Upgrade rate to malignancy of uncertain malignant potential breast lesions (B3 lesions) diagnosed on vacuum-assisted biopsy (VAB) in screen detected microcalcifications: Analysis of 366 cases from a single institution.

Autor: Bianchi S; Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy., Caini S; Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy. Electronic address: s.caini@ispro.toscana.it., Vezzosi V; Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy., Orzalesi L; Division of Breast Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Piovesan L; Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy., Mantellini P; Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy., Ambrogetti D; Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2024 Jan; Vol. 170, pp. 111258. Date of Electronic Publication: 2023 Dec 10.
DOI: 10.1016/j.ejrad.2023.111258
Abstrakt: Purpose: We retrospectively investigated clinical, radiological, and pathological features of B3 lesions associated with the risk of subsequent upgrade to malignancy.
Methods: We included consecutive vacuum-assisted biopsies (VABs) performed during 2011-2020 on suspicious microcalcifications not associated with other radiological signs diagnosed as B3 lesions and followed by surgical excision (SE) with definitive histological examination. Multiple logistic regression models were fitted to identify independent predictors of malignancy.
Results: Out of the 366 B3 lesions included, 56 (15.3 %, 95 % CI 11.8-19.4 %) had upgraded to malignancy at SE: of these, 42/366 (11.5 %, 95 % CI 8.4-15.2 %) and 14/366 (3.8 %, 95 % CI 2.1-6.3 %) were in situ and invasive carcinoma, respectively. At univariate analysis, variables positively associated with upgrade to malignancy were age ≥ 60 years (p = 0.008), mixed morphology (p = 0.018), scattered distribution (p = 0,001), extension of microcalcifications > 10 mm (p = 0.001), and mixed B3 lesion (p = 0.017). Among B3 subtypes, the highest rates of upgrade were observed for AIDEP, LCIS/LIN2, FEA + AIDEP, FEA + LCIS/LIN2, and FEA + AIDEP + LCIS/LIN2 (24.6 %, 21.4 %, 25.3 %, 20.0 % and 40.0 % respectively), while FEA and ALH/LIN1 had a lower rates of upgrade (7.5 % and 3.7 %, respectively). Multiple logistic regression analysis confirmed as risk factors older age (p = 0.029), larger extension (p = 0.001) and mixed morphology (p = 0.007) of microcalcifications, AIDEP (p = 0.011) among pure B3 lesions, and FEA + AIDEP (p = 0.001) and FEA + AIDEP + LCIS/LIN2 (p = 0.037) among mixed B3 lesions.
Conclusions: Based on our findings, vacuum-assisted excision is reasonable as definitive management for FEA and ALH/LIN1, while SE should remain the mainstay of treatment for AIDEP and LCIS/LIN2, whose upgrade rates are too high to safely recommend VAE.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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