Volume 90, Issue 12 pp. 2521-2526

BREAST SURGERY

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8-year experience (2012–2019)

Yang Y. Huang MBBS, GradDipSurgAnat, FRACS,

Corresponding Author

Yang Y. Huang MBBS, GradDipSurgAnat, FRACS

[email protected]

orcid.org/0000-0002-0035-7515

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Correspondence

Mr Yang Y. Huang, Department of Breast Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Email: [email protected]

Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing

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Hyerin Park BBiomedSc,

Hyerin Park BBiomedSc

orcid.org/0000-0001-8741-4262

Department of Surgery, The University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia

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Sally McLaren BSc (Hons), PhD, MBBS, FRCPA,

Sally McLaren BSc (Hons), PhD, MBBS, FRCPA

Department of Anatomical Pathology, PathWest Laboratory Medical WA, Perth, Western Australia, Australia

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Palan Thirunavukkarasu MBBS, FRACS,

Palan Thirunavukkarasu MBBS, FRACS

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Joshua T. W. Lin MBBS, FRACS,

Joshua T. W. Lin MBBS, FRACS

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Ramela Rajakaruna MBBS, FRCPA,

Ramela Rajakaruna MBBS, FRCPA

Department of Anatomical Pathology, PathWest Laboratory Medical WA, Perth, Western Australia, Australia

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Ravinder Dhillon MBBS, MMedSc, FRANZCR,

Ravinder Dhillon MBBS, MMedSc, FRANZCR

Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Ananda K. Ponniah MBBS, FRACS,

Ananda K. Ponniah MBBS, FRACS

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Yang Y. Huang MBBS, GradDipSurgAnat, FRACS,

Corresponding Author

Yang Y. Huang MBBS, GradDipSurgAnat, FRACS

[email protected]

orcid.org/0000-0002-0035-7515

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Correspondence

Mr Yang Y. Huang, Department of Breast Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia. Email: [email protected]

Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing

Search for more papers by this author

Hyerin Park BBiomedSc,

Hyerin Park BBiomedSc

orcid.org/0000-0001-8741-4262

Department of Surgery, The University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia

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Sally McLaren BSc (Hons), PhD, MBBS, FRCPA,

Sally McLaren BSc (Hons), PhD, MBBS, FRCPA

Department of Anatomical Pathology, PathWest Laboratory Medical WA, Perth, Western Australia, Australia

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Palan Thirunavukkarasu MBBS, FRACS,

Palan Thirunavukkarasu MBBS, FRACS

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Joshua T. W. Lin MBBS, FRACS,

Joshua T. W. Lin MBBS, FRACS

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Ramela Rajakaruna MBBS, FRCPA,

Ramela Rajakaruna MBBS, FRCPA

Department of Anatomical Pathology, PathWest Laboratory Medical WA, Perth, Western Australia, Australia

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Ravinder Dhillon MBBS, MMedSc, FRANZCR,

Ravinder Dhillon MBBS, MMedSc, FRANZCR

Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Ananda K. Ponniah MBBS, FRACS,

Ananda K. Ponniah MBBS, FRACS

Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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First published: 23 September 2020

https://doi.org/10.1111/ans.16315

Citations: 8

Y. Y. Huang MBBS, GradDipSurgAnat, FRACS; H. Park BBiomedSc; S. McLaren BSc (Hons), PhD, MBBS, FRCPA; P. Thirunavukkarasu MBBS, FRACS; J. T. W. Lin MBBS, FRACS; R. Rajakaruna MBBS, FRCPA; R. Dhillon MBBS, MMedSc, FRANZCR; A. K. Ponniah MBBS, FRACS.

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Abstract

Background

B3 breast lesions identified on core needle biopsy have uncertain malignant potential. Traditional management of these lesions has been surgical excision, but there is growing interest in less invasive and more cost-effective alternatives such as vacuum-assisted excisional biopsy (VAEB). Determining the rate of malignant upgrade for B3 lesions is important as it may identify low-risk lesions where VAEB could be considered.

Methods

A retrospective study was conducted of women undergoing an elective excisional biopsy for a B3 lesion identified on core needle biopsy at a tertiary Australian breast centre. The pre-operative biopsy diagnosis and subsequent excisional biopsy diagnosis were used to calculate the proportion of cases where the diagnosis was upgraded to malignancy.

Results

A total of 299 eligible patients were identified. Pre-operative diagnosis of papillary lesion with atypia was associated with the highest upgrade rate (50%, n = 12). The next highest upgrade rates occurred in those with flat epithelial atypia (37.50%, n = 8); atypical ductal hyperplasia (24.71%, n = 85); lobular carcinoma in situ (LCIS)/atypical lobular hyperplasia with calcification (17.65%, n = 17); and papillary lesion without atypia (4.72%, n = 106). Patients with radial scar (n = 51), classical LCIS without calcification (n = 7) and mucocoele-like lesion (n = 8) had a 0% upgrade rate.

Conclusion

VAEB may be appropriate for low malignant risk lesions such as papillary lesion without atypia, mucocoele-like lesion and radial scar lesion without atypia. Open-surgical-excisional biopsy remains appropriate for high upgrade lesions such as atypical ductal hyperplasia, papillary lesion with atypia, flat epithelial atypia and classical LCIS with calcification. Long-term prospective randomized multicentre studies and continuing multidisciplinary approach is recommended for future clinical implementation.

Conflicts of interest

None declared.

Supporting Information

Reference

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Citing Literature

Volume90, Issue12

December 2020

Pages 2521-2526

Filename	Description
ans16315-sup-0001-FigureS1.docxWord 2007 document , 34.1 KB	Figure S1 Proposed management flowchart for B3 lesion
ans16315-sup-0002-FigureS2.docxWord 2007 document , 19.3 KB	Figure S2 B3 lesion risk stratification
ans16315-sup-0003-TableS1.docxWord 2007 document , 15.2 KB	Table S1 Patient demographics and lesion characteristics
ans16315-sup-0004-TableS2.docxWord 2007 document , 14.5 KB	Table S2 B3 pathologies and corresponding radiological lesion descriptors
ans16315-sup-0005-TableS3.docxWord 2007 document , 19.5 KB	Table S3 Upgrade rates for B3 lesions on needle biopsy
ans16315-sup-0006-TableS4.docxWord 2007 document , 15.7 KB	Table S4 Screening vs. symptomatic patient upgrade rates

B3 lesion upgrade rates in a tertiary Australian breast centre: a 8-year experience (2012–2019)

Abstract

Background

Methods

Results

Conclusion

Conflicts of interest

Supporting Information

Reference

Citing Literature

References

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B3 lesion upgrade rates in a tertiary Australian breast centre: a 8-year experience (2012–2019)

Abstract

Background

Methods

Results

Conclusion

Conflicts of interest

Supporting Information

Reference

Citing Literature

References

Related

Information