1. Lesions of uncertain malignant potential of the breast (B3) on vacuum-assisted biopsy for microcalcifications: Predictors of malignancy
- Author
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Alberto Tagliafico, Giovanna Romanucci, Giovanna Mariscotti, Riccardo Bussone, Pier Paolo Campanino, Paolo Belli, Isabella Castellano, Paolo Fonio, Nehmat Houssami, Irene Ruggirello, Jacopo Nori, Massimo Calabrese, Manuela Durando, Chiara Zuiani, Andrea Caneva, Francesca Caumo, Viviana Londero, Giulia Bicchierai, Simonetta Bianchi, Carla Di Loreto, Antonino Mulè, and Laura Bergamasco more...
- Subjects
medicine.medical_treatment ,Biopsy ,Microcalcifications ,Logistic regression ,Breast surgery ,Noninfiltrating ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Diagnosis ,Needle ,Breast ,Mastectomy ,Univariate analysis ,Vacuum-assisted breast biopsy ,medicine.diagnostic_test ,Biopsy, Needle ,Calcinosis ,General Medicine ,Middle Aged ,030220 oncology & carcinogenesis ,Female ,Radiology ,Carcinoma in Situ ,Mammography ,Adult ,Image-Guided Biopsy ,medicine.medical_specialty ,Intraductal ,Breast Neoplasms ,Malignancy ,1117 Public Health and Health Services ,Diagnosis, Differential ,03 medical and health sciences ,Multidisciplinary management ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,1112 Oncology and Carcinogenesis ,Risk factor ,Pathological ,Aged ,Retrospective Studies ,B3 lesions ,Carcinoma, Intraductal, Noninfiltrating ,Logistic Models ,Precancerous Conditions ,business.industry ,Carcinoma ,medicine.disease ,Differential ,business ,Lobular Neoplasia - Abstract
To investigate clinical, radiologic and pathologic features of B3 lesions diagnosed on VABB targeting microcalcifications, for identifying predictors of malignancy.This retrospective multi-centre study included consecutive VABBs performed over a 10-year period on suspicious microcalcifications not associated with other radiological signs diagnosed as B3 on histology from VABB, with outcomes ascertained by surgical excision. Clinical, demographic, radiological and histological (B3 subcategory) data were collected. For statistical analysis (univariate and binary logistic regression), the primary outcome variable was the upgrade rate to malignancy after surgery. Predictors of upgrade to malignancy were identified from clinical, demographic, radiological and pathological variables (including B3 subcategory).Amongst 447 VABBs, there were 57(12.7 %) upgrades to malignancy at surgical histology (36 DCIS and 21 invasive cancer). At univariate analysis, variables significantly associated with increased risk of upgrade to malignancy were age55 years (p = 0.01), lesion size10 mm (p 0.0001), BI-RADS 4b-c and 5 (p = 0.0001), and fine pleomorphic morphology (p = 0.002) of microcalcifications. Binary logistic regression confirmed as significant independent risk factors age, lesion size and BI-RADS category (p = 0.02, 0.02 and 0.0006 respectively). Amongst subcategories of B3 lesions, lobular neoplasia was significantly(p = 0.04) associated with upgrade, confirmed as an independent risk factor [p = 0.03, OR = 2.3(1.1-4.7)]. Flat epithelial atypia was significantly(p = 0.004) associated with reduced odds of upgrade, but binary logistic regression showed only borderline association [p = 0.052, OR = 0.4(0.2-1.01)].Across B3 lesions diagnosed on histology from VABB of suspicious microcalcifications, older age, size10 mm, BI-RADS category≥ 4b on imaging, and lobular neoplasia were risk factors for upgrade to malignancy. This information can be used to discuss patients' tailored management options. more...
- Published
- 2020