B3 Breast Lesions: Positive Predictive Value and Follow-Up on a Large Single-Institution Series.

Autor: Bernini M; Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy., Spolveri F; Breast Surgery Division, Breast Unit, San Jacopo Hospital, Pistoia, Italy. Electronic address: federico.spolveri@icloud.com., Tofani L; Department of Statistic, Computer Science, Applications, University of Florence, Florence, Italy., De Benedetto D; Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy., Bicchierai G; Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy., Bellini C; Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy., Morrone D; Diagnostic Senology Unit, Villa Donatello Clinic, Florence, Italy., Nori Cucchiari J; Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy., Bianchi S; Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy., Livi L; Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy., Orzalesi L; Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy., Meattini I; Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Jul; Vol. 299, pp. 366-373. Date of Electronic Publication: 2024 May 29.
DOI: 10.1016/j.jss.2024.04.057
Abstrakt: Introduction: Lesions of uncertain malignant potential (B3) represent 10% of core needle biopsies (CNBs) or vacuum-assisted breast biopsies (VABBs). Traditionally, B3 lesions are operated on. This study investigated the association between B3 subtypes and malignancy to determine the best management.
Methods: Pre- and postoperative histological reports from 226 patients, who had undergone excisional surgery for B3 lesions, following CNB or VABB, were retrospectively analyzed. The correlation between the CNB/VABB diagnosis and the final pathology was investigated, along with the correlation between malignancy upgrade and the type of mammographic lesion. The positive predictive value (PPV) of malignancy of B3 lesions was calculated by simple logistic regression. Patients without cancer diagnosis underwent a 7-y follow-up.
Results: Pathology showed 171 (75.6%) benign and 55 (24.3%) malignant lesions. The PPV was 24.3% (P = 0.043), including 31 (13.7%) ductal carcinomas in situ and 24 (10.6%) invasive carcinomas. The most frequently upgraded lesions were atypical ductal hyperplasia, 34.2% (P = 0.004), followed by lobular intraepithelial neoplasia, 27.5% (P = 0.025). The median diameter of mammographic lesions was 1.5 [0.9-2.5] cm, while for surgical specimens, it was 5 [4-7] cm (P < 0.0001). Mammographic findings and histology showed a significant correlation (P = 0.038). After a 7-y follow-up, 15 (8.9%) patients developed carcinoma, and 7 patients (4%) developed a new B3 lesion.
Conclusions: We can conclude that atypical ductal hyperplasia and lobular intraepithelial neoplasia still require surgery for a significant PPV. Other types that lacked significance or confidence intervals were too wide to draw any conclusion.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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