ORIGINAL ARTICLE   

Il Giornale Italiano di Radiologia Medica 2018 Novembre-Dicembre;5(6):712-7

DOI: 10.23736/S2283-8376.18.00129-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

B3 lesions undergoing tomobiopsy-guided VABB: is mammographic finding a predictor of malignancy?

Isabella DE SERIO ✉, Katerina JERMAN, Viviana LONDERO, Chiara ZUIANI

Dipartimento di Area Medica, Istituto di Radiologia, Università di Udine, Udine, Italia

BACKGROUND: Breast borderline lesions (B3) demonstrate a malignancy upgrade ranging from 9% to 35% on subsequent surgical excision (SE). Our purpose was to evaluate the existence of a mammographic (Mx) finding able to predict the likelihood of malignancy on SE in Mx B3 lesions, without an US correlate, that underwent tomobiopsy-guided vacuum-assisted breast biopsy (VABB).
METHODS: Between March 2015 and December 2017 we have retrospectively analyzed 64 B3 lesions (8 papillary lesions, 35 radial sclerosing lesions, 7 atypical ductal hyperplasia, 14 lobular neoplasia). Mx findings were divided into 6 categories (microcalcifications [M], architectural distorsions [DA], architectural distorsions with microcalcifications [DA+M], masses, masses with microcalcifications and masses with architectural distorsions) and were assessed according to BIRADS suspicion degree. The relation between Mx findings and malignancy upgrade rate was evaluated with exact Fisher test. We have calculated the different Mx findings’s positive predictive value (PPV) of malignancy related to BIRADS score (3 versus 4-5).
RESULTS: An overall upgrade rate of 13% (8/64) was observed for presence of malignancy at SE (5 intraductal carcinomas G1-G2, 2 intraductal carcinomas G3 and 1 invasive lobular carcinoma G2). A statistically significative (P=0.02) association was found between malignancy upgrade and lesions having DA+M as Mx finding. PPVs were 18% for M (2/11), 13% for DA (1/8) and 50% for DA+M (2/4). None of other Mx findings were upgraded to malignancy.
CONCLUSIONS: A higher, statistically significant, likelihood of upgrade, was found for B3 lesions that mammographically present as DA+M, with a PPV of 50% in case of BI-RADS 4-5.

KEY WORDS: Breast neoplasms - Mammography - Diagnosis