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

Christoph J Rageth,Zsuzsanna Varga,Pascal A Baltzer,Michael Knauer,Rahel A Kubik-Huch,Caroline Malhaire,Elizabeth A M O’Flynn,Martin Sonnenschein,Andreas Boos,Maria P Foschini,Sophie Dellas,Alexander Mundinger,Florian Dammann,Thomas Decker,Elisabeth Morris,Katja Pinker,Eva Maria Fallenberg,Christoph Tausch

doi:10.1007/s10549-018-05071-1

Abstract

PurposeThe second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations.MethodsThis study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy.ResultsIn 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 (p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 (p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (p = 0.07)].ConclusionsMinimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.

Highlights

Lesions of uncertain malignant potential in the breast (B3 lesions) represent a heterogeneous group of abnormalities with an overall risk for malignancy of 9.9%–35.1% after total resection [1]
Open surgical excision has been recommended for all B3 lesions; over the last decade there has been a trend towards minimally invasive breast biopsy or percutaneous excision using a vacuum-assisted device where larger volumes of tissue can be removed compared to core biopsy, equivalent to a smallwide local excision while retaining the same diagnostic
From 2007 until 2017, a total of 31,574 vacuum-assisted biopsy (VAB) were entered in the database. 6,020 cases (19.1%) showed a B3 lesion (4339 were pure and the other ones were combined B3 lesions)

Summary

Introduction

Lesions of uncertain malignant potential in the breast (B3 lesions) represent a heterogeneous group of abnormalities with an overall risk for malignancy of 9.9%–35.1% after total resection [1]. Open surgical excision has been recommended for all B3 lesions; over the last decade there has been a trend towards minimally invasive breast biopsy or percutaneous excision using a vacuum-assisted device where larger volumes of tissue can be removed compared to core biopsy, equivalent to a smallwide local excision while retaining the same diagnostic. Extended author information available on the last page of the article accuracy as open surgery [2], but with the obvious benefits of saving the patient a surgical procedure, and cost. Management and practice vary greatly from country to country, there is a trend universally for more conservative management as an alternative to open surgery. The 2016 recommendations from the first International Consensus Conference on B3 lesions [7] during the biannual International Breast

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Conclusion