Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Abstract

Purpose The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations. Methods This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy. Results In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 ( p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 ( p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 ( p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 ( p = 0.07)]. Conclusions Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.

Follow‐up of B3 breast lesions without residual microcalcifications post vacuum‐assisted biopsy, can contrast‐enhanced digital mammography help?

“…The post-VAB image showed the clip in the upper quadrant of the right breast in the site of a LN lesion. The recombined image showed a mass lesion in that site with a marked enhancement classified as BI-RADS 4, resulted CDI at histologic examination thus a true positive CEDM caseThe underestimation rate in the study of Villa et al and Schiaffino et al were lower than our value but these studies evaluated only ADH lesions while we included all types of B3 lesions diagnosed during the study period, and the majority (76.5%) were represented by LN and ADH, which are the two histotypes of B3 lesions with the highest rates of upgrade in the literature 1,2. Just the ADH lesions are the type of B3 lesion for which surgical excision is still almost always recommended excepting some selected cases as analyzed in the two aforementioned studies.…”

“…The underestimation rate in the study of Villa et al and Schiaffino et al were lower than our value but these studies evaluated only ADH lesions while we included all types of B3 lesions diagnosed during the study period, and the majority (76.5%) were represented by LN and ADH, which are the two histotypes of B3 lesions with the highest rates of upgrade in the literature …”

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

“…However, considering the fact that close follow up of low‐grade DCIS currently is subject of several prospective studies, our study shows that when a diagnostic surgical excision of high‐risk lesions at CNB is performed, more than 85% of all excisions (71% [120/169] benign pathology and 14.2% [24/169] low‐grade DCIS) may be preventable in the near future. In order to decrease this number of potentially unnecessary surgical excisions, one may opt for vacuum‐assisted excision of high‐risk lesions as an alternative to surgical excision …”

“…In order to decrease this number of potentially unnecessary surgical excisions, one may opt for vacuum-assisted excision of high-risk lesions as an alternative to surgical excision. [30][31][32] Our study has certain strengths and limitations. To the best of our knowledge, it is the first study that describes trends in the detection of high-risk lesions in a screened population.…”

External Validation of a Risk Stratification Score for B3 Breast Lesions Detected at Ultrasound Core Needle Biopsy

“…While there still is no clear international consensus on how B3 lesions should be managed, the approach to B3 lesions has undergone significant changes in the last decade. Currently, diagnostic surgical excision is no longer the only available management option and percutaneous excision using a vacuum-assisted device, known as a vacuum assisted breast biopsy (VABB), is recommended for many of these pathological entities [4,5]. However, most cases diagnosed at core needle biopsy (CNB) are still referred to surgery to examine the entire lesion and establish a definitive diagnosis [6,7].…”