B3 category in breast core needle biopsy – Observation or surgical treatment?

Abstract

Ultrasound imaging of the breast is an essential part of comprehensive gynecologic patient care. In many countries, gynecologists and gynecologic oncologists not only perform ultrasound scans, but also carry out histopathological verification of breast focal lesions with the use of various biopsy techniques. Histopathological diagnoses of the B3 category, i.e. lesions of uncertain malignant potential, are the most controversial. They primarily include intraductal papilloma, atypical ductal hyperplasia, atypical lobular hyperplasia, classic lobular carcinoma in situ, flat epithelial atypia, phyllodes tumor, radial scar and complex sclerosing lesion. Despite their benign histological nature, these pathologies may accompany malignant hyperplasia, and a diagnosis established on the basis of the biopsy material carries a certain risk of underestimation. In this paper, we reviewed literature concerning further treatment of patients following a core needle biopsy or a vacuum-assisted biopsy diagnosis of B3 lesions. According to the literature data, such treatment is not uniform and depends not only on the lesion type, but also on the method used to verify it. Each time, it is also recommended to carry out a thorough clinical and pathological correlation and an assessment of how representative the specimens are. It has been shown that not all patients must be selected for surgery, and an increasing number of publications indicate the possibility of maintaining only an imaging follow-up program.