La radiologia medica

, Volume 115, Issue 8, pp 1246–1257 | Cite as

B3 breast lesions determined by vacuum-assisted biopsy: how to reduce the frequency of benign excision biopsies

  • M. Tonegutti
  • V. Girardi
  • S. Ciatto
  • E. Manfrin
  • F. Bonetti
Breast Radiology / Senologia



The aim of this study was to identify parameters allowing differentiation among the diverse group of B3 lesion at stereotactic vacuum-assisted biopsy (VAB) to identify patients with a low risk of cancer and who can therefore be referred for follow-up rather than surgery and thus reduce the number of unnecessary surgical procedures.

Materials and methods

Among 608 VAB procedures performed for nonpalpable ultrasound (US)-occult mammographic abnormality, 102 cases of B3 were included in this study. Mammographic lesion type, lesion size, Breast Imaging Reporting and Data System (BIRADS) category, number of specimens per lesion and presence of atypia were retrospectively analysed. Results were compared with histological findings at surgery (53 cases) or mammographic findings during follow-up (49 cases). Statistical analysis was performed with univariate analysis (chi-square test), and statistical significance was set at p<0.05.


The majority of cases were depicted as isolated microcalcifications (82.3%), were smaller than 10 mm (80.4%), had a low level of radiological suspicion (64.7%) and had 11 or more cores sampled (94.1%). Atypia at VAB was reported in 60 of 102 cases (58.8%). Carcinoma was found at excision in 5/60 (8%) B3 lesions with atypia and in no B3 lesions without atypia (p=0.146). Cancer at surgery was more frequent among cases of isolated microcalcifications (p=0.645), cases with high radiological suspicion (p=0.040) and those with a smaller number of cores sampled (borderline significant p=0.064).


On the basis of our experience, the presence or absence of atypia in our series proved to be the reliable criterion to prompt or avoid surgery in cases with a VAB finding of B3 lesion. This criterion may therefore be adopted in practice to more accurately select patients for surgery.


Breast neoplasm Breast biopsy VAB Atypical intraductal epitelial proliferation B3 lesion 

Lesioni mammarie B3 alla biopsia in stereotassi vacuum assisted: come ridurre le biopsie chirurgiche benigne



Identificare i parametri che consentano di distinguere nell’ambito del variegato gruppo di lesioni B3 diagnosticate tramite vacuum assisted breast biopsy (VABB), lesioni che per il loro ridotto rischio di malignità possano essere indirizzate al follow-up piuttosto che all’intervento cosÌ da contenere il numero di procedure chirurgiche non necessarie.

Materiali e metodi

Nella serie consecutiva di 608 pazienti con alterazioni mammografiche, non palpabili, non evidenziabili con ecografia e con vario grado di sospetto avviate al VABB, sono stati inclusi nello studio i 102 casi con diagnosi VABB di lesione B3. Le lesioni B3 sono state classificate secondo i seguenti parametri: aspetto mammografico, dimensioni, giudizio radiologico di sospetto, numero di frustoli, presenza di atipia. Il gold standard è stato il risultato dell’escissione chirurgica (53 casi) o il follow-up mammografico (49 casi). La valutazione statistica è stata condotta con analisi univariata (χ2 test; p value significativo<0,05).


L’aspetto radiologico più frequente delle B3 è rappresentato da microcalcificazioni isolate (82,3%), il diametro è risultato inferiore a 10 mm (80,4%), il livello di sospetto radiologico è stato lieve (64,7%) e si sono prelevati più di 11 frustoli/procedura (94,1%). La diagnosi microistologica VABB è stata di B3 con atipia in 60 su 102 casi (58,8%). La presenza di lesione maligna all’escissione chirurgica è stata osservata in 5/60 (8%) delle lesioni B3 con atipia e in nessuna lesione B3 senza atipia (p=0,146) ed è risultata più frequente in caso di microcalcificazioni isolate (p=0,645), in presenza di alterazione con giudizio radiologico altamente sospetto (p=0,040), nei casi con più ridotto campionamento (p=0,064).


La presenza o l’assenza di atipie nella serie esaminata è criterio affidabile per prospettare o, rispettivamente, evitare l’intervento chirurgico nei casi di lesione B3 diagnosticate al VABB. Tale parametro può pertanto essere assunto nella pratica corrente come discriminante per indirizzare la paziente all’allargamento chirurgico.

Parole chiave

Neoplasia mammaria Biopsia mammaria VAB Proliferazione atipica Lesioni B3 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Royal College of Pathologists (2001) NHS Non-operative Diagnosis Subgroup of the National Coordination Group for Breast Screening Pathology. Guidelines for Non-operative Diagnostic Procedures and Reporting in Breast Cancer Screening (NHSBSP publication no. 50). NHS Cancer Screening Programmes, SheffieldGoogle Scholar
  2. 2.
    Perry N, Broeders M, de Wolf C et al (2006) European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Office for Official Publications of the European Communities, LuxembourgGoogle Scholar
  3. 3.
    Hartmann LC, Sellers TA, Frost MH et al (2005) Benign breast disease and the risk of breast cancer. N Engl J Med 353:229–237CrossRefPubMedGoogle Scholar
  4. 4.
    Abdel-Fatah TM, Powe DG, Hodi Z et al (2007) High frequency of coexistence of columnar cell lesions, lobular neoplasia, and low grade ductal carcinoma in situ with invasive tubular carcinoma and invasive lobular carcinoma. Am J Surg Pathol 31:417–426CrossRefPubMedGoogle Scholar
  5. 5.
    Simpson PT, Gale T, Reis-Filho JS et al (2005) Columnar cell lesions of the breast: the missing link in breast cancer progression? A morphological and molecular analysis. Am J Surg Pathol 29:734–746CrossRefPubMedGoogle Scholar
  6. 6.
    Abdel-Fatah TM, Powe DG, Hodi Z et al (2008) 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 32:513–523CrossRefPubMedGoogle Scholar
  7. 7.
    Darling ML, Smith DN, Lester SC et al (2000) Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol 175:1341–1346PubMedGoogle Scholar
  8. 8.
    Elsheikh TM, Silverman JF (2005). Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol 29:534–543CrossRefPubMedGoogle Scholar
  9. 9.
    Lee AH, Denley HE, Pinder SE et al (2003) Excision biopsy findings of patients with breast needle core biopsies reported as suspicious of malignancy (B4) or lesion of uncertain malignant potential (B3). Histopathology 42:331–336CrossRefPubMedGoogle Scholar
  10. 10.
    Liberman L, Tornos C, Huzjan R et al (2006) Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol 186:1328–1334CrossRefPubMedGoogle Scholar
  11. 11.
    Kunju LP and Kleer CG (2007) Significance of flat epithelial atypia on mammotome core needle biopsy: Should it be excised? Hum Pathol 38:35–41CrossRefPubMedGoogle Scholar
  12. 12.
    Burnett SJ, Ng YY, Perry NM et al (1995) Benign biopsies in the prevalent round of breast screening: a review of 137 cases. Clin Radiol 50:254–258CrossRefPubMedGoogle Scholar
  13. 13.
    Carder PJ, Liston JC (2003) Will the spectrum of lesions prompting a “B3” breast core biopsy increase the benign biopsy rate? J Clin Pathol 56:133–138CrossRefPubMedGoogle Scholar
  14. 14.
    Manfrin E, Mariotto R, Remo A et al (2009) Benign breast lesions at risk of developing cancer-a challenging problem in breast cancer screening programs: five years’ experience of the Breast Cancer Screening Program in Verona (1999–2004). Cancer 115:499–507CrossRefPubMedGoogle Scholar
  15. 15.
    Houssami N, Ciatto S, Bilous M et al (2007) Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3). Br J Cancer 96:1253–1257CrossRefPubMedGoogle Scholar
  16. 16.
    Tavassoli FA, Devilee P (2003) World Health Organization classification of tumors. Pathology and genetics of tumors of the breast and female genital organs. IARC Press, LyonGoogle Scholar
  17. 17.
    Dillon MF, McDermott EW, Hill AD et al (2007) Predictive value of breast lesions of “uncertain malignant potential” and “suspicious for malignancy” determined by needle core biopsy. Ann Surg Oncol 14:704–711CrossRefPubMedGoogle Scholar
  18. 18.
    Page DL, Dupont WD, Rogers LW, Rados MS (1985) Atypical hyperplastic lesions of the female breast. A longterm follow-up study. Cancer 55:2698–2708CrossRefPubMedGoogle Scholar
  19. 19.
    Shaaban AM, Sloane JP, West CR et al (2002) Histopathologic types of benign breast lesions and the risk of breast cancer: case-control study. Am J Surg Pathol 26:421–430CrossRefPubMedGoogle Scholar
  20. 20.
    Feeley L, Quinn CM (2009) Columnar cell lesions of the breast. Histopathology 52:11–19CrossRefGoogle Scholar
  21. 21.
    Berg JC, Visscher DW, Vierkant RA et al (2008) Breast cancer risk in women with radial scars in benign breast biopsies. Breast Cancer Res Treat 108:167–174CrossRefPubMedGoogle Scholar
  22. 22.
    Tonegutti M, Girardi V (2008) Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions. Radiol Med 113:65–75CrossRefPubMedGoogle Scholar
  23. 23.
    American College of Radiology (1998) Breast imaging reporting and data system (BI-RADS). American College of Radiology, RestonGoogle Scholar
  24. 24.
    Jackman RJ, Nowels KW, Shepard MJ et al(1994) Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology 193:91–95PubMedGoogle Scholar
  25. 25.
    Brenner RJ, Bassett LW, Fajardo LL et al (2001) Stereotactic core-needle breast biopsy: a multi-institutional prospective trial. Radiology 218:866–872PubMedGoogle Scholar
  26. 26.
    Liberman L, Cohen MA, Dershaw DD et al (1995) Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy. AJR Am J Roentgenol 164:1111–1113PubMedGoogle Scholar
  27. 27.
    Kettritz U, Rotter K, Schreer I et al (2004) Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 100:245–251CrossRefPubMedGoogle Scholar
  28. 28.
    Philpotts LE, Lee CH, Horvath LJ et al (1997) Canceled stereotactic coreneedle biopsy of the breast: analysis of 89 cases. Radiology 205:423–428PubMedGoogle Scholar
  29. 29.
    Ciatto S, Houssami N, Ambrogetti D et al (2007) Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4000 consecutive biopsies. Breast Cancer Res Treat 101:291–297CrossRefPubMedGoogle Scholar
  30. 30.
    Brem RF, Lechner MC, Jackman RJ et al (2008) Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR Am J Roentgenol 190:637–641CrossRefPubMedGoogle Scholar
  31. 31.
    Jackman RJ, Birdwell RL, Ikeda DM (2002) Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology 224:548–554CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • M. Tonegutti
    • 1
  • V. Girardi
    • 2
  • S. Ciatto
    • 3
  • E. Manfrin
    • 4
  • F. Bonetti
    • 4
  1. 1.Servizio di RadiosenologiaCasa di Cura “P. Pederzoli”Peschiera del Garda, VeronaItaly
  2. 2.Dipartimento di RadiodiagnosticaPoliclinico Universitario G.B. RossiVeronaItaly
  3. 3.Istituto per lo Studio e la Prevenzione OncologicaFirenzeItaly
  4. 4.Dipartimento di Anatomia PatologicaPoliclinico Universitario G.B. RossiVeronaItaly

Personalised recommendations