Key points
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B3 lesions are various pathologies with differing risks of associated malignancy.
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Tailored management of B3 lesions has been increasingly favored to reduce overtreatment.
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Most patients with high-risk lesions may be sparred surgical excision.
Background
High-risk lesion | Management |
---|---|
Lobular Neoplasia (LN) | Surgical excision or VAE If after VAB, the lesion has been radiologically removed, imaging follow-up is recommended |
Atypical Intraductal Epithelial Proliferation (AIDEP) | Surgical excision or VAE VAE is suggested in unifocal ADH in small lesions If the lesion has been removed completely and only focal ADH with calcifications exists, imaging follow-up recommended |
Flat Epithelial Atypia (FEA) | VAE If after VAB, the lesion has been radiologically removed, imaging follow-up |
Papillary Lesion (PL) | |
With atypia | Surgical excision and imaging follow-up |
Without atypia | VAE |
Phyllodes Tumor (PT) | Surgical Excision |
Radial Scar (RS) | |
With atypia | VAE and imaging follow-up |
Without atypia | VAE |
Atypical ductal hyperplasia
High-risk lesion | Upgrade rate to malignancy | Upgrade Rate to Malignancy by Core-Needle Biopsy (CNB) or Vacuum-Assisted Biopsy (VAB) |
---|---|---|
Lobular neoplasia (LN) | 17% (95% CI 13–21%) | Overall range 0–40% |
Atypical lobular hyperplasia (ALH) | 12% (95% CI 5–21%) | CNB (14G) 16% VAB (9G): 6–25.4% for ALH and LCIS |
Lobular carcinoma in situ (LCIS) | 22% (95% CI 14–31%) | CNB (14G) 25% VAB: 6–25.4% for ALH and LCIS |
Atypical Intraductal Epithelial Proliferation (AIDEP) | 28% (95% CI 24–31%) | CNB (14G) 31% VAB (14G) 24% & (11G) 19% |
Flat epithelial atypia (FEA) | 11% (95% CI 8–14%) | CNB (14G) 10–21% VAB (11G) 6% |
Papillary lesion (PL) | 12% (95% CI 10–15%) | 13.2% |
No atypia | 7% (95% CI 4–10%) | CNB (14G) mean 3.9% (range 0–20%) VAB (11G) mean 7.7% (range 0–18.3%) |
Atypia | 32% (95% CI 23–41%) | CNB (14G) mean 46.7% (range 6.7–71.4%) VAB (11G) mean 33% (range 0–71%) |
Radial Scar or Complex Sclerosing Lesions (RS/CSL) | 8% (95% CI 6–11%) | |
No atypia | 6% (95% CI 2–13%) | CNB (14G) 9% (1–28%) VAB (11G) 1% (0–10%) |
Atypia | 18% (95% CI 8–32%) | CNB (14G) 33% VAB (11G) 2% (range 0–18%) |
Histopathology
Immunoprofile
Prognosis
Diagnosis
High-risk lesion | Imaging findings |
---|---|
Lobular Neoplasia (LN) | Amorphous microcalcifications and grouped distribution |
Atypical Intraductal Epithelial Proliferation (AIDEP) | Fine pleomorphic microcalcifications and linear or segmental distribution Irregular-shaped small hypoechoic mass with micro-lobulated edges |
Flat Epithelial Atypia (FEA) | Grouped microcalcifications |
Papillary Lesion (PL) | A solid, round mass with well-defined borders; an intra-cystic mass; or a hypo-echoic, well-defined mass in a dilated duct With internal vascular stalk and with/without microcalcifications |
Phyllodes Tumor (PT) | Ovoid high-density mass lesion with irregular edges and usually lobulated Large size |
Radial Scars (RS) | Radiolucent architectural distortion with or without calcifications |