Institute of Pathology, Universitätsmedizin Charité Berlin, 10117 Berlin, Germany.
Hum Pathol. 2010 Apr;41(4):522-7. doi: 10.1016/j.humpath.2009.09.005. Epub 2009 Dec 11.
The biological behavior and the optimal management of benign breast lesions with uncertain malignant potential, the so-called B3 lesions, found in breast needle core biopsies is still under debate. We addressed this study to compare histologic findings in B3 needle core biopsies with final excision specimens to determine associated rates of malignancy. Consecutive needle core biopsies were performed in a 3-year period (January 1, 2006-December 31, 2008). Biopsies were image-guided (31 by ultrasound, 85 stereotactic vacuum-assisted, 6 unknown) for evaluation of breast abnormalities. We reviewed 122 needle core biopsies with B3 lesions of 91 symptomatic patients and 31 screen-detected women and compared the B3 histologic subtypes with the final excision histology. A total of 1845 needle core biopsies were performed and B3 lesions comprised 6.6% of all B categories. The most common histologic subtype in biopsies was flat epithelia atypia in 35.2%, followed by papillary lesions in 21% and atypical ductal hyperplasia in 20%. Reports on excision specimens were available in 66% (81 patients). Final excision histology was benign in 73 (90.2%) and malignant in 8 (9.8%) patients (2 invasive cancer, 6 ductal carcinoma in situ). Of all B3 subtypes, atypical ductal hyperplasia and flat epithelial atypia were associated with malignancy, whereas only atypical ductal hyperplasia was accompanied by invasive cancer. Of all lesions, flat epithelial atypia was most frequently found in excision specimens (18%). In our study, flat epithelial atypia and atypical ductal hyperplasia are common lesions of the B3 category in needle core biopsies of the breast. Both lesions are associated with malignancy, whereas only atypical ductal hyperplasia was related to invasive cancer. We conclude that an excision biopsy after diagnosis of flat epithelial atypia is recommended depending on clinical and radiologic findings.
在乳腺针芯活检中发现的具有不确定恶性潜能的良性乳腺病变，即所谓的 B3 病变，其生物学行为和最佳治疗方法仍存在争议。我们进行这项研究是为了比较 B3 针芯活检和最终切除标本的组织学发现，以确定相关的恶性肿瘤发生率。在 3 年期间（2006 年 1 月 1 日至 2008 年 12 月 31 日）连续进行了针芯活检。这些活检是为了评估乳腺异常而进行的影像引导（31 次超声引导，85 次立体定向真空辅助，6 次未知）。我们回顾了 91 例有症状患者和 31 例筛查发现的妇女的 122 例 B3 病变针芯活检，并将 B3 组织学亚型与最终切除组织学进行了比较。总共进行了 1845 次针芯活检，B3 病变占所有 B 类的 6.6%。活检中最常见的组织学亚型是 35.2%的扁平上皮异型，其次是 21%的乳头状病变和 20%的非典型导管增生。有 66%（81 例）可获得切除标本的报告。最终切除组织学在 73 例（90.2%）患者中为良性，在 8 例（9.8%）患者中为恶性（2 例浸润性癌，6 例导管原位癌）。在所有 B3 亚型中，非典型导管增生和扁平上皮异型与恶性肿瘤相关，而只有非典型导管增生伴有浸润性癌。在所有病变中，扁平上皮异型在切除标本中最常见（18%）。在我们的研究中，扁平上皮异型和非典型导管增生是乳腺针芯活检中 B3 类常见病变。这两种病变都与恶性肿瘤相关，而只有非典型导管增生与浸润性癌有关。我们的结论是，根据临床和影像学表现，建议在诊断为扁平上皮异型后进行切除活检。
