Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Breast Cancer Reports
Published in: Current Breast Cancer Reports 2/2019

Open Access 01-06-2019 | Lesion of Uncertain Malignant Potential in the Breast | Breast Cancer Imaging and Screening (N Sharma, Section Editor)

Management of B3 Lesions—Practical Issues

Authors: Abeer M. Shaaban, Nisha Sharma

Published in: Current Breast Cancer Reports | Issue 2/2019

Login to get access

Abstract

Purpose of the Review

Breast lesions of uncertain malignant potential (B3) are a heterogeneous group of diagnostic entities that can be associated with atypia. These are associated with in situ or invasive malignancy in 20–30% of cases. The management of those lesions has been both controversial and challenging for the multidisciplinary teams.

Recent Findings

This is an up-to-date review of the current International Consensus on the management of B3 lesions with emphasis on the practical considerations.

Summary

Through multidisciplinary management pathways, the vast majority of B3 lesions should be managed by vacuum-assisted excision, rather than surgical excision. Exceptions to this pathway and the rationale for surgical excision are discussed.
Literature
1.
Abdel-Fatah TM, Powe DG, Hodi Z, Reis-Filho JS, Lee AH, Ellis IO. Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol. 2008;32(4):513–23.CrossRef
2.
El-Sayed ME, Rakha EA, Reed J, Lee AH, Evans AJ, Ellis IO. Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology. 2008;53(6):650–7.CrossRef
3.
Richter-Ehrenstein C, Maak K, Roger S, Ehrenstein T. Lesions of “uncertain malignant potential” in the breast (B3) identified with mammography screening. BMC Cancer. 2018;18(1):829.CrossRef
4.
Bianchi S, Caini S, Renne G, Cassano E, Ambrogetti D, Cattani MG, et al. Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast. 2011;20(3):264–70.CrossRef
5.
Saladin C, Haueisen H, Kampmann G, Oehlschlegel C, Seifert B, Rageth L, et al. Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in Switzerland and recommended further management. Acta Radiol. 2016;57(7):815–21.CrossRef
6.
Mooney KL, Bassett LW, Apple SK. Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 2016;29(12):1471–84.CrossRef
7.
Rakha EA, Ahmed MA, Aleskandarany MA, Hodi Z, Lee AH, Pinder SE, et al. Diagnostic concordance of breast pathologists: lessons from the National Health Service Breast Screening Programme Pathology External Quality Assurance Scheme. Histopathology. 2017;70(4):632–42.CrossRef
8.
O’Malley FP, Mohsin SK, Badve S, Bose S, Collins LC, Ennis M, et al. Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast. Mod Pathol. 2006;19(2):172–9.CrossRef
9.
• Strachan C, Horgan K, Millican-Slater RA, Shaaban AM, Sharma N. Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice? J Clin Pathol. 2016;69(3):248–54 A large UK screen detected B3 series reporting on a 5-year follow-up of the vacuum-assisted excision pathway in the management of B3 lesions including the upgrade rate on VAE and providing real-life evidence supporting implementing this multidisciplinary pathway. CrossRef
10.
Nguyen CV, Albarracin CT, Whitman GJ, Lopez A, Sneige N. Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision. Ann Surg Oncol. 2011;18(3):752–61.CrossRef
11.
Rakha EA, Ho BC, Naik V, Sen S, Hamilton LJ, Hodi Z, 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):626–32.CrossRef
12.
Renshaw AA, Gould EW. Long term clinical follow-up of atypical ductal hyperplasia and lobular carcinoma in situ in breast core needle biopsies. Pathology. 2016;48(1):25–9.CrossRef
13.
Mayer S, Kayser G, Rucker G, Bogner D, Hirschfeld M, Hug C, et al. Absence of epithelial atypia in B3-lesions of the breast is associated with decreased risk for malignancy. Breast. 2017;31:144–9.CrossRef
14.
Eusebi V, Feudale e FMP, Micheli A, Conti A, Riva C, et al. Long-term follow-up of in situ carcinoma of the breast. Sem Diagn Pathol. 1994;11(3):223–35.
15.
Bennett IC. The changing role of vacuum-assisted biopsy of the breast: a new prototype of minimally invasive breast surgery. Clinical Breast Cancer. 2017;17(5):323–5.CrossRef
16.
Rageth CJ, O’Flynn EA, Comstock C, Kurtz C, Kubik R, Madjar H, et al. First iInternational Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016;159(2):203–13.CrossRef
17.
•• Rageth CJ, O’Flynn EAM, Pinker K, Kubik-Huch RA, Mundinger A, Decker T, et al. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast cancer research and treatment. 2018.The second, recently poublished, consensus supports the recommendations of the first consensus. ADH and phyllodes tumours are managed by surgical excisions. Minimally invasive breast biopsies via VAB are recommended for all other B3 lesions . More frequent imaging surveillance particularly for lobular neoplasia.
18.
Programme. NBS. Clinical guidance for breast cancer screening assessment. NHSBSP publication number 49. 2016;Fourth edition.
19.
•• Pinder SE, Shaaban A, Deb R, Desai A, Gandhi A, Lee AHS, et al. NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol. 2018;73(8):682–692. These are the current comprehensive B3 pathology guidelines produced by the NHSBSP B3 Writing Group. The paper provided an overview of the diagnostic criteria and management recommendations of B3 catregoris, lesion by lesion, including diagramatic representation of the management pathways within a multidicplinary framework. VAE is recommended for further sampling of all B3 lesions diagnosed on conventional core or VAB in all categories except: papilloma with atypia, cellular fibroepithelial lesions, B3 spindle cell lesions, vascular lesions and other rare lesions such as myofibroblastomas and apocrine adenosis. The document provides guidance on the adequate weight of VAE samples (4 g) and the approximate number of cores required depending on needle gauge and make of the vacuum-assisted device.
20.
Calhoun BC. Core needle biopsy of the breast: an evaluation of contemporary data. Surg Pathol Clin 2018;11(1):1–16, 1.CrossRef
21.
•• Schnitt SJ. Problematic issues in breast core needle biopsies. Mod Pathol 2019. A recently published useful review of the types of B3 lesions, challenges in their core biopsy diagnosis and update on the current management strategies in the US. ADH is managed by surgical excision. ALH/LCIS is managed by either radiological follow-up/VAE or surgical excision. The latter is performed if there is radiological-pathological discordance or if other high-risk lesions are present.
22.
23.
Rakha EA, Shaaban AM, Haider SA, Jenkins J, Menon S, Johnson C, et al. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology. 2013;62(6):894–8.CrossRef
Metadata
Title
Management of B3 Lesions—Practical Issues
Authors
Abeer M. Shaaban
Nisha Sharma
Publication date
01-06-2019
Publisher
Springer US
Published in
Current Breast Cancer Reports / Issue 2/2019
Print ISSN: 1943-4588
Electronic ISSN: 1943-4596
DOI
https://doi.org/10.1007/s12609-019-0310-6

Other articles of this Issue 2/2019

Current Breast Cancer Reports 2/2019 Go to the issue

Correction

Correction to: Ablative Treatment of Breast Cancer; Are We There Yet?

Breast Cancer Imaging and Screening (N Sharma, Section Editor)

Interval Cancers and Duty of Candour, a UK Perspective

Local-Regional Evaluation and Therapy (DM Euhus, Section Editor)

Surgical Therapy for Women with Multiple Synchronous Ipsilateral Breast Cancer (MIBC): Current Evidence to Guide Clinical Practice

Breast Cancer Imaging and Screening (N Sharma, Section Editor)

Diffusion-Weighted Magnetic Resonance Imaging of the Breast: an Accurate Method for Measuring Early Response to Neoadjuvant Chemotherapy?

Local-Regional Evaluation and Therapy (DM Euhus, Section Editor)

Role of Liquid Biopsy in Clinical Decision-Making for Breast Cancer

Local-Regional Evaluation and Therapy (DM Euhus, Section Editor)

Ablative Treatment of Breast Cancer; Are We There Yet?
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits