Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

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Abstract

Purpose

The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations.

Methods

This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy.

Results

In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 ( p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 ( p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 ( p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 ( p = 0.07)].

Conclusions

Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.

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Most cited references 87

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David Lucas, Ahmad Aref, P Chuba … (2005)

Noninvasive lesions involving the lobules of the breast are increasingly diagnosed as incidental microscopic findings at the time of lumpectomy or core-needle biopsy. We investigated the incidence rates of invasive breast cancer (IBC) after a diagnosis of lobular carcinoma-in-situ (LCIS) by using Surveillance, Epidemiology, and End Results (SEER) data. Patients (N = 4,853) having a diagnosis of primary LCIS in the time period of 1973 to 1998 were identified using the SEER Public Use CD-ROM data. The database was then searched for patients with subsequent primary IBC occurrences (n = 350). The clinical and pathologic characteristics of patients with subsequent primary IBCs were compared with the characteristics of patients with primary IBCs attained during the same time period (N = 255,114). The incidence of IBC increased over time from diagnosis of LCIS, with 7.1% +/- 0.5% incidence of IBC at 10 years. IBCs detected after partial mastectomy occurred in either breast (46% ipsilateral and 54% contralateral); however, after mastectomy, most IBCs were contralateral (94.7%). IBCs occurring after LCIS more often represented invasive lobular histology (23.1%) compared with primary IBCs (6.5%). The standardized incidence ratio (the ratio of observed to expected cases) for developing IBC was 2.4 (95% CI, 2.1 to 2.6) adjusted for age and year of diagnosis. LCIS is associated with increased risk of subsequent invasive disease, with equal predisposition in either breast. The minimum risk of developing IBC after LCIS is 7.1% at 10 years.

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Author and article information

Contributors

Christoph J. Rageth:

ORCID: http://orcid.org/0000-0001-9117-2825

+41 79 642 67 52 , jcr@2cr.ch

Journal

Journal ID (nlm-ta): Breast Cancer Res Treat

Journal ID (iso-abbrev): Breast Cancer Res. Treat

Title: Breast Cancer Research and Treatment

Publisher: Springer US (New York )

ISSN (Print): 0167-6806

ISSN (Electronic): 1573-7217

Publication date (Electronic): 30 November 2018

Publication date PMC-release: 30 November 2018

Publication date (Print): 2019

Volume: 174

Issue: 2

Pages: 279-296

Affiliations

[1 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Département de Gynécologie et d’Obstétrique, Centre du sein, , Hôpitaux Universitaires de Genève, ; Bd de la Cluse 30, 1211 Geneva 14, Switzerland

[2 ]GRID grid.451349.e, The Rose Centre, , St George’s University Hospitals NHS Foundation Trust, ; Perimeter Road, London, SW17 0QT UK

[3 ]ISNI 0000 0001 2171 9952, GRID grid.51462.34, Breast Imaging Service, Department of Radiology, , Memorial Sloan Kettering Cancer Center, ; 300 E 66th St, New York, NY 10065 USA

[4 ]ISNI 0000 0004 0508 7512, GRID grid.482962.3, Department of Medical Services, Institute of Radiology, , Kantonsspital Baden, ; im Ergel, 5404 Baden, Switzerland

[5 ]ISNI 0000 0004 0479 2981, GRID grid.490240.b, Zentrum Radiologie der Niels-Stensen-Kliniken; Marienhospital Osnabrück, ; Bischofsstraße 1, 49074 Osnabrück, Germany

[6 ]ISNI 0000 0001 0211 9062, GRID grid.491786.5, Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, ; Salvador-Allende-Straße 30, 17036 Neubrandenburg, Germany

[7 ]Brust-Zentrum Zürich, Seefeldstr. 214, 8008 Zurich, Switzerland

[8 ]ISNI 0000 0004 0479 0855, GRID grid.411656.1, Interventional and Pediatric Radiology, Department of Diagnostic, , Inselspital, University Hospital Bern, ; Freiburgstrasse 10, 3010 Bern, Switzerland

[9 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, , Medical University of Vienna, ; Währinger Gürtel 18-20, 1090 Vienna, Austria

[10 ]ISNI 0000 0004 1936 973X, GRID grid.5252.0, Department of Radiology, University Hospital, , Ludwig Maximilian University Munich, ; Marchioninistr. 15, 81377 Munich, Germany

[11 ]ISNI 0000 0004 1757 1758, GRID grid.6292.f, Department of Biomedical and Neuromotor Sciences, Unit of Anatomic Pathology at Bellaria Hospital, , University of Bologna, ; Via Altura 3, 40139 Bologna, Italy

[12 ]ISNI 0000 0004 1937 0642, GRID grid.6612.3, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, , University of Basel, ; Petersgraben 4, 4031 Basel, Switzerland

[13 ]ISNI 0000 0001 2294 4705, GRID grid.413349.8, Breast Center St. Gallen, , Cantonal Hospital St. Gallen, ; Rorschacher Str. 95, 9007 St. Gallen, Switzerland

[14 ]ISNI 0000 0004 1784 3645, GRID grid.440907.e, Imaging Department, Institut Curie, , PSL Research University, ; Paris, France

[15 ]Division of Radiology, Breast Center Bern (Brustzentrum Bern), Klinik Engeried, Lindenhofgruppe AG, Riedweg 15, 3012 Bern, Switzerland

[16 ]ISNI 0000 0004 0478 9977, GRID grid.412004.3, Institute of Diagnostic and Interventional Radiology, , University Hospital Zurich, ; Rämistr. 100, 8091 Zurich, Switzerland

[17 ]ISNI 0000 0004 0478 9977, GRID grid.412004.3, Institute of Pathology and Molecular Pathology, , University Hospital Zurich, ; Switzerland Schmelzbergstrasse 12., 8091 Zurich, Switzerland

[18 ]Ringlikerstrasse 53, 8142 Uitikon Waldegg, Switzerland

Author information

Christoph J. Rageth http://orcid.org/0000-0001-9117-2825

Article

Publisher ID: 5071

DOI: 10.1007/s10549-018-05071-1

PMC ID: 6538569

PubMed ID: 30506111

SO-VID: d84c67f1-1f3f-42da-8256-0f9f1c63d8db

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 21 November 2018

Date accepted : 23 November 2018

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: b3 lesions,vacuum-assisted biopsy,consensus,breast,uncertain malignant potential,breast surgery

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: b3 lesions, vacuum-assisted biopsy, consensus, breast, uncertain malignant potential, breast surgery

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

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Conclusions

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Karger: Oncology

Most cited references 87

European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document.

Adhesion molecule signalling: not always a sticky business.

Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data.

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