Management of B3 Lesions—Practical Issues

Shaaban, Abeer M.; Sharma, Nisha

doi:10.1007/s12609-019-0310-6

Cited by 16 publications

(29 citation statements)

References 19 publications

(12 reference statements)

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“…Of note, the differential diagnosis between ADH and low-grade DCIS is based only on lesion size. As such, ADH cannot be definitively diagnosed over low-grade DCIS at percutaneous biopsy, as the biopsied sample may belong to a larger low-grade DCIS lesion that was not entirely sampled; instead, some authors recommend use the term AIDEP to describe findings indicating ADH or low-grade DCIS at percutaneous biopsy [ 6 , 10 , 19 ].…”

Section: Atypical Ductal Hyperplasiamentioning

confidence: 99%

“…Initially, the first International Consensus Conference on lesions of uncertain malignant potential (B3 lesions) [ 14 ] recommended follow-up without surgical intervention for all ADH lesions determined to have been completely removed through percutaneous biopsies. However, the upgrade rate for this type of lesions was found to be approximately 14% [ 6 ], which is too high for continuing with this initial recommendation. As such, the second International Consensus Conference replaced this initial recommendation with the recommendation that ADH management should be based on surgery and that clinical surveillance can only be justified in particular cases and after a proper multidisciplinary evaluation [ 5 ].…”

Section: Atypical Ductal Hyperplasiamentioning

confidence: 99%

“…B3 lesions reportedly represent approximately 3-21% of all breast lesions and carry a low but potential risk of associated malignancy ranging from 0.2 to 5% [2,3]. B3 lesions are considered non-obligate precursors of malignancy because they can develop into higher-grade lesions, predominantly ductal carcinoma in situ (DCIS) and less frequently low-grade invasive tumors [4][5][6]. Some B3 lesions also function as risk indicators; for example, women diagnosed with a proliferative breast disease with atypia have a fourfold to tenfold higher risk of developing breast cancer compared with those without atypia [7,8] in any location of the same or the contralateral breast [9].…”

Section: Introductionmentioning

confidence: 99%

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High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

et al. 2021

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Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).

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Section: Atypical Ductal Hyperplasiamentioning

confidence: 99%

Section: Atypical Ductal Hyperplasiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

et al. 2021

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“…B3 lesions with atypia are generally managed with an intervention-oriented approach: as explained in the guidelines issued by the UK National Health Service, this choice tends to allow a more precise characterization of the extent of the atypia around the 3 mm diagnostic cut-off between atypical hyperplasia and DCIS, albeit with the obvious disadvantages of patients’ discomfort brought about by the invasive procedure and the related potential complications. Surgical excision is generally recommended in the USA, while European guidelines tend to favor VAE, albeit with some discrepancies between UK recommendations and those of the International Consensus Conferences [ 15 , 16 , 40 ]. The role of imaging surveillance—which is sometimes proposed even for B3b lesions—is the chief topic of an extensive debate [ 38 , 39 ] that, like the widespread lack of consensus, stems from the high variability in the rates of upgrade to malignancy [ 16 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Girardi

Guaragni

Ruzzenenti

et al. 2021

Cancers

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The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8–4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1–2.1%) than B3b lesions (4.7%, 95% CI 2.9–7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1–232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.

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“…The challenge of B3 lesions, including the papillary lesions, is that the lesions have a risk of associated DCIS or malignancy within the B3 lesion. The most important predictor of upgrade to malignancy is the presence of atypia; with a 9-13.2% upgrade in papillary lesions with no atypia and 36-47.8% [4,5] in papillary lesions with atypia. Due to the variety of upgrade, the management of the lesion has been a matter of discussion.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guided vacuum assisted excision of breast papillary lesions with no atypia: Single centre experience after 2018 UK Breast Screening guidelines

Presa-Abos¹,

Juttla²,

Kumar³

et al. 2020

Breast Cancer Rep

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Purpose: Papillary lesions with no atypia (PLNA) are breast lesions with unknown potential of malignancy (B3). New B3 guidelines published in 2018 by NHS Breast Screening Programme proposed VAE (vacuum assisted excision) of PLNA as an alternative to open surgical excision. This study aims to summarise our results using ultrasound guided VAE as diagnostic and therapeutic tool for PLNA, as well as to demonstrate how the technique works and describe the patient experience. Material and Methods: Retrospective analysis of the US guided VAE (7G needle) for treatment of PLNA since July 2018. We reviewed the procedure, time taken, technical specifications, potential complications and the results. Results: Twenty one PLNA were excised. The size of the lesions was 5-28 mm. Eighteen of the lesions were completely excised. In 16 of the lesions a post biopsy clip was inserted. The procedure lasted an average of 30 minutes (including consenting and positioning). During and after the procedure there were no complications. Twenty of the excised lesions came back as papillary lesions with no atypia. One of the lesions was up graded to atypical ductal hyperplasia. None of them were upgraded to B5 lesions. Conclusion: Ultrasound guided VAE could be used as first line treatment or diagnosis of papillary lesions with no atypia. The procedure is simple and easy to perform with no complications. In the majority of the cases the lesion can easily be removed completely.

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Management of B3 Lesions—Practical Issues

Cited by 16 publications

References 19 publications

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Ultrasound guided vacuum assisted excision of breast papillary lesions with no atypia: Single centre experience after 2018 UK Breast Screening guidelines

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