Orsaria Paolo, Grasso Antonella, Carino Rita, Caredda Emanuele, Sammarra Matteo, Altomare Carlo, Rabitti Carla, Gullotta Gabriella, Perrone Giuseppe, Pantano Francesco, Buonomo Oreste Claudio, Altomare Vittorio
Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy.
Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.
Tumori. 2020 Apr;106(2):115-125. doi: 10.1177/0300891619868301. Epub 2019 Aug 27.
Most cases of breast lesions of uncertain malignant potential (B3) undergo surgical intervention. We aimed to analyze the outcome of B3 lesion subtypes in a large series of screen-detected cases.
We screened 2,986 core needle biopsies to classify B3 lesions. Positive predictive values (PPVs) for malignancy were calculated for a comprehensive risk characterization according to clinicopathologic and morphologic variables.
B3 lesions comprised 35% atypical ductal hyperplasia (PPV = 20%), 16.7% flat epithelial atypia (PPV = 12%), 22.7% lobular neoplasia (PPV = 16.2%), 9% papillary lesion (PPV = 18.5%), 8.6% phyllodes tumor (PPV = 3.8%), and 8% radial scars (PPV = 4.1%) based on histopathologic diagnosis. Upgrade rates were 15.9% for calcifications, 13.7% for mass lesions, and 16.7% for architectural deformities, with 8.3% of malignant lesions classified as ductal carcinoma in situ and 6.7% as invasive cancers (PPV = 15%).
B3 lesions entail a heterogeneous risk of malignancy, and careful radiologic-pathologic correlation is required for optimal treatment.
大多数恶性潜能不确定的乳腺病变（B3）病例都接受了手术干预。我们旨在分析一系列筛查发现病例中B3病变亚型的结果。
我们对2986例粗针活检进行筛查，以对B3病变进行分类。根据临床病理和形态学变量计算恶性肿瘤的阳性预测值（PPV），以进行全面的风险特征描述。
根据组织病理学诊断，B3病变包括35%的非典型导管增生（PPV = 20%）、16.7%的扁平上皮不典型增生（PPV = 12%）、22.7%的小叶肿瘤（PPV = 16.2%）、9%的乳头状病变（PPV = 18.5%）、8.6%的叶状肿瘤（PPV = 3.8%）和8%的放射状瘢痕（PPV = 4.1%）。钙化的升级率为15.9%，肿块病变为13.7%，结构异常为16.7%，8.3%的恶性病变分类为导管原位癌，6.7%为浸润性癌（PPV = 15%）。
B3病变具有异质性的恶性风险，为实现最佳治疗，需要仔细的放射学-病理学相关性分析。
