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Bernini M, Spolveri F, Tofani L, De Benedetto D, Bicchierai G, Bellini C, Morrone D, Nori Cucchiari J, Bianchi S, Livi L, Orzalesi L, Meattini I. B3 Breast Lesions: Positive Predictive Value and Follow-Up on a Large Single-Institution Series. J Surg Res 2024; 299:366-373. [PMID: 38815523 DOI: 10.1016/j.jss.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
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.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Middle Aged
- Retrospective Studies
- Adult
- Aged
- Follow-Up Studies
- Biopsy, Large-Core Needle
- Predictive Value of Tests
- Mammography
- Breast/pathology
- Breast/diagnostic imaging
- Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Aged, 80 and over
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Affiliation(s)
- Marco Bernini
- Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Federico Spolveri
- Breast Surgery Division, Breast Unit, San Jacopo Hospital, Pistoia, Italy.
| | - Lorenzo Tofani
- Department of Statistic, Computer Science, Applications, University of Florence, Florence, Italy
| | | | - Giulia Bicchierai
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Chiara Bellini
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Doralba Morrone
- Diagnostic Senology Unit, Villa Donatello Clinic, Florence, Italy
| | | | - Simonetta Bianchi
- Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
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2
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Nicosia L, Mariano L, Pellegrino G, Ferrari F, Pesapane F, Bozzini AC, Frassoni S, Bagnardi V, Pupo D, Mazzarol G, De Camilli E, Sangalli C, Venturini M, Pizzamiglio M, Cassano E. Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention. Cancers (Basel) 2024; 16:837. [PMID: 38398228 PMCID: PMC10886664 DOI: 10.3390/cancers16040837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Luciano Mariano
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy;
| | - Federica Ferrari
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Davide Pupo
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Giovanni Mazzarol
- Division of Pathology, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (E.D.C.)
| | - Elisa De Camilli
- Division of Pathology, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (E.D.C.)
| | - Claudia Sangalli
- Data Management, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
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Yeow YJ, Yu CC, Cheung YC, Chen SC. A cohort study of mammography-guided vacuum-assisted breast biopsy in patients with compressed thin breasts (≦ 3 cm). Asian J Surg 2023; 46:4296-4301. [PMID: 37150735 DOI: 10.1016/j.asjsur.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVES In the women with compressed thin thickness (≦ 3 cm), mammographic guiding vacuum-assist breast biopsy (MG-VABB) is a technical challenge. We herein report their performance of MG-VABB on suspicious microcalcification by modern mammography. METHODS We retrospectively reviewed the consecutive MG-VABB in our hospital from February 2019 to January 2021. All the patients received biopsy because of suspicious microcalcifications discovered by mammography and had at least one-year post-biopsy follow-up. RESULTS We reviewed 745 consecutive patients revealing 195 with compressed thin breasts ≦ 3 cm (mean age: 50.12 ± 7.0; breast thickness: 24.99 mm range 11.6-30 mm). Of the 191 patients received biopsy, the microcalcification retrieval rate was 97.9%. Using the half-open notch biopsy or horizontal needle approach, the biopsies were technically achieved in 30.4% and 9.4% of patients respectively. Regarding to the gold standard of surgicohistology, the cancer sensitivities was 88.46% and the atypia upgrade rate was 16.67%. There was no statistical difference of the procedure time between stereotactic guided and tomosynthesis guided. CONCLUSIONS The modern MG-VABB has technically improve the performance of biopsy to the patients with compressed thin breasts (≦ 3 cm), revealing approximate results to those breasts > 3 cm. The diagnosis helps the management of suspicious microcalcifications discovered by mammography.
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Affiliation(s)
- Yun-Jen Yeow
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan; Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan.
| | - Shin-Cheh Chen
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
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Giambersio E, Depretto C, Trimboli RM, Di Leo G, D'Ascoli E, Della Pepa G, Irmici G, Rabiolo L, Scaperrotta GP. Utility of detection of breast calcifications with integrated real-time radiography system (IRRS) during digital breast tomosynthesis (DBT)-guided vacuum assisted biopsy (VAB): initial single-center experience. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01636-3. [PMID: 37115391 DOI: 10.1007/s11547-023-01636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To determine whether the presence of calcifications in specimens collected during stereotactic-guided vacuum-assisted breast biopsies (VABB) is sufficient to ascertain their adequacy for final diagnosis at pathology. MATERIALS AND METHODS Digital breast tomosynthesis (DBT)-guided VABBs were performed on 74 patients with calcifications as target. Each biopsy consisted of the collection of 12 samplings with a 9-gauge needle. This technique was integrated with a real-time radiography system (IRRS) which allowed the operator to determine whether calcifications were included in the specimens at the end of each of the 12 tissue collections through the acquisition of a radiograph of every sampling. Calcified and non-calcified specimens were separately sent to pathology and evaluated. RESULTS A total of 888 specimens were retrieved, 471 containing calcifications and 417 without. In 105 (22.2%) samples out of 471 with calcifications cancer was detected, while the remaining 366 (77.7%) were non-cancerous. Out of 417 specimens without calcifications 56 (13.4%) were cancerous, whereas 361 (86.5%) were non-cancerous. Seven hundred and twenty-seven specimens out of all 888 were cancer-free (81.8%, 95%CI 79-84%). CONCLUSION Although there is a statistical significative difference between calcified and non-calcified samples and the detection of cancer (p < 0.001), our study shows that the sole presence of calcifications in the specimens is not sufficient to determine their adequacy for final diagnosis at pathology because non-calcified samples can be cancerous and vice-versa. Ending biopsies when calcifications are first detected through IRRS could lead to false negative results.
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Affiliation(s)
- Emilia Giambersio
- Postgraduate School in Radiodiagnostics, Università degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Catherine Depretto
- Breast Imaging Unit, IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | | | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milan), Italy
| | - Elisa D'Ascoli
- Postgraduate School in Radiodiagnostics, Università degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Gianmarco Della Pepa
- Postgraduate School in Radiodiagnostics, Università degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giovanni Irmici
- Postgraduate School in Radiodiagnostics, Università degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lidia Rabiolo
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
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5
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Horvat JV. High-Risk Lesion Management. Semin Ultrasound CT MR 2023; 44:46-55. [PMID: 36792273 DOI: 10.1053/j.sult.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-risk lesions or lesions of uncertain malignant potential are frequent findings on image-guided needle biopsy of the breast and comprise a number of distinct entities. These lesions are known for having risk of underlying malignancy and are usually associated with an increased lifetime risk for breast cancer. Surgical excision was traditionally recommended for all high-risk lesions but recent studies have demonstrated that vacuum-assisted excision or surveillance may be adequate for some lesions. While management of high-risk lesion varies among institutions, this chapter describes the management recommendations based on recent literature of the most frequent types of lesions.
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Affiliation(s)
- Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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6
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The impact of vacuum-assisted excision in the management of indeterminate B3 lesions in the NHS Breast Screening Programme in England. Clin Radiol 2021; 76:470.e23-470.e29. [PMID: 33814122 DOI: 10.1016/j.crad.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
AIM To assess the impact of vacuum-assisted excision (VAE) on the management of B3 lesions in the England NHS Breast Screening Programme following an update of national guidance. A secondary aim was to investigate the histological features of malignancies resulting from upgrade of B3 lesions by either VAE or surgery. MATERIALS AND METHODS The study population was all women recalled for assessment after breast screening who had a wide-bore needle biopsy with a B3 result over the period 01/04/2018 to 31/03/2019. Data were extracted from the National Breast Screening Service (NBSS) computer system at unit level. Women with a B3 result were split into those with and without atypia. The upgrade rates and histological features of malignancies in the different groups were analysed. RESULTS In total, 2,234,514 women attended for screening between 1/4/218 and 31/3/2019, 84,559 women were referred to assessment, and of those 40,037 women had a core biopsy resulting in 3,355 were B3 lesions (8.38%). Within these, 556 cancers were diagnosed, giving an upgrade rate of 16.57% (556/3,355). The upgrade for B3 lesions with atypia was significantly higher than for B3 lesions without atypia (29.1% versus 13.3%, p<0.001). CONCLUSION The introduction of the new B3 guidelines has resulted in 73.8% of B3 lesions with atypia and 65.1% of B3 lesions with no atypia having VAE rather than surgery. The data highlights the importance of managing these indeterminate lesions appropriately with an overall upgrade rate of 16.57%.
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Huang YY, Park H, McLaren S, Thirunavukkarasu P, Lin JTW, Rajakaruna R, Dhillon R, Ponniah AK. B3 lesion upgrade rates in a tertiary Australian breast centre: a 8-year experience (2012-2019). ANZ J Surg 2020; 90:2521-2526. [PMID: 32969161 DOI: 10.1111/ans.16315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND B3 breast lesions identified on core needle biopsy have uncertain malignant potential. Traditional management of these lesions has been surgical excision, but there is growing interest in less invasive and more cost-effective alternatives such as vacuum-assisted excisional biopsy (VAEB). Determining the rate of malignant upgrade for B3 lesions is important as it may identify low-risk lesions where VAEB could be considered. METHODS A retrospective study was conducted of women undergoing an elective excisional biopsy for a B3 lesion identified on core needle biopsy at a tertiary Australian breast centre. The pre-operative biopsy diagnosis and subsequent excisional biopsy diagnosis were used to calculate the proportion of cases where the diagnosis was upgraded to malignancy. RESULTS A total of 299 eligible patients were identified. Pre-operative diagnosis of papillary lesion with atypia was associated with the highest upgrade rate (50%, n = 12). The next highest upgrade rates occurred in those with flat epithelial atypia (37.50%, n = 8); atypical ductal hyperplasia (24.71%, n = 85); lobular carcinoma in situ (LCIS)/atypical lobular hyperplasia with calcification (17.65%, n = 17); and papillary lesion without atypia (4.72%, n = 106). Patients with radial scar (n = 51), classical LCIS without calcification (n = 7) and mucocoele-like lesion (n = 8) had a 0% upgrade rate. CONCLUSION VAEB may be appropriate for low malignant risk lesions such as papillary lesion without atypia, mucocoele-like lesion and radial scar lesion without atypia. Open-surgical-excisional biopsy remains appropriate for high upgrade lesions such as atypical ductal hyperplasia, papillary lesion with atypia, flat epithelial atypia and classical LCIS with calcification. Long-term prospective randomized multicentre studies and continuing multidisciplinary approach is recommended for future clinical implementation.
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Affiliation(s)
- Yang Y Huang
- Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Hyerin Park
- Department of Surgery, The University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Sally McLaren
- Department of Anatomical Pathology, PathWest Laboratory Medical WA, Perth, Western Australia, Australia
| | - Palan Thirunavukkarasu
- Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Joshua T W Lin
- Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Ramela Rajakaruna
- Department of Anatomical Pathology, PathWest Laboratory Medical WA, Perth, Western Australia, Australia
| | - Ravinder Dhillon
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Ananda K Ponniah
- Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Elsharkawy M, Vestring T, Raatschen HJ. A ten-year, single-center experience: Concordance between breast core needle biopsy/vacuum-assisted biopsy and postoperative histopathology in B3 and B5a cases. PLoS One 2020; 15:e0233574. [PMID: 32437426 PMCID: PMC7241768 DOI: 10.1371/journal.pone.0233574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose To determine the concordance rate between core needle biopsy/vacuum-assisted biopsy (CNB/VAB) and postoperative histopathology in B3 (lesions of uncertain malignant potential) and B5a (in situ) lesions found on mammograms or ultrasound. Material and methods 2,029 consecutive biopsies performed over 10 years for patients who underwent mammograms or ultrasounds. For CNB 14G needle and for VAB 8G/10G needles were used. In all biopsies, we identified the age, BI-RADS®, histopathological biopsy results, B-category, nuclear grade for DCIS and postoperative histopathology results in B3 and B5a cases from the biopsy. Results The B-categories from CNB/VAB were as follows: B2 42.2 percent (n = 856), B3 4.5 percent (n = 91), B5a 5.7 percent (n = 115), and B5b 47.6 percent (n = 967). In the B3-category, 72/91 patients underwent surgical excision, with a concordance rate of 83.3 percent (n = 60/72) and a discordance rate of 16.7 percent (n = 12/72) to postoperative histopathology. From the discordant cases, 67.7 percent (n = 8/12) showed DCIS and 32.3 percent (n = 4/12) showed invasive breast cancer. The BIRADS of the discordant cases was 4b in 41.7 percent (n = 5/12) and 5 in 58.3 percent (n = 7/12). The PPVs for malignancy of B3 lesions were 0.21, with no statistical significance between subgroups. In the B5a-category, 101 of 115 patients underwent surgery in our hospital, with a concordance rate of 80.2 percent (n = 81/101) and a discordance rate of 19.8 percent (n = 20/101) to postoperative histopathology. From the discordant cases, 55 percent (n = 11/20) showed invasive breast carcinoma of no special type (NST). Conclusion Our concordance rate for B3 (83.3 percent) and B5a (80.2 percent) lesions in the biopsies to postoperative histopathology is matching to previously published literature. Surgical excision is our recommendation for lesions biopsied with a B3 category in the histopathology and a BIRADS category of (4b, 4c and 5). The PPVs for malignancy of B3 lesions showed no statistical significance between subgroups. Also, the nuclear grade of DCIS was not statistically significant in terms of upgrade into invasive breast cancer.
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Affiliation(s)
- Mohamed Elsharkawy
- Diagnostic and Interventional Radiology/Neuroradiology Department, Agaplesion Diakonieklinikum, Rotenburg Wuemme, Germany
- * E-mail:
| | - Thomas Vestring
- Diagnostic and Interventional Radiology/Neuroradiology Department, Agaplesion Diakonieklinikum, Rotenburg Wuemme, Germany
| | - Hans-Juergen Raatschen
- Diagnostic and Interventional Radiology Department, Hannover Medical School, Hanover, Germany
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9
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Nadrljanski MM, Milosevic ZC. Relative apparent diffusion coefficient (rADC) in breast lesions of uncertain malignant potential (B3 lesions) and pathologically proven breast carcinoma (B5 lesions) following breast biopsy. Eur J Radiol 2020; 124:108854. [PMID: 32007817 DOI: 10.1016/j.ejrad.2020.108854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/12/2020] [Accepted: 01/23/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess relative apparent diffusion coefficient (rADC) and ADC in B3 and B5 lesions in premenopausal female patients, added to standard morpho-dynamic breast contrast-enhanced MRI. METHODS 104 patients with histologically confirmed B3 (N1 = 52) and matched B5 lesions (N2 = 52), were examined on MRI (1.5 T, full diagnostic protocol, diffusion weighted imaging - b50, b850) in a retrospective analysis following the IRB approval: Atypical ductal hyperplasia (ADH, n1 = 20), Flat epithelial atypia (FEA, n2 = 11), Classic lobular neoplasia (CLN, n3 = 8), Papillary lesion (PL, n4 = 6) and Phyllodes tumor (PT, n5 = 7). rADC and ADC were computed for each lesion. The two-tailed Mann-Whitney U test was used for comparison with B5 lesions. RESULTS Mean rADC value for B3 lesions, (N1 = 52): 0.81+/-0.08 mm2/s x 10-3 and B5 lesions, (N2 = 52): 0.58+/-0.07 mm2/s x 10-3 is statistically different (p < 0.00001). Mean rADC values [mm2/s x 10-3], per entity in B3 are: ADH, 0.82+/-0.06; FEA, 0.75+/-0.03; CLN, 0.73+/-0.03; PL, 0.94+/-0.02; PT 0.86+/-0.05. CONCLUSIONS Although morpho-dynamic features of borderline and malignant lesions may overlap, the initial results in this research, suggest the highly significant difference in both ADC and rADC between B3 and B5 lesions. Larger trials are needed to confirm the initial data.
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Affiliation(s)
- Mirjan M Nadrljanski
- Institute of Oncology and Radiology of Serbia, Clinic for Radiology and Radiation Oncology, Dept. or Radiology, Dept. of Breast Imaging, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Zorica C Milosevic
- Institute of Oncology and Radiology of Serbia, Clinic for Radiology and Radiation Oncology, Dept. or Radiology, Dept. of Breast Imaging, School of Medicine, University of Belgrade, Belgrade, Serbia
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10
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Gašljević G, Hertl K, Gazić B, Lamovec J, Žgajnar J. Reducing indications for radial scar surgical excision in Slovenian breast cancer screening program. Ann Diagn Pathol 2019; 45:151438. [PMID: 31927469 DOI: 10.1016/j.anndiagpath.2019.151438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Management of the radial scar (RS)/complex sclerosing lesion (CSL) diagnosed by core needle biopsy (CNB) in breast cancer screening population (BCSP) is controversial due to its intrinsic malignant potential. We aimed to determine (i) the rate of upgrade of the RS/CSL to malignant lesions and (ii) radiological characteristics and CNB histopathological findings of the lesions related to the upgrade of the RS/CSL to malignant lesions after surgical excision in our BCSP. PATIENTS AND METHODS Database of Slovenian National Breast Cancer Screening Program was checked for terms RS/CSL in all patients who underwent CNB in the period 2008-2018. The ratios of upgrade from CNB RS/SCL to malignant lesions after surgical excision were calculated with specific interest to the radiological characteristics and the CNB patohistologically findings of the lesions. RESULTS Of 162 patients with diagnosis of RS/CSL on the CNB, 121/156 (78%) cases underwent surgical excision. 6 of 121 (5%) cases were upgraded to a malignant diagnosis in surgical specimen, 3 cases of invasive carcinoma and 3 cases of DCIS, respectively. Five of the upgraded cases (5/6, 83.3%) showed atypical epithelial proliferative lesions (AEPL) on CNB. In one upgraded case without AEPL the lesion presented as 33 mm architectural distortion with microcalcifications on the mammogram. CONCLUSIONS In BCSP setting RS/CSL without AEPL/papilloma and those measuring less than 2 cm in the largest diameter can be followed radiologically. Increasing the number of cores and adequate sampling of the periphery and the centre of the RS/CSL improves the pick-up rate of associated atypia/malignancy.
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Özçağlayan TİK, Gürdal SÖ, Öznur M, Özçağlayan Ö, Doğru M, Topçu B. Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions? Diagn Interv Radiol 2019; 25:428-434. [PMID: 31650964 PMCID: PMC6837293 DOI: 10.5152/dir.2019.18427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods. METHODS From July 2015 to December 2016, a total of 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed. RESULTS After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015). CONCLUSION BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.
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Affiliation(s)
- Tuğba İlkem Kurtoğlu Özçağlayan
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Sibel Özkan Gürdal
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Meltem Öznur
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Ömer Özçağlayan
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Mücahit Doğru
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Birol Topçu
- From the Departments of Radiology (T.İ.K.Ö. , Ö.Ö., M.D.), General Surgery (S.Ö.G.), Pathology (M.Ö.), Biostatistics (B.T.), Namık Kemal University School of Medicine, Tekirdağ, Turkey
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Pozzi G, Castellano I, D'Anna MR, De Matteis A, Milanesio L, Durando M, Ferrando PM, Bergamasco L, Ala A. B3-lesions of the breast: Risk of malignancy after vacuum-assisted breast biopsy versus core needle biopsy diagnosis. Breast J 2019; 25:1308-1309. [PMID: 31338958 DOI: 10.1111/tbj.13476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Giada Pozzi
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Rosa D'Anna
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Antonio De Matteis
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Luisella Milanesio
- Breast Screening Unit (Regional Reference Center), AOU Città della Salute e della Scienza, Turin, Italy
| | - Manuela Durando
- Radiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Pietro Maria Ferrando
- Plastic Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Laura Bergamasco
- Department of Medical and Surgical Sciences, Division of Statistics, AOU Città della Salute e della Scienza, Turin, Italy
| | - Ada Ala
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
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Santucci D, Faiella E, Calabrese A, Favale L, Zobel BB, de Felice C. Our Radiological Experience on B3 Lesions: Correlation Between Mammographic and MRI Findings With Histologic Definitive Result. Clin Breast Cancer 2019; 19:e643-e653. [PMID: 31377083 DOI: 10.1016/j.clbc.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate mammographic and magnetic resonance imaging (MRI) features in B3 lesions. PATIENTS AND METHODS From 2011 to 2018, 139 patients with histologically proven B3 lesions who underwent mammography or/and MRI, were retrospectively reviewed. B3 lesions were classified in: atypical ductal hyperplasia (ADH), lobular neoplasia (LN), papillary lesion (PL), radial scar (RS), flat epithelial atypia (FEA), phyllodes tumor (PT), or mesenchymal lesion. Imaging features evaluated were: the presence of microcalcifications, mass and architectural distortions on mammograms and type of margins (circumscribed, irregular, spiculate), enhancement (mass-like, non-mass-like), size (≤ 15 mm, > 15 mm), and kinetics curves (I, II, III) on MRI. The definitive histologic results confirmed benign lesion or were upgraded to malignancy, and the positive predictive value was calculated. RESULTS Histologic classification of B3 lesions counted 45 (32.37%) ADH, 12 (8.63%) LN, 25 (17.99%) PL, 5 (3.61%) RS, 31 (22.31%) FEA, 20 (14.39%) PT, and 1 (0.70%) mesenchymal lesion. One hundred seven patients had mammography, and 38 had MRI. In 90 (65%) cases, the histologic diagnosis confirmed B3, in 15 (11%) cases, benign lesion, and in 34 (24%) cases, malignancies were found, with best positive predictive value for mesenchymal tumor (1), ADH (0.36), and FEA (0.4). Significant correlations comparing core needle biopsy groups and microcalcifications (P = .016) and presence of mass (P = .002) and comparing definitive histology with the presence of mass (P = .023), were found. Regarding MRI, the morphology correlated with core needle biopsy groups (P = .038); morphology (P = .024), dimension (P = .040), and kinetic curve (P = .005) correlated with malignancy. CONCLUSIONS The B3 category includes different entities, with various risk of malignancy; their heterogeneity is associated with specific mammographic and MRI features, although further confirmations are needed.
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Affiliation(s)
- Domiziana Santucci
- Department of Radiology, University of Rome "Campus Bio-medico", Rome, Italy.
| | - Eliodoro Faiella
- Department of Radiology, University of Rome "Campus Bio-medico", Rome, Italy
| | | | - Luisa Favale
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | | | - Carlo de Felice
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
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Pre- and post-contrast versus post-contrast cone-beam breast CT: can we reduce radiation exposure while maintaining diagnostic accuracy? Eur Radiol 2018; 29:3141-3148. [PMID: 30488110 DOI: 10.1007/s00330-018-5854-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/27/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate whether post-contrast cone-beam breast CT (CBBCT) alone is comparable to the current standard of combined pre- and post-contrast CBBCT regarding diagnostic accuracy and superior regarding radiation exposure. MATERIAL AND METHODS This study included 49 women (61 breasts) with median age 57.9 years and BI-RADS 4/5 lesions diagnosed on mammography/ultrasound in density type c/d breasts. Two radiologists rated post-contrast CBBCT and pre- and post-contrast CBBCT with subtraction images on the BI-RADS scale separately for calculation of inter- and intra-observer agreement and in consensus for diagnostic accuracy assessment. Sensitivity, specificity, and area under the curve (AUC) were compared via McNemar test and DeLong method, respectively. Subtraction imaging misregistration were measured from 1 (no artifacts) to 4 (artifacts with width > 4 mm). RESULTS A total of 100 lesion (51 malignant; 6 high risk; 43 benign) were included. AUC, sensitivity, and specificity showed no significant differences comparing post-contrast CBBCT alone versus pre- and post-contrast CBBCT (AUC 0.84 vs. 0.83, p = 0.643; sensitivity 0.89 vs. 0.85, p = 0.158; specificity 0.73 vs. 0.76, p = 0.655). Inter- and intra-observer agreement was excellent (intra-class correlation coefficient ICC = 0.76, ICC = 0.83, respectively). Radiation dose was significantly lower for post-contrast CBBCT alone versus pre- and post-contrast CBBCT (median average glandular radiation dose 5.9 mGy vs. 11.7 mGy, p < 0.001). High-degree misregistrations were evident in the majority of subtraction images (level 1/2/3/4 16.9%/27.1%/16.9%/39%), in particular for bilateral exams (3.2%/29.2%/8.3%/58.3%). CONCLUSION Diagnostic accuracy of post-contrast CBBCT alone is comparable to pre- and post-contrast CBBCT in type c/d breasts, while yielding a significant twofold radiation dose reduction. KEY POINTS • The diagnostic accuracy of post-contrast CBBCT alone is comparable to dual acquisition of pre- and post-contrast CBBCT. • Acquisition of the post-contrast CBBCT scan alone reduces radiation exposure compared to pre- and post-contrast CBBCT, thus countering one of the main limitations of CBBCT. • High-degree misregistration artifacts limit the interpretation of subtraction images from pre- and post-contrast CBBCT studies.
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Hot S, Coşkun ZÜ, Akçakaya A, Bender Ö, Türkmen ÜA, Nayır PÖ, Sarı A, Hot AB. The breast lesion excision system procedure: An optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety. Saudi Med J 2018; 39:891-896. [PMID: 30251732 PMCID: PMC6201004 DOI: 10.15537/smj.2018.9.22573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety. Methods: A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyıl University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded. Results: All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed. Conclusion: The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.
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Affiliation(s)
- Semih Hot
- Department of Surgery, Okmeydanı Education Research Hospital, University of Health Science, Istanbul, Turkey. E-mail.
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Giuliani M, Rinaldi P, Rella R, D'Angelo A, Carlino G, Infante A, Romani M, Bufi E, Belli P, Manfredi R. A new risk stratification score for the management of ultrasound-detected B3 breast lesions. Breast J 2018; 24:965-970. [PMID: 30216597 DOI: 10.1111/tbj.13115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
To develop a predictive scoring system for ultrasound-detected B3 lesions at ultrasound-guided core needle biopsy (US-CNB). A total of 2724 consecutive US-CNBs performed in our Institution (January 2011 to December 2014) were retrospectively reviewed. Inclusion criteria were as follows: (a) histopathological examination of the entire lesion or (b) availability of radiologic follow-up (FUP) ≥24 months. Patient- and lesion-related variables-patients' age, lesion consistency, lesion size, vascularization, BI-RADS category, and US-CNB result-were analyzed. Positive predictive values (PPVs) for malignancy were calculated correlating US-CNB results with excision histology or FUP. A scoring system for underlying malignancy was developed using risk factors weighting. A total of 102 B3 lesions were included: 27 atypical ductal hyperplasia (26.5%), 5 lobular intraepithelial neoplasia (4.9%), 32 radial scar (31.4%), 37 papillary lesions (36.3%), and 1 fibroepithelial lesion (0.9%). Surgery was performed on 71/102 (69.6%) lesions, and 22/71 were malignant; the remaining 31/102 lesions (30.4%) were unchanged at FUP. The overall PPV for malignancy was 21.6%. Patients' age (odds ratio [OR] = 3.63, P = 0.008), lesion consistency (OR = 5.96, P = 0.001), BI-RADS category (OR = 17.52, P < 0.001), and CNB result (OR = 3.6, P = 0.008) were associated with a higher risk of malignancy underestimation and selected as risk factors in the score definition. Two risk groups were identified: low (0-2 points) and high risk (3-5 points), with significantly different risk of malignancy underestimation (8.0% vs 59.3%, P < 0.001). The proposed score helps to predict the risk of malignancy underestimation and choose the management of B3 lesions at US-CNB.
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Affiliation(s)
- Michela Giuliani
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierluigi Rinaldi
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Rossella Rella
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna D'Angelo
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgio Carlino
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Amato Infante
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Romani
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Enida Bufi
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Belli
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
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Bednarova I, Londero V, Linda A, Girometti R, Lorenzon M, Bednarova S, Zuiani C. Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia (B3a)? Radiol Med 2018; 123:809-817. [PMID: 29974332 DOI: 10.1007/s11547-018-0914-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate excision histology outcome of B3a lesions diagnosed at imaging-guided core biopsy and assess whether clinical and radiologic features may predict upgrade to malignancy. METHODS A total of 153 B3a lesions (74 papillomas, 51 radial scars and 28 fibro-epithelial lesions) that underwent surgical excision were assessed. PPV for malignancy in all B3a lesions and specific for each sub-category was evaluated. Multivariate analysis was conducted to identify association between clinical (age, family or personal history of breast cancer, symptoms), diagnostic findings (imaging modality, lesion size, final BI-RADS category) and final excision outcome. RESULTS Eleven (7%) of 153 B3a lesions were upgraded to malignancy. All carcinomas diagnosed on excision were non-high grade DCIS. Following features were significantly associated with malignancy: lesions identified only on mammography (3/21; 14%), both mammography and ultrasound (7/44; 16%), lesion size > 10 mm (10/74; 13.5%) and BI-RADS category 4-5 (8/29; 27.6%). The absence of residual microcalcification after biopsy was associated with decreased risk for malignancy (15/16[93.7%]; p = 0.0297). Lesion size > 10 mm (OR = 9.3832; 95%; p = 0.0398) and BI-RADS category 4-5 (OR = 12.6004; 95%; p = 0.0006) were found to be independent predictors of upgrade to malignancy. CONCLUSIONS B3a lesions are associated with low risk of malignancy at excision. Lesion size > 10 mm and BI-RADS 4-5 category may represent useful predictors of upgrade to malignancy.
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Affiliation(s)
- Iliana Bednarova
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy.
| | - Viviana Londero
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Anna Linda
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Rossano Girometti
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Michele Lorenzon
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Sandra Bednarova
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Chiara Zuiani
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
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Wienbeck S, Fischer U, Luftner-Nagel S, Lotz J, Uhlig J. Contrast-enhanced cone-beam breast-CT (CBBCT): clinical performance compared to mammography and MRI. Eur Radiol 2018; 28:3731-3741. [DOI: 10.1007/s00330-018-5376-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
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Uhlig J, Fischer U, Surov A, Lotz J, Wienbeck S. Contrast-enhanced cone-beam breast-CT: Analysis of optimal acquisition time for discrimination of breast lesion malignancy. Eur J Radiol 2018; 99:9-16. [DOI: 10.1016/j.ejrad.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/23/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
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20
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Menezes GL, Winter-Warnars GA, Koekenbier EL, Groen EJ, Verkooijen HM, Pijnappel RM. Simplifying Breast Imaging Reporting and Data System classification of mammograms with pure suspicious calcifications. J Med Screen 2017; 25:82-87. [PMID: 28691862 PMCID: PMC5956567 DOI: 10.1177/0969141317715281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To investigate the risk of malignancy following stereotactic breast biopsy of calcifications classified as Breast Imaging Reporting and Data System (BI-RADS) 3, 4, and 5. Methods The study included women with pure calcifications (not associated with masses or architectural distortions) who underwent stereotactic breast biopsy at the Dutch Cancer Institute between January 2011 and October 2013. Suspicious calcifications (Breast Imaging Reporting and Data System 3, 4, or 5) detected on mammography were biopsied. All lesions were assessed by breast radiologists and classified according to the BI-RADS lexicon. Results Overall, 473 patients underwent 497 stereotactic breast biopsies. Sixty-six percent (326/497) of calcifications were classified B4, 30% (148/497) B3, and 4% (23/497) B5. Of the 226 (45%) malignant lesions, there were 182 pure ductal carcinoma in situ, 22 mixed ductal carcinoma in situ and invasive carcinomas (ductal or lobular), 21 pure invasive carcinomas, and one angiosarcoma. Malignancy was found in 32% (95% confidence interval [CI] 0.24 to 0.39) of B3, 49% (95% CI 0.43 to 0.54) of B4, and 83% (95% CI 0.61 to 0.95) of B5 calcifications. Conclusions Considering the high predictive value for malignancy in B3 calcifications, we propose that these lesions should be classified as suspicious (B4), especially in a screening setting.
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Affiliation(s)
- Gisela Lg Menezes
- 1 Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Eva L Koekenbier
- 1 Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Emma J Groen
- 3 Department of Pathology, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Helena M Verkooijen
- 1 Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- 1 Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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Feasibility of Vacuum-Assisted Breast Cone-Beam CT-Guided Biopsy and Comparison With Prone Stereotactic Biopsy. AJR Am J Roentgenol 2017; 208:1154-1162. [PMID: 28199139 DOI: 10.2214/ajr.16.16760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The feasibility of breast vacuum-assisted biopsy (VAB) guided by cone-beam CT (CBCT) was assessed. The initial clinical performance of CT-guided breast VAB was compared with that of established prone stereotactic VAB. MATERIALS AND METHODS In this retrospective clinical trial, VABs were performed for women with mammographically suspicious breast lesions using a dedicated breast CBCT protocol. The technical success rate, total intervention time, and complications were documented and compared with examinations performed by prone stereotactic VAB. RESULTS Between June 2015 and March 2016, 65 patients with 68 target lesions underwent image-guided VAB. CT-guided VAB was performed for 29 patients with 31 lesions. Thirty-six patients with 37 lesions underwent prone stereotactic VAB. The type of lesion was not different between the two groups (p = 0.135). Technical success rate was achieved in 31 of 33 lesions (93.9%) with CT-guided VAB versus 37 of 38 lesions (97.4%) with prone stereotactic VAB. The mean (± SD) total intervention time was 22.7 ± 8.4 minutes for CT-guided VAB versus 28.8 ± 9.4 minutes for prone stereotactic VAB (p < 0.05). Reidentifying and targeting lesions took about the same time for both systems (p = 0.362). The time for tissue sampling was significantly faster with CT-guided VAB (p < 0.05). No major complications were observed with either system. CONCLUSION CT-guided VAB is safe and feasible using the currently available breast CBCT protocol. The mean total intervention time to complete VAB and the time for tissue sampling was significantly faster using CT-guided VAB in comparison with prone stereotactic VAB.
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