Department of Gynaecology and Obstetrics, Breast Unit, Klinikum Frankfurt (Oder), Müllroser Chaussee 7, 15236, Frankfurt (Oder), Germany.
Mammography Screening Unit Brandenburg Sued, Thiemstrasse 112, 03050, Cottbus, Germany.
BMC Cancer. 2018 Aug 16;18(1):829. doi: 10.1186/s12885-018-4742-6.
Core needle biopsy (CNB) is a standard diagnostic procedure in the setting of breast cancer screening. However, CNB may result in the borderline diagnoses of lesion of uncertain malignant potential (B3). The aim of this study was to access the outcome of lesions diagnosed as B3 category in a large series of screen-detected cases to evaluate the rates of malignancy for the different histological subtypes.
We identified all CNBs over a six-year period (2009-2015) in a breast cancer screening unit in Germany. A total of 8.388 CNB's were performed for screen detected breast lesions. B3 diagnosis comprised 4.5% (376/8.388). Of the 376 patients who were diagnosed as B3, 299 underwent subsequent excision biopsy with final excision histology.
Out of 376 patients diagnosed with B3 lesions, the prevalence of different histopathology showed 161 (42.8%) patients with atypical ductal hyperplasia (ADH), 98 (26.1%) with flat epithelial atypia (FEA), 50 women (13.3%) showed lobular neoplasia (LN), in 40 (10.6%) patients papillary findings and in 27 patients (7.2%) a radial scar complex. Final excision histology was benign in 74% (221/299) and malignant in 26% (78/299) of the patients. Lesion specific positive predictive values (PPV) for a subsequent diagnosis of in situ or invasive carcinoma were as follows: ADH 40%, FEA 20.5%, papillary lesion 13.5%, radial scar 16.6%, LN 0%.
Our results show that approximately one-third of core needle biopsies of screen detected breast lesions classified as B3 are premalignant or malignant on excision. Lesions of uncertain malignant potential of the breast (B3) are heterogeneous in respect to risk of malignancy.
在乳腺癌筛查中，核心针活检（CNB）是一种标准的诊断程序。然而，CNB 可能导致边界诊断为不确定恶性潜能的病变（B3）。本研究的目的是评估在大型筛查病例系列中诊断为 B3 类别的病变的结果，以评估不同组织学亚型的恶性肿瘤发生率。
我们在德国的一个乳腺癌筛查单位确定了在六年期间（2009-2015 年）进行的所有 CNB。总共对 8388 例筛查发现的乳腺病变进行了 CNB。B3 诊断占 4.5%（376/8388）。在被诊断为 B3 的 376 名患者中，有 299 名患者接受了随后的切除活检，最终切除组织学。
在被诊断为 B3 病变的 376 名患者中，不同组织病理学的患病率显示，161 名患者（42.8%）患有不典型导管增生（ADH），98 名患者（26.1%）患有扁平上皮不典型性（FEA），50 名患者（13.3%）显示小叶肿瘤（LN），40 名患者（10.6%）有乳头状发现，27 名患者（7.2%）有放射状瘢痕复合物。在 299 名患者中，最终切除组织学为良性的患者占 74%（221/299），恶性的患者占 26%（78/299）。随后诊断为原位或浸润性癌的病变特异性阳性预测值（PPV）如下：ADH 为 40%，FEA 为 20.5%，乳头状病变为 13.5%，放射状瘢痕为 16.6%，LN 为 0%。
我们的结果表明，在筛查发现的乳腺病变中，约三分之一的核心针活检被分类为 B3 的病变在切除时为前恶性或恶性。乳腺不确定恶性潜能的病变（B3）在恶性肿瘤风险方面存在异质性。
