Abstract
PurposeTo investigate a risk stratification strategy for lesions of uncertain malignant potential (B3) diagnosed by vacuum-assisted breast biopsy (VABB) of mammographic microcalcifications. MethodsPatients who underwent VABB for microcalcification-only lesions with a diagnosis of B3 and subsequent surgery were included in this retrospective, IRB-approved study. Seventy-six B3-lesions (final histology: 66 benign, 10 malignant) were included (Tr). Data on B3 lesion type and presence of atypia, microcalcification characteristics (BI-RADS), removal at biopsy and concomitant lesions were collected. After univariate analysis (Chi-square test), data were combined into a risk stratification algorithm by using a ten-fold, cross-validated Classification and Regression Tree analysis (CRT). The algorithm was tested on a testing dataset (Te) of 23 B3-lesions (six malignant, 17 benign). ResultsMalignancy was more frequent in women with a concomitant cancer (P < 0.001) and highly suspicious microcalcifications (P < 0.001). The CRT algorithm retained three characteristics: morphology; presence of atypia; presence of concomitant cancer. The algorithm identified 25/76 (32.9 %,Tr) and 6/23 (26.1 %,Te) lesions at low risk of malignancy. No malignant cases were identified at surgery (0/31). There were 3/76 (3.9 %,Tr) and 1/23 (4.3 %,Te) lesions assigned as high-risk by the algorithm and confirmed at surgery (4/4). In the remaining lesions (48/76, 63.1 %,Tr; 16/23, 69.6 %,Te), malignancy rates varied between 9% and 88.4 %; thus, surgery could not have been avoided. ConclusionWe constructed and tested a risk stratification algorithm for B3 microcalcifications, including clinical, imaging, and pathological features, to assign probabilities of malignancy, which has the potential to reduce unnecessary surgeries.
Highlights
Breast lesions of uncertain malignant potential found at imageguided biopsy, referred to as “B3′′ lesions, are a heterogeneous group of histopathological entities characterized by an increased risk of associated malignancy and an increased risk of subsequent development of invasive breast cancer in either breast [1,2].The diagnosis of B3-lesions has significantly increased in the last several decades with the spread of screening programs and new imaging modalities [2,3]
The training group consisted of 76 patients with 76 B3 lesions
Our analysis of clinical, imaging, and pathological features revealed the possibility to stratify the malignancy risk of lesions of uncertain malignant potential diagnosed by vacuum-assisted breast biopsy (VABB) of mammographic microcalcifications using imaging characteristics and readily available clinical and histopathological data
Summary
Breast lesions of uncertain malignant potential found at imageguided biopsy, referred to as “B3′′ lesions, are a heterogeneous group of histopathological entities characterized by an increased risk of associated malignancy and an increased risk of subsequent development of invasive breast cancer in either breast [1,2].The diagnosis of B3-lesions has significantly increased in the last several decades with the spread of screening programs and new imaging modalities [2,3]. Lesions of uncertain ma lignant potential appear with disparate imaging features, ranging from masses to architectural distortions or microcalcifications [3,5], and the risk of missing a malignant component associated with a B3-lesion at image-guided biopsy varies from 2% to 58 %. The non-negligible prevalence of can cer in this population leads to a high rate of unnecessary surgeries [1] This evidence underscores the need to identify imaging or clinical features that might indicate or exclude malignancy and that could improve clinical decision making in patients with a B3-diagnosis after VABB
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