Our Radiological Experience on B3 Lesions: Correlation Between Mammographic and MRI Findings With Histologic Definitive Result

Clin Breast Cancer. 2019 Oct;19(5):e643-e653. doi: 10.1016/j.clbc.2019.06.004. Epub 2019 Jun 26.

Abstract

Introduction: The purpose of this study was to evaluate mammographic and magnetic resonance imaging (MRI) features in B3 lesions.

Patients and methods: From 2011 to 2018, 139 patients with histologically proven B3 lesions who underwent mammography or/and MRI, were retrospectively reviewed. B3 lesions were classified in: atypical ductal hyperplasia (ADH), lobular neoplasia (LN), papillary lesion (PL), radial scar (RS), flat epithelial atypia (FEA), phyllodes tumor (PT), or mesenchymal lesion. Imaging features evaluated were: the presence of microcalcifications, mass and architectural distortions on mammograms and type of margins (circumscribed, irregular, spiculate), enhancement (mass-like, non-mass-like), size (≤ 15 mm, > 15 mm), and kinetics curves (I, II, III) on MRI. The definitive histologic results confirmed benign lesion or were upgraded to malignancy, and the positive predictive value was calculated.

Results: Histologic classification of B3 lesions counted 45 (32.37%) ADH, 12 (8.63%) LN, 25 (17.99%) PL, 5 (3.61%) RS, 31 (22.31%) FEA, 20 (14.39%) PT, and 1 (0.70%) mesenchymal lesion. One hundred seven patients had mammography, and 38 had MRI. In 90 (65%) cases, the histologic diagnosis confirmed B3, in 15 (11%) cases, benign lesion, and in 34 (24%) cases, malignancies were found, with best positive predictive value for mesenchymal tumor (1), ADH (0.36), and FEA (0.4). Significant correlations comparing core needle biopsy groups and microcalcifications (P = .016) and presence of mass (P = .002) and comparing definitive histology with the presence of mass (P = .023), were found. Regarding MRI, the morphology correlated with core needle biopsy groups (P = .038); morphology (P = .024), dimension (P = .040), and kinetic curve (P = .005) correlated with malignancy.

Conclusions: The B3 category includes different entities, with various risk of malignancy; their heterogeneity is associated with specific mammographic and MRI features, although further confirmations are needed.

Keywords: B3 lesions; Definitive surgery; Magnetic resonance imaging (MRI); Malignancy; Mammography.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology*
  • Carcinoma, Ductal, Breast / diagnostic imaging
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Intraductal, Noninfiltrating / diagnostic imaging
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Lobular / diagnostic imaging
  • Carcinoma, Lobular / pathology
  • Female
  • Fibrocystic Breast Disease / diagnostic imaging
  • Fibrocystic Breast Disease / pathology
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Mammography / methods*
  • Middle Aged
  • Phyllodes Tumor / diagnostic imaging
  • Phyllodes Tumor / pathology
  • Precancerous Conditions / diagnostic imaging
  • Precancerous Conditions / pathology
  • Prognosis
  • Retrospective Studies
  • Young Adult