Sebastian Mayer1, Gian Kayser2, Gerta Rücker3, Diana Bögner4, Marc Hirschfeld5, Christiane Hug6, Elmar Stickeler7, Gerald Gitsch6, Thalia Erbes6. 1. Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany. Electronic address: sebastian.mayer@uniklinik-freiburg.de. 2. Institute of Surgical Pathology, Department of Pathology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany. 3. Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany. 4. West London Mental Health NHS Trust, United Kingdom. 5. Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; Institute of Veterinary Medicine, Georg-August-University Goettingen, Germany. 6. Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany. 7. Department of Gynecology and Obstetrics, University Medical Center RWTH Aachen, Aachen, Germany.
Abstract
INTRODUCTION: Lesions of uncertain malignant potential (B3) represent a heterogeneous group with an overall risk for malignancy of 9.85-35.1% after total resection. Positive predictive values (PPV) for malignancy vary depending on B3 subtype. The aim of this study was to evaluate the PPV for malignancy in B3 lesions and to determine the clinical significance of atypia-dependent sub-classification (a = without epithelial atypia; b = with epithelial atypia) of B3 into B3a and B3b and papillary lesions (PL) in PLa and PLb. METHODS: 219 patients with histopathologically proven B3 lesions on core needle/vacuum-assisted biopsy who subsequently underwent diagnostic excision biopsy were included in this study. PPVs for malignancy were reported for B3 in general and all B3 sub-categories. Logistic regression analysis identified associations between B3-subgroups and outcome after excision biopsy as well as the impact of clinical and diagnostic findings on excision diagnosis. RESULTS: The overall PPV rate was 10.0% (22/219). Excision histology exhibited a higher malignancy rate in PLb (2/7; PPV: 28.6%) than in PLa (6/127; PPV: 4.7%) (p = 0.057) and in B3b (12/50; PPV: 24.0%) compared to B3a category (8/165; PPV: 4.8%) (p < 0.001). DISCUSSION: These findings support the necessity of B3 lesion sub-classification into B3a and B3b and of PL into PLa and PLb when considering epithelial atypia. The determination of atypia status represents a relevant factor in risk-stratification for clinical management of B3 lesions. Should future studies using the sub-classification of PL confirm these results, observation may be a safe option for the clinical management of patients with asymptomatic PLa lesions.
INTRODUCTION: Lesions of uncertain malignant potential (B3) represent a heterogeneous group with an overall risk for malignancy of 9.85-35.1% after total resection. Positive predictive values (PPV) for malignancy vary depending on B3 subtype. The aim of this study was to evaluate the PPV for malignancy in B3 lesions and to determine the clinical significance of atypia-dependent sub-classification (a = without epithelial atypia; b = with epithelial atypia) of B3 into B3a and B3b and papillary lesions (PL) in PLa and PLb. METHODS: 219 patients with histopathologically proven B3 lesions on core needle/vacuum-assisted biopsy who subsequently underwent diagnostic excision biopsy were included in this study. PPVs for malignancy were reported for B3 in general and all B3 sub-categories. Logistic regression analysis identified associations between B3-subgroups and outcome after excision biopsy as well as the impact of clinical and diagnostic findings on excision diagnosis. RESULTS: The overall PPV rate was 10.0% (22/219). Excision histology exhibited a higher malignancy rate in PLb (2/7; PPV: 28.6%) than in PLa (6/127; PPV: 4.7%) (p = 0.057) and in B3b (12/50; PPV: 24.0%) compared to B3a category (8/165; PPV: 4.8%) (p < 0.001). DISCUSSION: These findings support the necessity of B3 lesion sub-classification into B3a and B3b and of PL into PLa and PLb when considering epithelial atypia. The determination of atypia status represents a relevant factor in risk-stratification for clinical management of B3 lesions. Should future studies using the sub-classification of PL confirm these results, observation may be a safe option for the clinical management of patients with asymptomatic PLa lesions.
Authors: Elisabetta Giannotti; Jonathan J James; Yan Chen; Rachel Sun; Amanjot Karuppiah; Julie Yemm; Andrew H S Lee Journal: Eur Radiol Date: 2021-06-08 Impact factor: 5.315
Authors: Svjetlana Mohrmann; Anna Maier-Bode; Frederic Dietzel; Petra Reinecke; Natalia Krawczyk; Thomas Kaleta; Ulrike Kreimer; Gerald Antoch; Tanja N Fehm; Katrin Sabine Roth Journal: Breast Care (Basel) Date: 2021-07-01 Impact factor: 2.268
Authors: Marco Lucioni; Chiara Rossi; Pascal Lomoro; Francesco Ballati; Marianna Fanizza; Alberta Ferrari; Carlos A Garcia-Etienne; Emanuela Boveri; Giulia Meloni; Maria Grazia Sommaruga; Elisa Ferraris; Angioletta Lasagna; Elisabetta Bonzano; Marco Paulli; Adele Sgarella; Giuseppe Di Giulio Journal: Eur Radiol Date: 2020-08-20 Impact factor: 5.315
Authors: Corrado Tagliati; Paola Piccinni; Paola Ercolani; Elisabetta Marconi; Barbara Franca Simonetti; Gian Marco Giuseppetti; Andrea Giovagnoni Journal: Pol J Radiol Date: 2021-04-30