Abstract
BackgroundCore needle biopsy (CNB) is a standard diagnostic procedure in the setting of breast cancer screening. However, CNB may result in the borderline diagnoses of lesion of uncertain malignant potential (B3). The aim of this study was to access the outcome of lesions diagnosed as B3 category in a large series of screen-detected cases to evaluate the rates of malignancy for the different histological subtypes.MethodsWe identified all CNBs over a six-year period (2009-2015) in a breast cancer screening unit in Germany. A total of 8.388 CNB’s were performed for screen detected breast lesions. B3 diagnosis comprised 4.5% (376/8.388). Of the 376 patients who were diagnosed as B3, 299 underwent subsequent excision biopsy with final excision histology.ResultsOut of 376 patients diagnosed with B3 lesions, the prevalence of different histopathology showed 161 (42.8%) patients with atypical ductal hyperplasia (ADH), 98 (26.1%) with flat epithelial atypia (FEA), 50 women (13.3%) showed lobular neoplasia (LN), in 40 (10.6%) patients papillary findings and in 27 patients (7.2%) a radial scar complex. Final excision histology was benign in 74% (221/299) and malignant in 26% (78/299) of the patients. Lesion specific positive predictive values (PPV) for a subsequent diagnosis of in situ or invasive carcinoma were as follows: ADH 40%, FEA 20.5%, papillary lesion 13.5%, radial scar 16.6%, LN 0%.ConclusionOur results show that approximately one-third of core needle biopsies of screen detected breast lesions classified as B3 are premalignant or malignant on excision.Lesions of uncertain malignant potential of the breast (B3) are heterogeneous in respect to risk of malignancy.
Highlights
Core needle biopsy (CNB) is a standard diagnostic procedure in the setting of breast cancer screening
Of the 376 patients who were diagnosed as B3, data of 299 patients who underwent subsequent excision biopsy and final excision histology were available for review
Out of 376 patients diagnosed as B3, the prevalence of the different histopathological findings showed 161 (42.8%) patients with atypical ductal hyperplasia (ADH), 98 (26.1%) patients with flat epithelial atypia (FEA), 50 women (13.3%) showed lobular neoplasia (LN), in 40 (10.6%) patients papillary findings and in 27 (7.2%) subjects the histology of a radial scar complex
Summary
Core needle biopsy (CNB) is a standard diagnostic procedure in the setting of breast cancer screening. The B classification [1] was proposed by the UK Breast screening program as a way of recognizing that between benign breast lesions (B2) and malignant lesions (B5) on core needle biopsy (CNB) lay a small group of lesions whose malignant potential could not be adequately ascertained by CNB alone (B3). These heterogeneous groups of lesions are of “uncertain malignant potential” and include various entities such as atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), lobular neoplasia (LN), papillary lesions and radial scars [1, 2]. Incidences for B3 lesions varies between the setting of Richter-Ehrenstein et al BMC Cancer (2018) 18:829 determine a subgroup in which surgical interventions might not be appropriate in order to tailor therapy in this subgroup of women
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