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

Christoph J Rageth,Zsuzsanna Varga,Astrid Baege,Christopher Comstock,Alexander Mundinger,Domenico Lepori,Gert Kampmann,Thomas Decker,Elisabeth Morris,Rahel Kubik,Jean-François Delaloye,Stefanie Hosch,Helmut Madjar,Christoph Tausch,Claudia Kurtz,Elizabeth Am O’Flynn

doi:10.1007/s10549-016-3935-4

Abstract

The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

Highlights

Breast lesions classified as lesions of uncertain malignant potential (B3) are a heterogeneous group of abnormalities with a borderline histological spectrum, and a variable but low risk of associated malignancy [1]
The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology
The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years

Summary

Introduction

Breast lesions classified as lesions of uncertain malignant potential (B3) are a heterogeneous group of abnormalities with a borderline histological spectrum, and a variable but low risk of associated malignancy [1]. Histological diagnosis of a B3 lesion is made by either core needle biopsy (CNB) mostly using a 14G spring-loaded CNB or by vacuum-assisted biopsy (VAB) using a 7G–11G device either under ultrasound, stereotactic, or MRI guidance following informed consent and local anesthetic. It is an incidental finding on a specimen which has been excised surgically. For many B3 lesions, instead of surgical excision, VAB may be sufficient for therapeutic excision which would benefit the patient and save on healthcare costs by obviating the need for surgery [7]

Objectives

Methods

Results

Conclusion