Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy including detailed review of epithelial atypia

Emad A Rakha (1) , Bernard Chi-Shern Ho (2) , Veena K Naik (3) , Soumadri Sen (1) , Lisa Hamilton (4) , Zsolt Hodi (1) , Ian Ellis (5) , Andrew Hs Lee (6)

1 Histopathology
2 Pathology
3 Histopathology
4 Breast Institute
5 Histopathology
6 Histopathology Department

Aim: To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia. Methods and results: 149 B3 and 26 B4 NCB diagnosed over a 2 year period (2007-2008) were compared to those diagnosed over a previous 2 year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5% and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs from 100% for suspicious of DCIS, to 40% for atypical ductal hyperplasia categorised as B3, and 14% for isolated flat epithelial atypia. Conclusion: The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations.

Mots clés: Medicine

Emad A Rakha, Bernard Chi-Shern Ho, Veena K Naik, Soumadri Sen, Lisa Hamilton, et al.. Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy including detailed review of epithelial atypia. Histopathology, 2011, 58 (4), pp.626. ⟨10.1111/j.1365-2559.2011.03786.x⟩. ⟨hal-00618803⟩