Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
Department of Clinical Pathology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
Eur J Radiol. 2021 Feb;135:109479. doi: 10.1016/j.ejrad.2020.109479. Epub 2020 Dec 14.
To investigate a risk stratification strategy for lesions of uncertain malignant potential (B3) diagnosed by vacuum-assisted breast biopsy (VABB) of mammographic microcalcifications.
Patients who underwent VABB for microcalcification-only lesions with a diagnosis of B3 and subsequent surgery were included in this retrospective, IRB-approved study. Seventy-six B3-lesions (final histology: 66 benign, 10 malignant) were included (Tr). Data on B3 lesion type and presence of atypia, microcalcification characteristics (BI-RADS), removal at biopsy and concomitant lesions were collected. After univariate analysis (Chi-square test), data were combined into a risk stratification algorithm by using a ten-fold, cross-validated Classification and Regression Tree analysis (CRT). The algorithm was tested on a testing dataset (Te) of 23 B3-lesions (six malignant, 17 benign).
Malignancy was more frequent in women with a concomitant cancer (P < 0.001) and highly suspicious microcalcifications (P < 0.001). The CRT algorithm retained three characteristics: morphology; presence of atypia; presence of concomitant cancer. The algorithm identified 25/76 (32.9 %,Tr) and 6/23 (26.1 %,Te) lesions at low risk of malignancy. No malignant cases were identified at surgery (0/31). There were 3/76 (3.9 %,Tr) and 1/23 (4.3 %,Te) lesions assigned as high-risk by the algorithm and confirmed at surgery (4/4). In the remaining lesions (48/76, 63.1 %,Tr; 16/23, 69.6 %,Te), malignancy rates varied between 9% and 88.4 %; thus, surgery could not have been avoided.
We constructed and tested a risk stratification algorithm for B3 microcalcifications, including clinical, imaging, and pathological features, to assign probabilities of malignancy, which has the potential to reduce unnecessary surgeries.
探讨一种用于真空辅助乳腺活检（VABB）诊断的乳腺微钙化不定恶性潜能病变（B3）的风险分层策略。
本回顾性研究经机构审查委员会批准，纳入了接受 VABB 治疗且微钙化病变仅为 B3 诊断、随后行手术治疗的患者。共纳入 76 例 B3 病变（最终组织学：66 例良性，10 例恶性）（Tr）。收集了 B3 病变类型和存在不典型性、微钙化特征（BI-RADS）、活检时切除和同时存在病变的资料。进行单变量分析（卡方检验）后，使用 10 倍交叉验证分类和回归树分析（CRT）将数据合并为风险分层算法。该算法在 23 例 B3 病变（6 例恶性，17 例良性）的测试数据集（Te）上进行了测试。
同时存在癌症的女性中，恶性肿瘤更常见（P<0.001），高度可疑的微钙化也更常见（P<0.001）。CRT 算法保留了三个特征：形态；存在不典型性；同时存在癌症。该算法识别出 76 例中的 25 例（32.9%，Tr）和 23 例中的 6 例（26.1%，Te）低恶性风险病变。手术中未发现恶性病例（31 例中 0 例）。算法将 3 例（3.9%，Tr）和 1 例（4.3%，Te）高风险病变诊断为高危，并在手术中得到证实（4/4）。在剩余的病变（48/76，63.1%，Tr；16/23，69.6%，Te）中，恶性率在 9%至 88.4%之间变化；因此，手术无法避免。
我们构建并测试了一种用于 B3 微钙化的风险分层算法，包括临床、影像学和病理学特征，以确定恶性肿瘤的可能性，这有可能减少不必要的手术。
