Abstract
PurposeTo determine the concordance rate between core needle biopsy/vacuum-assisted biopsy (CNB/VAB) and postoperative histopathology in B3 (lesions of uncertain malignant potential) and B5a (in situ) lesions found on mammograms or ultrasound.Material and methods2,029 consecutive biopsies performed over 10 years for patients who underwent mammograms or ultrasounds. For CNB 14G needle and for VAB 8G/10G needles were used. In all biopsies, we identified the age, BI-RADS®, histopathological biopsy results, B-category, nuclear grade for DCIS and postoperative histopathology results in B3 and B5a cases from the biopsy.ResultsThe B-categories from CNB/VAB were as follows: B2 42.2 percent (n = 856), B3 4.5 percent (n = 91), B5a 5.7 percent (n = 115), and B5b 47.6 percent (n = 967). In the B3-category, 72/91 patients underwent surgical excision, with a concordance rate of 83.3 percent (n = 60/72) and a discordance rate of 16.7 percent (n = 12/72) to postoperative histopathology. From the discordant cases, 67.7 percent (n = 8/12) showed DCIS and 32.3 percent (n = 4/12) showed invasive breast cancer. The BIRADS of the discordant cases was 4b in 41.7 percent (n = 5/12) and 5 in 58.3 percent (n = 7/12). The PPVs for malignancy of B3 lesions were 0.21, with no statistical significance between subgroups. In the B5a-category, 101 of 115 patients underwent surgery in our hospital, with a concordance rate of 80.2 percent (n = 81/101) and a discordance rate of 19.8 percent (n = 20/101) to postoperative histopathology. From the discordant cases, 55 percent (n = 11/20) showed invasive breast carcinoma of no special type (NST).ConclusionOur concordance rate for B3 (83.3 percent) and B5a (80.2 percent) lesions in the biopsies to postoperative histopathology is matching to previously published literature. Surgical excision is our recommendation for lesions biopsied with a B3 category in the histopathology and a BIRADS category of (4b, 4c and 5). The PPVs for malignancy of B3 lesions showed no statistical significance between subgroups. Also, the nuclear grade of DCIS was not statistically significant in terms of upgrade into invasive breast cancer.
Highlights
In Europe, the female breast was the most common cancer site in 2018 (523,000 cases) [1]
Surgical excision is our recommendation for lesions biopsied with a B3 category in the histopathology and a BIRADS category of (4b, 4c and 5)
The PPVs for malignancy of B3 lesions showed no statistical significance between subgroups
Summary
In Europe, the female breast was the most common cancer site in 2018 (523,000 cases) [1]. Breast biopsies are commonly performed to evaluate mammographic or palpable findings that are of concern, and the majority reveal benign findings [2]. The breast imaging and data system (BI-RADS1) categorizes mammographic findings from 0 to 6 [3], with categories 4 (including a- low; b- moderate; and c- high suspicion of malignancy) and 5 requiring tissue biopsy. According to guidelines for non-operative diagnostic procedures and reporting in breast cancer screening, the histological results of core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) are categorized from B1 to B5 [4]. The B1 and B2 categories respectively represent normal and benign lesions, while the B4 and B5 categories respectively represent suspicious and malignant lesions [4]. The B5 category is further subdivided into B5a, which comprise in-situ carcinomas and the B5b, which comprise the invasive carcinomas [4]
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