Breast lesions excised via vacuum-assisted system: could we get any clues for B3 lesions before excision biopsy?

Abstract

Background The purpose of this study was to determine the validity of the ultrasound features as well as patient characteristics assigned to B3 (uncertain malignant potential) breast lesions before vacuum-assisted excision biopsy (VAEB). Methods This study population consisted of 2245 women with breast-nodular abnormalities, which were conducted ultrasound-guided VAEB (US-VAEB). Patient’s clinical and anamnestic data and lesion-related ultrasonic feature variables of B3 captured before US-VAEB were compared with those of benign or malignant cases, using histopathological results as a benchmark. Results The proportions of benign, B3 and malignant breast lesions diagnosed post-US-VAEB were 88.5, 8.2 and 3.4% respectively. B3 high frequent occurred in BI-RADS-US grade 3 (7.7%), grade 4a (11.0%) and grade 4b (9.1%). The overall malignancy underestimation rate of B3 was 4.4% (8/183). Malignant lesions were found mostly in the range of BI-RADS grade 4b (27.3%), grade 4c (33.3%) and grade 5 (100%). Multivariate binary logistic regression analyses (B3 vs benign) showed that non-menopausal patients (95% CI 1.628–8.616, P = 0.002), single (95% CI 1.370–2.650, P = 0.000) or vascularity (95% CI 1.745–4.150, P = 0.000) nodules in ultrasonic features were significant risk factors for B3 occurrences. In addition, patients elder than 50 years (95% CI 3.178–19.816, P = 0.000), unclear margin (95% CI 3.571–14.119, P = 0.000) or suspicious calcification (95% CI 4.010–30.733, P = 0.000) lesions were significantly associated with higher risks of malignant potentials for B3 cases (malignant vs B3). Conclusion The results of this study indicate that ultrasound findings and patients’ characteristics might provide valuable information for distinguishing B3 lesions from benign breast abnormalities before VAEB, and help to reduce malignancy underestimation of B3.

Unexpected breast cancer mimicking benign lesions on ultrasound-guided vacuum-assisted excision biopsy: A retrospective cross-sectional study over a 20-year period

“…No reports concerning T2 stage UEBC were found in the literature. Table 1 shows that 69.1% (56/81) of UEBCs occurred in patients aged <50 years, which was higher than 66.7% in a previous study by Zheng et al (17). The difference may have been caused by random error.…”

“…In the literature, the incidence of UEBC diagnosed by US-VAEB was 1.1–3.4% ( 15 – 17 ). In our study, it was lower at 0.42%.…”

Efficacy and safety of microwave ablation for benign breast lesions: a systematic review and meta-analysis.

“…For lesions of BI-RADS grade 3 and below, is it safe to perform MWA without histological evaluation? In a study of 2245 women with breast-nodular abnormalities [45], vacuum-assisted excision biopsy was performed to obtain histopathological results. The malignancy rate in BI-RADS grade 3 lesions is only 1.9%, which indicated that the overwhelming majority of BI-RADS grade 3 cases were unnecessarily subjected to biopsy.…”

“…Therefore, it can be considered that MWA is relatively safe even in a very small number of BI-RADS grade 3 malignant lesions, but long-term imaging follow-up observation after MWA is necessary. However, for lesions of BI-RAD grade 4a, the probability of malignancy is greatly increased [45], so it is necessary to obtain histopathological results by CNB or vaccum-assisted (VAB) before microwave ablation. This would bring additional costs to the patient in addition to ablation.…”