Indeterminate (B3) Breast Lesions and the Ongoing Role of Diagnostic Open Biopsy.

IF 1.6 Q4 ONCOLOGY International Journal of Breast Cancer Pub Date : 2021-12-27 eCollection Date: 2021-01-01 DOI:10.1155/2021/5555458
Elizabeth Tan, Asiri Arachchi, Michael Cheng, Darren Lockie
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引用次数: 1

Abstract

Introduction: Due to their uncertain malignant potential, indeterminate breast lesions on core needle biopsy (CNB) require diagnostic open biopsy (DOB). This study evaluated DOB results given largely benign pathology. Lesions included are atypical papilloma, atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and radial scar/complex sclerosing lesions (RS/CSL). Methodology. A retrospective audit from 2010 to 2017 analysed patients with a screen-detected suspicious lesion and indeterminate (B3) CNB diagnosis. Primary outcome was the malignancy upgrade rate, with secondary evaluation of patient factors predictive of malignancy including age, symptoms, mammogram characteristics, lesion size, biopsy method, and past and family history.

Results: 152 patients (median age 57 years) were included, with atypical papillomas being the largest subgroup (44.7%). On DOB histology, 99.34% were benign, resulting in a 0.66% malignancy upgrade rate. Patient characteristic analysis identified 86.84% of B3 lesions were in patients greater than 50 years old. 90.13% were asymptomatic, whilst 98.68% and 72.37% had a negative past and family history. Majority 46.71% of lesions had the mammogram characteristic of being a mass. However, with 57.89% of the lesion imaging size less than 4 mm, a corresponding 60.5% of core needle biopsies were performed stereotactically. The small malignant subgroup limited predictive factor evaluation.

Conclusion: Albeit a low 0.66% malignancy upgrade rate in B3 lesions, no statistically significant patient predictive factors were identified. Until predictive factors and further assessment of vacuum-assisted excision (VAE) techniques evolve, DOB remains the standard of care.

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不确定(B3)乳腺病变和开放性活检诊断的持续作用。
导读:由于不确定的恶性潜能,核心穿刺活检(CNB)的不确定乳腺病变需要诊断性开放活检(DOB)。本研究评估了DOB结果,主要是良性病理。病变包括不典型乳头状瘤、不典型导管增生(ADH)、不典型小叶增生(ALH)和放射状疤痕/复杂硬化病变(RS/CSL)。方法。2010年至2017年的回顾性审计分析了筛查发现的可疑病变和不确定(B3) CNB诊断的患者。主要预后指标为恶性肿瘤升级率,对预测恶性肿瘤的患者因素进行二次评估,包括年龄、症状、乳房x光片特征、病变大小、活检方法、既往史和家族史。结果:纳入152例患者(中位年龄57岁),非典型乳头状瘤是最大的亚组(44.7%)。在DOB组织学上,99.34%为良性,恶性升级率0.66%。患者特征分析发现86.84%的B3病变发生在年龄大于50岁的患者中。无症状者占90.13%,既往史和家族史阴性者占98.68%和72.37%。46.71%的病变具有肿块特征。然而,由于57.89%的病变成像尺寸小于4 mm,相应的60.5%的核心针活检是立体定向进行的。小的恶性亚组限制了预测因素的评估。结论:虽然B3病变的恶性升级率为0.66%,但没有发现具有统计学意义的患者预测因素。直到预测因素和进一步评估真空辅助切除(VAE)技术的发展,DOB仍然是标准的护理。
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来源期刊
CiteScore
3.40
自引率
0.00%
发文量
25
审稿时长
19 weeks
期刊介绍: International Journal of Breast Cancer is a peer-reviewed, Open Access journal that provides a forum for scientists, clinicians, and health care professionals working in breast cancer research and management. The journal publishes original research articles, review articles, and clinical studies related to molecular pathology, genomics, genetic predisposition, screening and diagnosis, disease markers, drug sensitivity and resistance, as well as novel therapies, with a specific focus on molecular targeted agents and immune therapies.
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