Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

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

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.

Diagnostic accuracy of the breast MRI Kaiser score in suspected architectural distortions and its comparison with mammography

Suspicious architectural distortion is an elusive finding in breast cancer diagnosis. This study aimed to evaluate the diagnostic accuracy of the Kaiser score for suspicious architectural distortions observed on mammography and compare it with the BI-RADS score of the lesion. Mammograms performed between January 2013 and March 2023 were retrospectively analyzed for the presence of suspicious architectural distortion. Forty-one patients, who had at least 1 year of radiological follow-up or pathology results, and underwent breast MRI, were included in the study. Mammography findings and the BI-RADS category of the lesion were assessed. MRI findings were evaluated and Kaiser scoring was performed according to the tree flowchart. Ninety-one percent of the enhanced lesions had a Kaiser score of 5 and above. In the diagnosis of malignancy, the Kaiser score yielded an accuracy of 75.61% (AUC 0.833). A statistically significant correlation was observed indicating that a malignant diagnosis was more prevalent in patients with a Kaiser score of 5 and above (p < 0.05). Additionally statistically significant relationship was also observed between the BI-RADS category of architectural distortions on mammography and the Kaiser score (p = 0.007). The combined utilization of mammography findings and the evidence-based Kaiser score in suspected architectural distortions provides more accurate results in the differential diagnosis of breast cancer.