Malignancy Rate and Malignancy Risk Assessment in Different Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions): An Analysis of 192 Cases from a Single Institution
Abstract:<b><i>Background:</i></b> The question of how to deal with B3 lesions is of emerging interest. <b><i>Methods:</i></b> In the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding. <b><i>Results:</i></b> The distribution of… Show more
“…2). This agrees with Mohrmann et al who stated that age and postmenopausal status were other significant risk factors for a malignant upgrade of a B3 lesion (p = 0.015) [20].…”
Section: Discussionsupporting
confidence: 92%
“…The most commonly detected B3 lesion in the population was papillary breast lesions, which is in agreement with Mohrmann et al, while in other studies Bianchi et al and Rakha et al, ADH was not the most commonly detected B3 lesion [20][21][22].…”
Section: Discussionsupporting
confidence: 89%
“…Eighteen out of 57 (31.5 %) of the cases histologically classified as B3 preoperatively proved malignant in the final histological analysis. Thus, the results are much higher than the previously published data by Houssami et al, Decker et al and Mohrmann et al where 14.1% of the cases histologically classified as B3 preoperatively proved malignant in the final histological analysis [20,27,28].…”
Background
High-risk breast lesions represent 3–21% of all breast lesions and are non-obligate precursors of malignancy. Various studies have evaluated the value of DCE-MRI including DWI and ADC mapping in the detection of high-risk breast lesions, differentiating them from malignant lesions and predicting upgrade risk after surgical excision reducing misdiagnosis and overtreatment. This study is a retrospective review of all image-guided breast biopsy procedures performed in 2021 at our institution, identified 68 patients with histopathologically proven high-risk breast and available MRI examinations with no concurrent ipsilateral malignancy. Image analysis of MRI examinations included morphological criteria, enhancement pattern, dynamic curves, DWI and ADC mapping assessment. Since our knowledge of high-risk breast lesions is still growing, this study is important to evaluate the merits of DCE-MRI in the assessment of high-risk breast lesions, to allow optimization of treatment, better limit it to those women at risk, and avoid overtreatment in women at low risk.
Results
The mean ADC value of high-risk breast lesions was not significantly different from that of malignant breast lesions (p value = 0.015). Non-mass enhancement and type III enhancing curve proved to be significant indicators of high-risk breast lesions upgrade in surgical pathology. Cut-off average ADC value for differentiating upgraded high-risk lesions from non-upgraded high-risk lesions proved 1.24 mm2/sec with sensitivity and specificity of 94 & 100%, respectively.
Discussion
Management of high-risk breast lesions is important in the screening setting, as they are non-obligate precursors of malignancy, and also function as risk indicators. Frequency and upgrade rates of high-risk lesions detected by MRI provide a reference for clinical management. DCE-MRI has a high negative predictive value in predicting the upgrade risk of high-risk lesions. In this study, non-mass enhancement and type III curve were proven to be indicators of high-risk lesion upgrade. Limitations of the study included small number of patients and limited follow-up period.
Conclusions
The use of multi-parametric DCE-MRI including DWI and ADC mapping provides complementary information to detect high-risk breast lesions and predict their upgrade rate.
“…2). This agrees with Mohrmann et al who stated that age and postmenopausal status were other significant risk factors for a malignant upgrade of a B3 lesion (p = 0.015) [20].…”
Section: Discussionsupporting
confidence: 92%
“…The most commonly detected B3 lesion in the population was papillary breast lesions, which is in agreement with Mohrmann et al, while in other studies Bianchi et al and Rakha et al, ADH was not the most commonly detected B3 lesion [20][21][22].…”
Section: Discussionsupporting
confidence: 89%
“…Eighteen out of 57 (31.5 %) of the cases histologically classified as B3 preoperatively proved malignant in the final histological analysis. Thus, the results are much higher than the previously published data by Houssami et al, Decker et al and Mohrmann et al where 14.1% of the cases histologically classified as B3 preoperatively proved malignant in the final histological analysis [20,27,28].…”
Background
High-risk breast lesions represent 3–21% of all breast lesions and are non-obligate precursors of malignancy. Various studies have evaluated the value of DCE-MRI including DWI and ADC mapping in the detection of high-risk breast lesions, differentiating them from malignant lesions and predicting upgrade risk after surgical excision reducing misdiagnosis and overtreatment. This study is a retrospective review of all image-guided breast biopsy procedures performed in 2021 at our institution, identified 68 patients with histopathologically proven high-risk breast and available MRI examinations with no concurrent ipsilateral malignancy. Image analysis of MRI examinations included morphological criteria, enhancement pattern, dynamic curves, DWI and ADC mapping assessment. Since our knowledge of high-risk breast lesions is still growing, this study is important to evaluate the merits of DCE-MRI in the assessment of high-risk breast lesions, to allow optimization of treatment, better limit it to those women at risk, and avoid overtreatment in women at low risk.
Results
The mean ADC value of high-risk breast lesions was not significantly different from that of malignant breast lesions (p value = 0.015). Non-mass enhancement and type III enhancing curve proved to be significant indicators of high-risk breast lesions upgrade in surgical pathology. Cut-off average ADC value for differentiating upgraded high-risk lesions from non-upgraded high-risk lesions proved 1.24 mm2/sec with sensitivity and specificity of 94 & 100%, respectively.
Discussion
Management of high-risk breast lesions is important in the screening setting, as they are non-obligate precursors of malignancy, and also function as risk indicators. Frequency and upgrade rates of high-risk lesions detected by MRI provide a reference for clinical management. DCE-MRI has a high negative predictive value in predicting the upgrade risk of high-risk lesions. In this study, non-mass enhancement and type III curve were proven to be indicators of high-risk lesion upgrade. Limitations of the study included small number of patients and limited follow-up period.
Conclusions
The use of multi-parametric DCE-MRI including DWI and ADC mapping provides complementary information to detect high-risk breast lesions and predict their upgrade rate.
“…Auf eine offene PE kann verzichtet werden, wenn suspekte Verkalkungen mittels Vakuumbiopsie bildgebend bereits vollständig oder weitestgehend vollständig entfernt wurden. Eine offene Exzision sollte bei FEA-Fällen mit Diskrepanz zur Bildgebung und bei sehr ausgedehnten Verkalkungen erfolgen [ 1 , 2 , 13 , 24 , 27 , 30 , 40 ]. …”
ZusammenfassungB3-Läsionen der Mamma stellen eine heterogene Gruppe von Läsionen mit unsicherem Malignitätspotenzial dar, welche histologisch klar definierte Diagnosen beinhalten und welche in diagnostischem und therapeutischem Kontext unterschiedlich gewichtet und behandelt werden. Vor allem die Entscheidung über die Schritte nach der Diagnose einer B3-Läsion an Stanzbiopsie oder Vakuumbiopsie können eine Herausforderung darstellen. B3-Läsionen werden oft wegen bildgebenden Kalzifikationen oder Herdbefunden entdeckt und biopsiert. Histologisch können die Veränderungen einer Reihe von häufigen Diagnosen (wie die atypische duktale Hyperplasie, die klassische lobuläre Neoplasie, flache Epithelatypien, intraduktale Papillome, radiäre Narben oder fibroepitheliale Tumoren vom Typ eines Phylloidestumors) oder seltenen Diagnosen (wie Mukozelen-ähnliche Läsion, atypische apokrine Läsionen und seltene stromale Proliferate) zugeordnet werden. Immunhistochemie ist hilfreich in der Differenzierung und einer korrekten nomenklatorischen Zuordnung dieser Läsionen (vor allem Östrogenrezeptoren, basale Zytokeratine, Myoepithelmarker oder stromale Markerpanel). Im klinischen Kontext bleibt die Korrelation der bildgebenden und histologischen Befunde der wichtigste Faktor in der Entscheidung der nächsten diagnostischen/therapeutischen Schritte.
“…For many years, the standard approach to B3 lesions has been open surgical excision (OE), especially for those with atypia detected by diagnostic VAB techniques. The rationale for OE is to detect any coincident significant malignant disease that was not detected by VAB, as in B3 lesions, the upgrade rate to ductal carcinoma in situ (DCIS) or invasive cancer has been shown to be 20-30% [5][6][7]. However, malignant lesions occurring among B3 lesions are usually associated with a favorable biological profile and prognosis, and the rate of progression to malignancy occurs over a long time [8,9].…”
<b><i>Introduction:</i></b> B3-lesions of the breast are a heterogeneous group of neoplasms, associated with a higher risk of breast cancer. Recent studies show a low upgrade rate into malignancy after subsequent open surgical excision (OE) of most B3-lesions when proven by vacuum-assisted biopsy (VAB). However, there is a lack of long-term follow-up data after VAB of high-risk lesions. The primary aim of this study was to demonstrate whether follow-up of B3 lesions is a beneficial and reliable alternative to OE in terms of long-term outcome. The secondary aim was to identify patient and lesion characteristics of B3 lesions for which OE is still necessary. <b><i>Methods:</i></b> This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the <i>t</i> test and Fisher’s exact test. A <i>p</i> value of <0.05 was considered statistically significant. <b><i>Results:</i></b> The median follow-up interval was 59 months (range: 24–143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31–119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up (<i>p</i> < 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient (<i>p</i> > 0.12). <b><i>Conclusion:</i></b> With a low risk of <6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6–7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (>10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
