The B3 conundrum—the radiologists' perspective

Abstract

The management of B3 lesions is both controversial and complicated. There have been recent publications regarding how best to manage this heterogeneous group particularly in light of the Marmot Review and with the advent of vacuumassisted biopsy technique. It is recognized that B3 lesions on core biopsy can be upgraded to malignancy in up to onethird of cases, but this is predominantly to ductal carcinoma in situ or low-grade invasive tumours. The upgrade rate is mainly associated with B3 lesions with epithelial atypia. This review summarizes the current management and focuses on the proposed future management of these B3 lesions.

The continuing role of breast fine‐needle aspiration biopsy after the introduction of the IAC Yokohama System For Reporting Breast Fine Needle Aspiration Biopsy Cytopathology

“…[28][29][30] However, several studies show that even in the histological examination of limited tissue specimen as CNB samples, it may be difficult to identify these types of lesions correctly. 31,32 Remarkably, in our series, the frequency of these entities was overall very limited (50/1745, 2.9%) and the distribution of these diagnoses according to the different IAC Yokohama System categories, (Table 1) reflected the challenging microscopic assessment of their cytological features.…”

“…The reason is that the uncertain interpretation of cytological features that may lead to an atypical diagnosis, occurs most frequently when low‐risk and borderline lesions such as atypical ductal hyperplasia, atypical intraductal papillomas, or low grade phyllodes tumor are sampled (Table 5). 28‐30 However, several studies show that even in the histological examination of limited tissue specimen as CNB samples, it may be difficult to identify these types of lesions correctly 31,32 . Remarkably, in our series, the frequency of these entities was overall very limited (50/1745, 2.9%) and the distribution of these diagnoses according to the different IAC Yokohama System categories, (Table 1) reflected the challenging microscopic assessment of their cytological features.…”

“…In fact, it not only reduces the likelihood of overdiagnosing cases with predominant benign features but with some worrisome cytological alterations but also limits the occurrence of false‐negative rates 33 . Interestingly, the corresponding diagnostic category adopted in CNB to classify histological lesions with uncertain malignant potential (B3) is upgraded to malignancy in up to 35% of cases upon surgical excision and is associated with a ROM of 21.2%, a percentage very similar to that observed in the atypical category 32,34,35 …”

“…histological lesions with uncertain malignant potential (B3) is upgraded to malignancy in up to 35% of cases upon surgical excision and is associated with a ROM of 21.2%, a percentage very similar to that observed in the atypical category. 32,34,35 In this study, the three in-situ lesions (two DCIS and one IPC)…”

A mimic of breast carcinoma 1-year post vacuum-assisted excision of a benign breast lesion

“…VAE is predominantly indicated for further sampling of B3 lesions 5 6. A lesion is designated as B3 when there is a risk of accompanying malignancy or upgrade to a more advanced lesion when additional tissue is examined.…”