Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia (B3a)?
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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.
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.
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.
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.
KeywordsB3a lesions Core biopsy Excisional biopsy Positive predictive value Breast cancer
The authors state that this work has not received any funding.
Compliance with ethical standards
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
The scientific guarantor of this publication is Chiara Zuiani.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained with waiver of patient informed consent.
This is a retrospective, observational study, performed at one institution.
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