Mayer Sebastian, Kayser Gian, Rücker Gerta, Bögner Diana, Hirschfeld Marc, Hug Christiane, Stickeler Elmar, Gitsch Gerald, Erbes Thalia
Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
Institute of Surgical Pathology, Department of Pathology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
Breast. 2017 Feb;31:144-149. doi: 10.1016/j.breast.2016.11.007. Epub 2016 Nov 17.
Lesions of uncertain malignant potential (B3) represent a heterogeneous group with an overall risk for malignancy of 9.85-35.1% after total resection. Positive predictive values (PPV) for malignancy vary depending on B3 subtype. The aim of this study was to evaluate the PPV for malignancy in B3 lesions and to determine the clinical significance of atypia-dependent sub-classification (a = without epithelial atypia; b = with epithelial atypia) of B3 into B3a and B3b and papillary lesions (PL) in PLa and PLb.
219 patients with histopathologically proven B3 lesions on core needle/vacuum-assisted biopsy who subsequently underwent diagnostic excision biopsy were included in this study. PPVs for malignancy were reported for B3 in general and all B3 sub-categories. Logistic regression analysis identified associations between B3-subgroups and outcome after excision biopsy as well as the impact of clinical and diagnostic findings on excision diagnosis.
The overall PPV rate was 10.0% (22/219). Excision histology exhibited a higher malignancy rate in PLb (2/7; PPV: 28.6%) than in PLa (6/127; PPV: 4.7%) (p = 0.057) and in B3b (12/50; PPV: 24.0%) compared to B3a category (8/165; PPV: 4.8%) (p < 0.001).
These findings support the necessity of B3 lesion sub-classification into B3a and B3b and of PL into PLa and PLb when considering epithelial atypia. The determination of atypia status represents a relevant factor in risk-stratification for clinical management of B3 lesions. Should future studies using the sub-classification of PL confirm these results, observation may be a safe option for the clinical management of patients with asymptomatic PLa lesions.
具有不确定恶性潜能的病变（B3）是一组异质性病变，全切术后总体恶变风险为9.85%-35.1%。其恶变的阳性预测值（PPV）因B3亚型而异。本研究旨在评估B3病变恶变的PPV，并确定依据非典型性将B3分为B3a和B3b以及将乳头状病变（PL）分为PLa和PLb的临床意义（a = 无上皮异型性；b = 有上皮异型性）。
本研究纳入了219例经粗针/真空辅助活检组织病理学证实为B3病变且随后接受诊断性切除活检的患者。报告了B3总体及所有B3亚类的恶变PPV。逻辑回归分析确定了B3亚组与切除活检结果之间的关联，以及临床和诊断结果对切除诊断的影响。
总体PPV率为10.0%（22/219）。切除组织学显示，PLb的恶变率（2/7；PPV：28.6%）高于PLa（6/127；PPV：4.7%）（p = 0.057），且B3b的恶变率（12/50；PPV：24.0%）高于B3a类（8/165；PPV：4.8%）（p < 0.001）。
这些发现支持在考虑上皮异型性时，将B3病变分为B3a和B3b以及将PL分为PLa和PLb的必要性。非典型性状态的确定是B3病变临床管理风险分层的一个相关因素。如果未来使用PL亚分类的研究证实这些结果，观察可能是无症状PLa病变患者临床管理的一个安全选择。
