Predictive Value of Breast Lesions of “Uncertain Malignant Potential” and “Suspicious for Malignancy” Determined by Needle Core Biopsy
The optimum management of patients whose needle core biopsy (NCB) results are of “uncertain malignant potential” (B3) or “suspicious for malignancy” (B4) is unclear. This study correlates B3 and B4 NCB findings with excision histology to determine associated rates of malignancy.
All NCBs categorized as B3 or B4 were identified from a series of 3729 NCBs. Results of biopsies were reported as normal/nondiagnostic (B1), benign (B2), uncertain malignant potential (B3), suspicious but not diagnostic of malignancy (B4), or malignant (B5) according to the B classification system. B3 lesions included atypical intraductal epithelial proliferations (AIEPs), lobular neoplasia, papillary lesions, radial scars, and potential phyllodes tumors. Histological concordance between NCB and excision specimen was analyzed.
A total of 211 B3 lesions and 51 B4 lesions were identified during the study period. The open biopsy rate after a B3/B4 finding was 86% (n = 226). The overall rate of malignancy for B3 lesions after excision was 21%. The B3 lesion-specific rates of malignancy were 6% for radial scars, 14% for papillomas, 35% for AIEP, and 44% for lobular neoplasia. Of the patients with a B4 categorization, 90% (44 of 49) were diagnosed with carcinoma after surgery. Those that were “suspicious for ductal carcinoma-in-situ” and “suspicious for invasion” correlated accurately with excision findings in 81% and 89% of patients, respectively.
Management of lesions in the B3 categorization must be tailored to the patient because the specific lesion types are associated with highly variable rates of malignancy. A repeat biopsy or a therapeutic wide local excision should be undertaken in lesions with a B4 NCB categorization because such lesions are associated with a particularly high risk of malignancy at excision.
KeywordsCategorization Excision histology Malignancy Needle core biopsy
- 1.Royal College of Pathologists. NHS Cancer Screening Programmes. Guidelines for Non Operative Diagnostic Procedures and Reporting In Breast Cancer Screening. Publication No. 50. NHSBSP, Sheffield, UK 2001. http://www.cancerscreening.nhs.uk/breastscreen/publications/nhsbps50.pdf
- 12.Brodie C, Doherty A, Quinn C. Fourteen-gauge needle core biopsy of mammographically evident radial scars. Is excision necessary? Cancer 2004; 100:652–3Google Scholar
- 15.Cawson JN, Malara F, Kavanagh A, et al. Fourteen-gauge needle core biopsy of mammographically evident radial scars. Is excision necessary? Cancer 2003; 97:345–51Google Scholar
- 16.Brenner RG, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast. When is excision necessary? AJR Am J Roentgenol 2002; 179:1179–84Google Scholar
- 23.Rendels HE. Core needle biopsy of challenging benign breast conditions: a comprehensive literature review. AJR Am J Roentgenol 2000; 174:1245–50Google Scholar
- 33.Dillon MF, Quinn CM, McDermott EW, et al. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery (in press)Google Scholar
- 36.Elston CW, Sloane JP, Amendoeira I, et al. Causes of inconsistency in diagnosing and classifying intraductal proliferations of the breast. European Commission Working Group on Breast Screening Pathology. Eur J Cancer 2000; 36:1769–72Google Scholar
- 38.Tavassoli FA, Devilee M, eds. World Health Organisation: Classification of Tumours: Pathology and Genetics. Tumours of the Breast and Female Genital Organs. Lyon, France: IARC Press, 2003Google Scholar
- 46.Darling ML, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcimoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol 2001; 177:250–1Google Scholar