#JUN YU GROMET UPGRADE#
After complete surgical resection of a B3 lesion, the overall risk for malignant upgrade is 9.9–35.1% in various studies. In the new WHO classification of breast tumours (fifth edition, 2019), LN is divided into atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) based on the widening and filling of the terminal ducto-lobular unit. The heterogeneous group of B3 lesions includes the following different histopathological entities: atypical ductal hyperplasia (ADH also known as atypical intraductal proliferation), flat epithelial atypia (FEA), lobular neoplasia (LN), papilloma (Pa), phyllodes tumour (PT), radial sclerosing scar (RS) and others, based on the World Health Organization (WHO) classification (fourth edition, 2012). The system briefly comprises five categories: B1, normal tissue or unsatisfactory B2, representative and benign lesion B3, benign lesion with unknown biological potential B4, suspicious for malignancy and B5, malignant. The B-classification system for evaluating core needle biopsies of the breast was established in 1999 by 23 European pathologists to achieve consistency in diagnosing breast diseases and define the prognostic features of carcinomas. Non-operative core needle biopsy was introduced in the mid-1990 to assess uncertain breast lesions in imaging trying to give a definitive histological diagnosis and recommend a further therapy/open resection, if necessary.
A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade ( p = 0.003).ī3 breast lesions represent only a very small group of breast diseases but have a special position concerning their malignant potential. Postmenopausal status was considered an increased risk for an upgrade ( p = 0.015). The most important risk factor was increasing age.
In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. The distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3% flat epithelial atypia (FEA), 7.8% lobular neoplasia (LN), 7.8% papilloma (Pa), 49.5% phylloidal tumour (PT), 8.9% radial sclerosing scar (RS), 3.1% mixed findings, 10.4% and other B3 lesions, 5.2%.
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