Predictive Value of Breast Lesions of “Uncertain Malignant Potential” and “Suspicious for Malignancy” Determined by Needle Core Biopsy

Dillon, Marcus L.; McDermott, Enda; Hill, A. D. K.; O’Doherty, Ann; O’Higgins, N. J.; Quinn, Cecily

doi:10.1245/s10434-006-9212-8

Cited by 79 publications

(80 citation statements)

References 40 publications

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“…(4,(9)(10)(11)(12). In our trial, ADH was the biggest subgroup of the B3-lesions, with 31%; similar observations have been made by other authors (5). The incidence of the other subgroups, such as PT, LIN, FEA and RS, differ among previous trials (4,9-10,13).…”

Section: Discussionsupporting

confidence: 89%

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B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

Hoffmann

Stamatis

Bittner

et al. 2016

Molecular and Clinical Oncology

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Abstract. The use of mammography screening, followed by needle core biopsy (NCB), is associated with an increasing amount of invasive procedures. A considerable amount of specimens must be classified as lesions with uncertain malignant potential (B3-lesion). In these cases, an open biopsy is indicated for further diagnosis. We evaluated patients with B3-lesions to determine the risk of malignancy corresponding to the histopathological NCB results and the type of radiological lesion identified. A total of 95 patients participating in the German mammography screening program with a B3-lesion following NCB (104 B3-lesions in total) were included in our analysis. We analyzed the correlation between the initial histopathological findings from the NCB specimen and cancer risk. We further analyzed the correlations of malignant results with the type of mammographic lesion. In 23 cases (22%), histopathological examination following excision revealed a malignant lesion, including invasive and in situ carcinoma. The positive predictive value of the subgroups of B3-lesions ranged between 0.11 and 0.31; the B3-lesion associated with the highest cancer risk was the atypical ductal hyperplasia; however, no significant difference was observed between the B3-lesion subgroups (P=0.309) regarding the risk of malignancy. Comparing the different types of mammographic findings, such as radiological mass or microcalcifications, there was no significant difference in the risk for malignancy (P=0.379). The different types of B3-lesions did not exhibit differences in the risk for malignancy, and the morphological type of mammographic lesion does not appear to be correlated with cancer risk; therefore, our results underline the need for open biopsy in patients with B3-lesions following NCB.

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Section: Discussionsupporting

confidence: 89%

“…The overall risk for malignancy of B3-lesions was 22% in our study; in 23 cases, postsurgical histological examination revealed a malignancy. Other studies reported an incidence of 8-35% (4)(5)(6)13,(18)(19)(20). The highest malignancy rate regarding the subgroup of the B3-lesions was found for ADH, with a PPV of 0.31.…”

Section: Discussionmentioning

confidence: 99%

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

Hoffmann

Stamatis

Bittner

et al. 2016

Molecular and Clinical Oncology

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“…, 15 21, 10 26, 12 34 16 to 35% 7 (average 23.5%, which is expected to be less in recent years 4 ). In our study, there was an association between radiological finding and outcome.…”

mentioning

confidence: 98%

“…The B3 category consists of a heterogeneous group of lesions which may yield only benign histology on initial NCB sampling but are recognized to show heterogeneity and may harbor malignancy elsewhere or to have an increased risk of associated adjacent malignancy. 5,6 Although the B3 category constitutes a relatively small proportion of all NCB (3-9%; average 6% 4,[7][8][9][10][11][12] ), most cases progress to surgical intervention to establish an excision histology diagnosis. This has significant implications particularly in screen-detected (nonsymptomatic) breast lesions in which final benign diagnoses after surgical intervention is a drawback of mammographic screening.…”

mentioning

confidence: 99%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

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In the setting of breast cancer screening, 5-9% of needle core biopsies are diagnosed as lesions of uncertain malignant potential (B3). The management of these lesions is potentially problematic as the data on their outcome remains limited. In our study, we aim to assess the outcome of screen-detected lesions diagnosed as B3 in a large series to validate previous studies and to characterize the malignant lesions detected after a B3 diagnosis. Therefore, the results of 1,025 needle core biopsies of women screened over a 7-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) in two different regions in the UK with B3 diagnoses who underwent surgical excision were reviewed and compared to the final excision histology. Final histology showed that 25% of cases were malignant (17% ductal carcinoma in situ and 8% invasive). Predictors of malignancy included calcification on imaging and epithelial atypia on needle core biopsy particularly atypical ductal hyperplasia [positive predictive value 50%]. Pure flat epithelial atypia showed the lowest positive predictive value amongst all epithelial atypia groups (21%). The positive predictive value was low for complex sclerosing lesions (9%) and papillary lesions (13%) without epithelial atypia. Malignant tumors detected after B3 diagnosis showed favorable histological features, the majority were in situ, and most belonged to the low grade breast neoplasia family that is associated with indolent behavior. The underlying radiological abnormality was calcification in 44% of cases and the imaging classification was malignant/suspicious in 38%. In conclusion, our results further emphasize the heterogeneity of B3 lesions and that the likelihood of malignancy varies substantially between different histological subtypes. Malignancy is particularly associated with epithelial atypia suggesting the use of two categories of with and without epithelial atypia. Radiological findings provided useful information regarding the nature and outcome of B3 lesions.

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“…They include radial scars, atypical ductal hyperplasia, papillary lesions, flat epithelial atypia, lobular neoplasia, mucinous lesions and fibroepithelial lesions that raise the possibility of phyllodes tumour. These categories have varying upgrade rates of 15-50% (Dillon et al, 2007;El-Sayed et al, 2008;Bianchi et al, 2011;Rakha et al, 2011;Ohsumi et al, 2012). Repeat core biopsy using VA cores and other non-surgical approaches have been proposed to limit surgery.…”

Section: Discussionmentioning

confidence: 99%

Performance Indices of Needle Biopsy Procedures for the Assessment of Screen Detected Abnormalities in Services Accredited by BreastScreen Australia

Farshid

Sullivan

Jones

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Predictive Value of Breast Lesions of “Uncertain Malignant Potential” and “Suspicious for Malignancy” Determined by Needle Core Biopsy

Cited by 79 publications

References 40 publications

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

B3-lesions of the breast and cancer risk - an analysis of mammography screening patients

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Performance Indices of Needle Biopsy Procedures for the Assessment of Screen Detected Abnormalities in Services Accredited by BreastScreen Australia

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