Correlation of needle core biopsy with excision histology in screen-detected B3 lesions: the Merrion Breast Screening Unit experience

• Published in: Journal of clinical pathology Vol. 62; no. 12; pp. 1136 - 1140
• Main Authors: Hayes, B D, O’Doherty, A, Quinn, C M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.12.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Biopsy; Biopsy, Needle - methods; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Calcification; Diagnosis, Differential; Epidemiologic Methods; Female; Histology; Humans; Investigative techniques, diagnostic techniques (general aspects); Mammography; Medical sciences; Medical screening; Middle Aged; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Anatomic pathology; Correlation; Excision; Biopsy; Needle; Breast; Histology; Mammary gland; Lesion; Medical screening
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp.2009.067280

Aims:Needle core biopsy (NCB) is a widely-used technique for non-operative evaluation of screen-detected breast lesions. Although most NCBs are B2 (benign) or B5 (malignant), some fall into the B3 category of “uncertain malignant potential”. This study aims to categorise the lesions prompting a B3 NCB in the Merrion Breast Screening Unit, and establish the incidence of malignancy on subsequent excision biopsy.Methods:Patients attending the Merrion Breast Screening Unit in Dublin between 2000 and 2008 who had a B3 NCB were identified. The NCB pathology reports were reviewed and the diagnosis correlated with excision histology; the latter was classified as benign, atypical or malignant. Lesion-specific positive predictive values (PPVs) for malignancy were derived.Results:141 patients with a B3 NCB were identified. The most frequent lesions on NCB were radial scar (RS; n = 57), atypical intraductal epithelial proliferation (AIDEP; n = 25) and papillary lesion (n = 24). The final diagnosis was malignant in 22 patients (16%), atypical in 40 (28%) and benign in 79 (56%). Two of the patients with a malignant diagnosis had invasive carcinoma. The lesion-specific PPVs were: lobular neoplasia 50%, AIDEP 32%, columnar cell lesion with atypia 12.5%, RS 12.3%, papillary lesion 8.3%, suspected phyllodes tumour 7.7%, and spindle cell lesion 0%. Atypia on RS NCB predicted an atypical or malignant excision diagnosis, but atypia on papillary lesion NCB did not.Conclusions:One-sixth of B3 NCBs in this series proved to be malignant on excision. The PPV for malignancy varied according to lesion type.