Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia (B3a)?

Bednarova, Iliana; Londero, Viviana; Linda, Anna; Girometti, Rossano; Lorenzon, Michele; Bednarova, Sandra; Zuiani, Chiara

doi:10.1007/s11547-018-0914-3

Cited by 3 publications

(4 citation statements)

References 31 publications

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“…Mean age, among clinical variables, is recognized to be a factor influencing the upgrade rate. A significant difference in the upgrade rate to malignancy has been also described with regard to lesion size (>10 mm) and final BI-RADS 4-5 category assessment [12,21]. In the current study we evaluated the applicability and the robustness of this risk stratification score [14] in an external population.…”

Section: Discussionmentioning

confidence: 94%

“…In this context, the score proposed by Giuliani et al [14] tried to provide guidance for management recommendations according to the histologic sub-classification in lesion with and without atypia and to other variables that are easily available and commonly used in the clinical practice. The role of these parameters in the prediction of upgrade rate of B3 lesions has already been investigated in other studies [12,[19][20][21]. Mean age, among clinical variables, is recognized to be a factor influencing the upgrade rate.…”

Section: Discussionmentioning

confidence: 98%

“…Given the differing upgrade rates to malignancy, an accurate estimation of the risk to individual patients in case of a newly diagnosed B3 lesion is the key to tailored management that avoids both under and over-treatment. Many studies have investigated imaging and histopathological features that may be useful in predicting the likelihood of malignancy in order to select cases in which surgical excision may not be necessary [11,12]. To date, no clinical or radio-pathological feature alone, or in combination, has been proven to accurately characterize borderline lesions with less than 2% chance of carcinoma at surgical excision, and to be able to be managed with short-term follow-up, according to the American College of Radiology recommendations [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Objective: The aim of this study was to externally validate the feasibility and robustness of a risk-stratification score for B3 lesions based on clinical, pathological, and radiological data for improved clinical decision making. Methods: 129 consecutive histologically confirmed B3 lesions diagnosed at ultrasound-guided biopsy at our institution were included in this retrospective study. Patient- and lesion-related variables were independently assessed by two blinded breast radiologists (R1, R2), by assigning each feature a score from 0 to 2 (maximum sum-score of 5). Sensitivity, specificity, positive and negative predictive values were calculated at two different thresholds (≥1 and 2). Categorical variables were compared using Chi-squared and Fisher exact tests. The diagnostic accuracy of the score to distinguish benign from malignant B3 lesions was assessed by receiver operating characteristic (ROC) analysis. Results: Surgery was performed on 117/129 (90.6%) lesions and 11 of these 117 (9.4%) lesions were malignant. No cancers were found at follow-up of at least 24 months. Area under the ROC-curve was 0.736 (R1) to 0.747 (R2), with no significant difference between the two readers (p = 0.5015). Using a threshold of ≥1, a sensitivity, specificity, PPV, and NPV of 90%/90% (R1/R2), 39%/38% (R1/R2), 11%/12% (R1/R2) and 97%/98% (R1/R2) were identified. Both readers classified 47 lesions with a score ≤1 (low risk of associated malignancy). Of these, only one malignant lesion was underdiagnosed (Ductal carcinoma in situ-G1). Conclusions: In our external validation, the score showed a high negative predictive value and has the potential to reduce unnecessary surgeries or re-biopsies for ultrasound-detected B3-lesions by up to 39%.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Axillary lymph node metastasis is one of the most important prognostic factors in breast cancer patients (8). For this reason, the meticulous detection of axillary metastases in newly diagnosed breast cancer is essential for disease staging and treatment decision making (9)(10)(11)(12)(13)(14). Unfortunately, the non-invasive differentiation between benign and malignant lymph nodes remains highly problematic, delaying the diagnosis, in case of metastatic risk in lymph nodes, to pathological examination (15,16).…”

Section: Introductionmentioning

confidence: 99%

Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: a narrative review

et al. 2020

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The presence of axillary lymph nodes metastases in breast cancer is the most significant prognostic factor, with a great impact on morbidity, disease-related survival and management of oncological therapies; for this reason, adequate imaging evaluation is strictly necessary. Physical examination is not enough sensitive to assess breast cancer nodal status; axillary ultrasonography (US) is commonly used to detect suspected or occult nodal metastasis, providing exclusively morphological evaluation, with low sensitivity and positive predictive value. Currently, sentinel lymph node biopsy (SLNB) and/or axillary dissection are the milestone for the diagnostic assessment of axillary lymph node metastases, although its related morbidity. The impact of magnetic resonance imaging (MRI) in the detection of nodal metastases has been widely investigated, as it continues to represent the most promising imaging modality in the breast cancer management. In particular, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values represent additional reliable non-contrast sequences, able to improve the diagnostic accuracy of breast cancer MRI evaluation. Several studies largely demonstrated the usefulness of implementing DWI/ADC MRI in the characterization of breast lesions. Herein, in the light of our clinical experience, we perform a review of the literature regarding the diagnostic performance and accuracy of ADC value as potential pre-operative tool to define metastatic involvement of nodal structures in breast cancer patients.

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Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy

et al. 2020

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Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia (B3a)?

Abstract: B3a lesions are associated with low risk of malignancy at excision. Lesion size > 10 mm and BI-RADS 4-5 category may represent useful predictors of upgrade to malignancy.

Cited by 3 publications

References 31 publications

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

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

Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: a narrative review

Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy

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