to 35% [ [ 6 , [11] , [12] , [13] , [14] ]]. The majority of the B3 lesions were upgraded to DCIS (69.2%) instead of invasive cancers (29.6%) and a much smaller proportion to malignant phyllodes (1.0%), similar to results in the literature [ [ 11 , 12 , 14 ]].…”

Malignancy mimic: Suspicious mammographic and sonographic findings post–vacuum-assisted excision biopsy

“…The B 5-tier classification for breast lesions is used to categorize core biopsy histological results [1] . Lesions of uncertain malignant potential (“B3” category) are a heterogeneous group, with upgrades to malignancy ranging from <2% to almost 40% [2] .…”