Open AccessA new risk stratification score for the management of ultrasound‐detected B3 breast lesions
Author(s) -
Giuliani Michela,
Rinaldi Pierluigi,
Rella Rossella,
D’Angelo Anna,
Carlino Giorgio,
Infante Amato,
Romani Maurizio,
Bufi Enida,
Belli Paolo,
Manfredi Riccardo
Publication year - 2018
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.13115
Subject(s) - medicine , malignancy , lesion , radiology , biopsy , odds ratio , pathology
To develop a predictive scoring system for ultrasound‐detected B3 lesions at ultrasound‐guided core needle biopsy (US‐CNB). A total of 2724 consecutive US‐CNBs performed in our Institution (January 2011 to December 2014) were retrospectively reviewed. Inclusion criteria were as follows: (a) histopathological examination of the entire lesion or (b) availability of radiologic follow‐up (FUP) ≥24 months. Patient‐ and lesion‐related variables—patients’ age, lesion consistency, lesion size, vascularization, BI‐RADS category, and US‐CNB result—were analyzed. Positive predictive values (PPVs) for malignancy were calculated correlating US‐CNB results with excision histology or FUP. A scoring system for underlying malignancy was developed using risk factors weighting. A total of 102 B3 lesions were included: 27 atypical ductal hyperplasia (26.5%), 5 lobular intraepithelial neoplasia (4.9%), 32 radial scar (31.4%), 37 papillary lesions (36.3%), and 1 fibroepithelial lesion (0.9%). Surgery was performed on 71/102 (69.6%) lesions, and 22/71 were malignant; the remaining 31/102 lesions (30.4%) were unchanged at FUP. The overall PPV for malignancy was 21.6%. Patients’ age (odds ratio [OR] = 3.63, P = 0.008), lesion consistency (OR = 5.96, P = 0.001), BI‐RADS category (OR = 17.52, P < 0.001), and CNB result (OR = 3.6, P = 0.008) were associated with a higher risk of malignancy underestimation and selected as risk factors in the score definition. Two risk groups were identified: low (0‐2 points) and high risk (3‐5 points), with significantly different risk of malignancy underestimation (8.0% vs 59.3%, P < 0.001). The proposed score helps to predict the risk of malignancy underestimation and choose the management of B3 lesions at US‐CNB.