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20.08.2020 | Breast

Positive predictive value for malignancy of uncertain malignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended?

verfasst von: Marco Lucioni, Chiara Rossi, Pascal Lomoro, Francesco Ballati, Marianna Fanizza, Alberta Ferrari, Carlos A. Garcia-Etienne, Emanuela Boveri, Giulia Meloni, Maria Grazia Sommaruga, Elisa Ferraris, Angioletta Lasagna, Elisabetta Bonzano, Marco Paulli, Adele Sgarella, Giuseppe Di Giulio

Erschienen in: European Radiology | Ausgabe 2/2021

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Abstract

Purpose

Breast lesions classified as of “uncertain malignant potential” represent a heterogeneous group of abnormalities with an increased risk of associated malignancy. Clinical management of B3 lesions diagnosed on vacuum-assisted breast biopsy (VABB) is still challenging: surgical excision is no longer the only available treatment and VABB may be sufficient for therapeutic excision. The aim of the present study is to evaluate the positive predictive value (PPV) for malignancy in B3 lesions that underwent surgical excision, identifying possible upgrading predictive factors and characterizing the malignant lesions eventually diagnosed. These results are compared with a subset of patients with B3 lesions who underwent follow-up.

Methods

A total of 1250 VABBs were performed between January 2006 and December 2017 at our center. In total, 150 B3 cases were diagnosed and 68 of them underwent surgical excision. VABB findings were correlated with excision histology. A PPV for malignancy for each B3 subtype was derived.

Results

The overall PPV rate was 28%, with the highest upgrade rate for atypical ductal hyperplasia (41%), followed by classical lobular neoplasia (29%) and flat epithelial atypia (11%). Only two cases of carcinoma were detected in the follow-up cohort, both associated with atypical ductal hyperplasia at VABB.

Conclusion

Open surgery is recommended in case of atypical ductal hyperplasia while, for other B3 lesions, excision with VABB only may be an acceptable alternative if radio-pathological correlation is assessed, if all microcalcifications have been removed by VABB, and if the lesion lacks high-risk cytological features.

Key Points

• Surgical treatment is strongly recommended in case of ADH, while the upgrade rate in case of pure FEA, especially following complete microcalcification removal by VABB, may be sufficiently low to advice surveillance as a management strategy.

• The use of 11-G- or 8-G-needle VABB, resulting in possible complete diagnostic excision of the lesion, can be an acceptable alternative in case of RS, considering open surgery only for selected high-risk patients.

• LN management is more controversial: surgical excision may be recommended following classical LN diagnosis on breast biopsy if an additional B3 lesion is concurrently detected while in the presence of isolated LN with adequate radiological-pathological correlation follow-up alone could be an acceptable option.

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Titel: Positive predictive value for malignancy of uncertain malignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended?
verfasst von: Marco Lucioni
Chiara Rossi
Pascal Lomoro
Francesco Ballati
Marianna Fanizza
Alberta Ferrari
Carlos A. Garcia-Etienne
Emanuela Boveri
Giulia Meloni
Maria Grazia Sommaruga
Elisa Ferraris
Angioletta Lasagna
Elisabetta Bonzano
Marco Paulli
Adele Sgarella
Giuseppe Di Giulio
Publikationsdatum: 20.08.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07161-5

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Positive predictive value for malignancy of uncertain malignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended?

Abstract

Purpose

Methods

Results

Conclusion

Key Points

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Key Points

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