scholarly journals Indeterminate (B3) Breast Lesions and the Ongoing Role of Diagnostic Open Biopsy

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Elizabeth Tan ◽  
Asiri Arachchi ◽  
Michael Cheng ◽  
Darren Lockie
Keyword(s):  
Family History ◽  
Predictive Factors ◽  
Radial Scar ◽  
Breast Lesions ◽  
Characteristic Analysis ◽  
Open Biopsy ◽  
Core Needle ◽  
Retrospective Audit ◽  
Ductal Hyperplasia ◽  
B3 Lesions

Introduction. Due to their uncertain malignant potential, indeterminate breast lesions on core needle biopsy (CNB) require diagnostic open biopsy (DOB). This study evaluated DOB results given largely benign pathology. Lesions included are atypical papilloma, atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and radial scar/complex sclerosing lesions (RS/CSL). Methodology. A retrospective audit from 2010 to 2017 analysed patients with a screen-detected suspicious lesion and indeterminate (B3) CNB diagnosis. Primary outcome was the malignancy upgrade rate, with secondary evaluation of patient factors predictive of malignancy including age, symptoms, mammogram characteristics, lesion size, biopsy method, and past and family history. Results. 152 patients (median age 57 years) were included, with atypical papillomas being the largest subgroup (44.7%). On DOB histology, 99.34% were benign, resulting in a 0.66% malignancy upgrade rate. Patient characteristic analysis identified 86.84% of B3 lesions were in patients greater than 50 years old. 90.13% were asymptomatic, whilst 98.68% and 72.37% had a negative past and family history. Majority 46.71% of lesions had the mammogram characteristic of being a mass. However, with 57.89% of the lesion imaging size less than 4 mm, a corresponding 60.5% of core needle biopsies were performed stereotactically. The small malignant subgroup limited predictive factor evaluation. Conclusion. Albeit a low 0.66% malignancy upgrade rate in B3 lesions, no statistically significant patient predictive factors were identified. Until predictive factors and further assessment of vacuum-assisted excision (VAE) techniques evolve, DOB remains the standard of care.

scholarly journals Relevance of B3 lesions in breast diagnosis – frequency and therapeutic consequences

2018 ◽  
Vol 15 (03) ◽  
pp. 153-159 ◽  
Author(s):  
Christin Madjar ◽  
James Seabert ◽  
Annette Fisseler-Eckhoff ◽  
Christian Gustmann ◽  
Isabell Hoffmann ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Atypical Ductal Hyperplasia ◽  
Radial Scar ◽  
Flat Epithelial Atypia ◽  
Surgical Removal ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Vacuum Biopsy ◽  
B3 Lesions ◽  
Epithelial Atypia

AbstractWith improvements in breast imaging and minimally invasive interventions, detection of early breast cancer has increased. However, with the improved diagnostic capabilities, the risk of false-positive benign lesions as well as lesions classified as B3 by histopathology has also increased. Varying rates of malignancies are associated with B3 lesions, raising the question of whether such lesions should always be surgically removed. The results of our retrospective analysis should assist in this decision-making process.307 core needle or vacuum-assisted needle biopsies in which B3 lesions were found were examined. The most common lesions were intraductal papillomas (44 %), atypical ductal hyperplasia (22.8 %), flat epithelial atypia (9.4 %), phyllodes tumours (6.5 %), radial scars (5.9 %), LIN 1 (4.9 %), complex fibroadenomas (3.3 %) and LIN 2 (1.6 %). The frequencies depended considerably on whether the tissue was obtained by core biopsy or vacuum biopsy. Stereotactic vacuum biopsy was generally performed in the case of microcalcification not apparent on sonography. Lesions visible on ultrasound had core needle biopsy.Surgery was performed in 254 cases and a malignancy was found in 27.2 % on the final histopathology. Malignancy was found in 24.6 % of 114 cases initially diagnosed as intraductal papilloma. Similarly, cancer was discovered in 48.4 % of the 62 cases of atypical ductal hyperplasia, in 2.4 % of the 41 cases of flat epithelial atypia, complex fibroadenoma and phyllodes tumour, in 20.7 % of the 29 cases of LIN 1 and radial scar as well as in 50 % of the 8 cases of LIN 2, adenomyoepithelioma and atypical apocrine metaplasia.These data indicate the necessity for complete surgical removal of a B3 lesion when it is discovered using the core needle or vacuum-assisted biopsy technique. The decision not to perform surgery can be made when the risk of associated malignancy is deemed low in the clinical pathology conference, but careful follow-up is essential.

Heterogeneous risk profiles among B3 breast lesions of uncertain malignant potential

2019 ◽  
Vol 106 (2) ◽  
pp. 115-125 ◽  
Author(s):  
Paolo Orsaria ◽  
Antonella Grasso ◽  
Rita Carino ◽  
Emanuele Caredda ◽  
Matteo Sammarra ◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Phyllodes Tumor ◽  
Malignant Potential ◽  
Flat Epithelial Atypia ◽  
Breast Lesions ◽  
Uncertain Malignant Potential ◽  
Predictive Values ◽  
Ductal Hyperplasia ◽  
B3 Lesions ◽  
Risk Of Malignancy

Background: Most cases of breast lesions of uncertain malignant potential (B3) undergo surgical intervention. We aimed to analyze the outcome of B3 lesion subtypes in a large series of screen-detected cases. Methods: We screened 2,986 core needle biopsies to classify B3 lesions. Positive predictive values (PPVs) for malignancy were calculated for a comprehensive risk characterization according to clinicopathologic and morphologic variables. Results: B3 lesions comprised 35% atypical ductal hyperplasia (PPV = 20%), 16.7% flat epithelial atypia (PPV = 12%), 22.7% lobular neoplasia (PPV = 16.2%), 9% papillary lesion (PPV = 18.5%), 8.6% phyllodes tumor (PPV = 3.8%), and 8% radial scars (PPV = 4.1%) based on histopathologic diagnosis. Upgrade rates were 15.9% for calcifications, 13.7% for mass lesions, and 16.7% for architectural deformities, with 8.3% of malignant lesions classified as ductal carcinoma in situ and 6.7% as invasive cancers (PPV = 15%). Conclusion: B3 lesions entail a heterogeneous risk of malignancy, and careful radiologic–pathologic correlation is required for optimal treatment.

scholarly journals Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens

Breast Cancer ◽  
2018 ◽  
Vol 26 (4) ◽  
pp. 452-458 ◽  
Author(s):  
Christoph J. Rageth ◽  
Ravit Rubenov ◽  
Cristian Bronz ◽  
Daniel Dietrich ◽  
Christoph Tausch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Multivariate Logistic Regression Model ◽  
Open Biopsy ◽  
Ductal Hyperplasia ◽  
B3 Lesions ◽  
Underestimation Rate

Abstract Background Risk assessment and therapeutic options are challenges when counselling patients with an atypical ductal hyperplasia (ADH) to undergo either open surgery or follow-up only. Methods We retrospectively analyzed a series of ADH lesions and assessed whether the morphological parameters of the biopsy materials indicated whether the patient should undergo surgery. A total of 207 breast biopsies [56 core needle biopsies (CNBs) and 151 vacuum-assisted biopsies (VABs)] histologically diagnosed as ADH were analyzed retrospectively, together with subsequently obtained surgical specimens. All histological slides were re-analyzed with regard to the presence/absence of ADH-associated calcification, other B3 lesions (lesion of uncertain malignant potential), extent of the lesion, and the presence of multifocality. Results The overall underestimation rate for the whole cohort was 39% (57% for CNB, 33% for VAB). In the univariate analysis, the method of biopsy (CNB vs VAB, p = 0.002) and presence of multifocality in VAB specimens (p = 0.0176) were significant risk factors for the underestimation of the disease (ductal carcinoma in situ or invasive cancer detected on subsequent open biopsy). In the multivariate logistic regression model, the absence of calcification (p = 0.0252) and the presence of multifocality (unifocal vs multifocal ADH, p = 0.0147) in VAB specimens were significant risk factors for underestimation. Conclusions Multifocal ADH without associated calcification diagnosed by CNB tends to have a higher upgrade rate. Because the upgrade rate was 16.5% even in the group with the lowest risk (VAB-diagnosed unifocal ADH with calcification), we could not identify a subgroup that would not require an open biopsy.

scholarly journals Breast diagnosis: Concordance analysis between the BI-RADS classification and Tsukuba sonoelastography score

2014 ◽  
Vol 87 (4) ◽  
pp. 250-257 ◽  
Author(s):  
Maria Magdalena Duma ◽  
Angelica Rita Chiorean ◽  
Marco Chiorean ◽  
Sorana Daniela Bolboaca ◽  
Madalina Florea ◽  
...  
Keyword(s):  
Breast Lesion ◽  
Percutaneous Biopsy ◽  
Radial Scar ◽  
Breast Lesions ◽  
Invasive Approach ◽  
Post Surgery ◽  
Elasticity Score ◽  
Ductal Hyperplasia ◽  
Less Invasive Approach

Aims. To establish the correlations between the ultrasound (US) BI-RADS classification and Tsukuba elastography score when assessing breast lesions. To determine which type of breast lesion (BI-RADS category) would benefit most from an elastographic assessment.Patients and Methods. The investigated sample of imaging comprised a number of 129 images belonging to 92 subjects examined with a Hitachi 8500 US device. Each lesion was assessed according to the BI-RADS and Tsukuba elastography score. Histopathology was obtained by means of percutaneous biopsy or post-surgery. Fibroadenoma-like lesions unchanged over a period of 3 years were considered benign.Results. The 1, 2 and BGR Tsukuba scores mostly correlated with BI-RADS II and III lesions such as cysts, hamartomas, lipomas, hematomas, non-palpable fibroadenomas. Palpable fibroadenomas initially included in BI-RADS IVa/b category, usually received benign elasticity scores (1 or 2), the exception being represented by a minority of cases of old, fibrotic or calcified lesions (elastic score 3 or 4). Non-specific  BI-RADS IVa/b lesions, such as mastopathic nodules demonstrated rather soft, elastic properties on elastogram (score 1 or 2). The 4 and 5 Ueno-Itoh scores were predominantly correlated with BI-RADS IVc and V categories represented by high risk lesions (radial scar, papillomas, atypical epithelial ductal hyperplasia) and in situ or invasive carcinomas.Conclusions. Generally the BI-RADS classification correlates well with the Tsukuba elasticity score, the main exception being represented by fibrotic, calcified lesions which falsely appear more suspicious post-elastography. BI-RADS III and IV lesions would benefit most from an elastographic assessment, a low Tsukuba score allowing a less invasive approach, while a high score imposes histopathological evaluation. 

scholarly journals High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Francesca Catanzariti ◽  
Daly Avendano ◽  
Giuseppe Cicero ◽  
Margarita Garza-Montemayor ◽  
Carmelo Sofia ◽  
...  
Keyword(s):  
High Risk ◽  
Lobular Carcinoma ◽  
Phyllodes Tumor ◽  
Surgical Excision ◽  
Diagnostic Tools ◽  
Radial Scar ◽  
Flat Epithelial Atypia ◽  
Ductal Hyperplasia ◽  
B3 Lesions ◽  
Management Recommendations

AbstractBreast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).

Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies

2020 ◽  
Vol 24 (06) ◽  
pp. 667-675
Author(s):  
Violeta Vasilevska Nikodinovska ◽  
Slavcho Ivanoski ◽  
Milan Samardziski ◽  
Vesna Janevska
Keyword(s):  
Soft Tissue ◽  
Complication Rate ◽  
Core Needle Biopsy ◽  
Multidisciplinary Team ◽  
Gold Standard ◽  
Needle Biopsy ◽  
Soft Tissue Tumors ◽  
Open Biopsy ◽  
Core Needle ◽  
Similar Accuracy

AbstractBone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.

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