Role of breast imaging in predicting outcome of lesions of uncertain malignant potential (B3) diagnosed at core needle biopsy.
OBJECTIVE
To elucidate whether breast imaging can predict final histologic diagnosis of lesions of uncertain malignant potential diagnosed at ultrasound core needle biopsy (CNB).


METHODS
The imaging characteristics (mammography, ultrasound, and magnetic resonance imaging [MRI]) of lesions of uncertain malignant potential in the breast that were obtained by ultrasound CNB were retrospectively analyzed in 87 women. Radiologic characteristics of lesions were compared to definitive histopathologic findings.


RESULTS
Out of 87 breast lesions of uncertain malignant potential, 27 (31%) were diagnosed as papillary lesions, 24 (28%) atypical ductal hyperplasia, 19 (22%) lobular intraepithelial neoplasia, 9 (10%) phyllodes tumors, 3 (3%) radial sclerosing lesions, and 5 (6%) unspecified lesions of uncertain malignant potential. The underestimation rate of malignancy at CNB based on the total number of lesions on final follow-up was 22%. Using multivariate logistic regression, Breast Imaging-Reporting and Data System (BI-RADS) score (odds ratio [OR] = 12.29, p = 0.027) and Göttingen MRI scoring system (OR = 8.1, p = 0.008) were found to be independent predictors of malignancy. Receiver operating characteristic analysis showed that Göttingen MRI score &gt;3 provides a plausibly good cutoff value with sensitivity of 100 (95% confidence interval [CI] 74%-100%) and specificity of 76% (95% CI 61%-88%).


CONCLUSIONS
Lesions of uncertain malignant potential classified as BI-RADS 5 and Göttingen score 4 or higher are at significantly higher risk of harboring malignancy and therefore should be recommended for surgical excision.
Department of Radiology, Clinical Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb - Croatia.
Marko
M
Petrovecki
Department of Radiology, Clinical Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb - Croatia.
Ana Marija
AM
Alduk
Department of Pathology and Cytology, Clinical Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb - Croatia.
Jasminka
J
Jakic-Razumovic
Department of Radiology, Clinical Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb - Croatia.
Ranka
R
Stern-Padovan
Community Health Center East, Zagreb - Croatia.
Vinko
V
Bubic
Department of Radiology, Clinical Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb - Croatia.
Maja
M
Prutki
D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary; D035501:Uncertainty