Outcomes of atypical (B3) core biopsy lesions diagnosed across BreastScreen NSW, Australia

Richard Chou; Diana Tran; Joseph Descallar; Bin Jalaludin; Patsy S Soon

doi:10.1016/j.breast.2024.103720

Outcomes of atypical (B3) core biopsy lesions diagnosed across BreastScreen NSW, Australia

Breast. 2024 Mar 29:75:103720. doi: 10.1016/j.breast.2024.103720. Online ahead of print.

Authors

Richard Chou¹, Diana Tran², Joseph Descallar³, Bin Jalaludin⁴, Patsy S Soon⁵

Affiliations

¹ Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.
² BreastScreen South Western Sydney Local Health District, Liverpool, NSW, Australia; Department of Radiology, Bankstown Hospital, Bankstown, NSW, Australia.
³ South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
⁴ Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; School of Population Health, University of New South Wales, NSW, Australia.
⁵ Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; BreastScreen South Western Sydney Local Health District, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia. Electronic address: patsy.soon@health.nsw.gov.au.

Abstract

Introduction: Atypical or B3 lesions comprise a heterogeneous group of uncertain malignant potential. B3 lesions diagnosed on core biopsy are usually recommended for diagnostic open biopsy. Identifying factors which could allow conservative management of B3 lesions would be helpful in avoiding unnecessary surgery. The aim of this study was to identify the upgrade rate to malignancy for B3 core biopsy lesions and to compare characteristics of lesions which were malignant and benign at excision.

Method: This retrospective study used data from BreastScreen New South Wales (NSW), Australia, of women who were diagnosed with B3 lesions on needle biopsy from 2011 to 2019.

Results: During the study period, 1927 B3 lesions were included. The upgrade rate to malignancy was 26.4%. Of the malignant lesions on excision, 29.6% were invasive and 69.2% were in situ. The rates of upgrade to invasive cancer and DCIS varied substantially with the core biopsy lesion type. Lesions with atypia on core biopsy had significantly higher upgrade rates to malignancy at 34.7% compared to 13.6% for lesions without atypia (p < 0.0001). Lesions with malignant pathology were significantly larger than those with benign pathology (difference = 5.1 mm (95% CI 2.7-7.5 mm), p < 0.001).

Conclusions: The overall upgrade rate of B3 lesions to malignancy was 26.4%. The majority of the lesions were upgraded to DCIS instead of invasive cancer. Upgrade rates varied by lesion type. Lesions with atypia had significantly higher upgrade rates to cancer compared to lesions without atypia. Malignant lesions were significantly larger than benign lesions.

Keywords: Atypical lesions; Breast; Breast cancer; Ductal carcinoma in situ.