Audit of wide bore needle biopsies graded B3: does the final pathology justify the increasing rate of benign biopsy?

A recent national audit of the West of London Breast Screening Service showed an increased rate of benign biopsy. This may be related to the increasing rate of wide bore needle (WBN) biopsies graded as B3 (indeterminate). Common B3 pathologies include atypical ductal hyperplasia (ADH), columnar cell change with hyperplasia or atypia (CCC) and intraduct papilloma (IP). Previous studies have shown an association of these lesions with malignancy [1, 2]. Our practise is to recommend excision biopsy of these B3 lesions.

We retrospectively audited surgical excision biopsies of B3 lesions between April 2004 and April 2005, recording mammogram findings, patient demographics, WBN and surgical excision pathological diagnoses.

Twenty-five women age 50–70 (mean age 58) had excision biopsy of their B3 lesions; 64% were microcalcifications, 28% masses and the remainder distortions.

The 14G core biopsy pathology included 38% ADH, 16% atypical lobular hyperplasia, 16% CCC and 12% IP.

The surgical excision pathology available in 14 of these women showed ductal carcinoma in situ in seven and invasive ductal carcinoma in situ in three, justifying our practise. We discuss how the surgical pathology correlates with that of the WBN.