The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review &amp; meta-analysis

Cullinane, Carolyn; Byrne, James; Kelly, Louise; Sullivan, Martin O; Corrigan, Mark; Redmond, H. P.

doi:10.1016/j.ejso.2022.04.005

Cited by 14 publications

(14 citation statements)

References 105 publications

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“…In addition, it has to be considered that, overall, 22.7% of patients with B3 lesions treated by OE or VAE were upgraded to BC, with upgrade risk being as high as 39.8% among ADH patients. Therefore, our study reinforces the idea that surgical removal of B3 lesions should always be considered, especially in the presence of ADH [ 29 , 30 , 31 ]. Other large-scale studies will be needed to investigate whether and when alternative management of B3 lesions may be feasible and whether the type of management may influence the future risk of BC diagnosis.…”

Section: Discussionsupporting

confidence: 86%

Breast Lesions of Uncertain Malignant Potential (B3) and the Risk of Breast Cancer Development: A Long-Term Follow-Up Study

Bellini

Cucchiari

Naro

et al. 2023

Cancers

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Breast lesions of uncertain malignant potential (B3) are frequently diagnosed in the era of breast cancer (BC) screening and their management is controversial. They are generally removed surgically, but some international organizations and guidelines for breast research suggest follow-up care alone or, more recently, propose vacuum-assisted excision (VAE). The risk of upgrade to BC is known, but very little data exist on its role as risk factor for future BC development. We analyzed 966 B3 lesions diagnosed at our institution, 731 of which had long-term follow-up available. Surgical removal was performed in 91%, VAE in 3.8%, and follow-up in 5.2% of cases. The B3 lesions included flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), lobular intraepithelial neoplasia (LIN), atypical papillary lesions (PLs), radial scars (RSs), and others. Overall, immediate upgrade to BC (invasive or in situ) was 22.7%. After long-term follow-up, 9.2% of the patients were diagnosed with BC in the same or contralateral breast. The highest risk was associated with ADH diagnosis, with 39.8% of patients upgraded and 13.6% with a future BC diagnosis (p < 0.0001). These data support the idea that B3 lesions should be removed and provide evidence to suggest annual screening mammography for women after a B3 diagnosis because their BC risk is considerably increased.

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Section: Discussionsupporting

confidence: 86%

Breast Lesions of Uncertain Malignant Potential (B3) and the Risk of Breast Cancer Development: A Long-Term Follow-Up Study

Bellini

Cucchiari

Naro

et al. 2023

Cancers

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“…A recent Irish study, on a large patient cohort, found similar results, observing an upgrade rate of 9% in RS without atypia, in contrast to an upgrade rate of 33% in RS with atypia [48]. Further studies reported the increased use of therapeutic VAE after CNB diagnosis of RS without atypia with a very low upgrade rate of 0.9-1.6% [46,[49][50][51]. The number and size of the biopsy specimens have an impact on the histopathological upgrade rate of a targeted OE, similar to other B3 lesions.…”

Section: Current Evidence For Underestimation After Cnb/vabmentioning

confidence: 60%

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Elfgen,

Leo,

Kubik-Huch

et al. 2023

Virchows Arch

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The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.

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“…Letztlich hängt das Risiko wie bei den papillären Läsionen aber in erster Linie von potenziell begleitenden anderen B3-Läsionen oder malignen/prämalignen Entitäten ab [ 55 ]. Die Upgraderate im nachfolgenden Operationspräparat bei reinen FEA-Fällen liegt deutlich unter 10 % [ 6 , 10 , 54 ]. Basierend auf der aktuellen Datenlage wird bei reiner FEA und bei kompletter radiologisch-pathologischer Korrelation zunehmend ein konservatives Vorgehen gewählt.…”

Section: Flache Epithelatypieunclassified

“…Gemäss aktueller Datenlage ist bei einer RS/KSL ohne Atypien im Allgemeinen mit niedrigem Unterschätzungsrisiko zu rechnen, welches sich bei zwischen 0 bis 10 % bewegt [ 36 , 39 , 40 , 48 ]. Hingegen gehen RS/KSL mit assoziierten atypischen Läsionen (wie ADH) mit einem höheren Unterschätzungsrisiko (5–30 %) einher [ 5 , 6 ].…”

Section: Radiäre Narbe/komplexe Sklerosierende Läsionunclassified

B3-Läsionen der Mamma: Histologische, klinische und epidemiologische Aspekte

2023

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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.

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The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis

Cited by 14 publications

References 105 publications

Breast Lesions of Uncertain Malignant Potential (B3) and the Risk of Breast Cancer Development: A Long-Term Follow-Up Study

Breast Lesions of Uncertain Malignant Potential (B3) and the Risk of Breast Cancer Development: A Long-Term Follow-Up Study

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

B3-Läsionen der Mamma: Histologische, klinische und epidemiologische Aspekte

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