Does a second image-guided biopsy contribute to the management of B3 lesions?

Introduction

B3 (benign with uncertain malignant potential) lesions such as atypias and papillary lesions have final surgical outcome of malignancy in about 20% of vacuum-assisted and 45% of image-guided core biopsies. We examine the benefits of undertaking a second image-guided biopsy in these cases.

Methods

A retrospective study of all B3 lesions diagnosed between January 2008 and December 2009 at the North London Breast Screening Service.

Results

Out of 235 biopsies in 167 women over a 2-year period, there were 191 B3 outcomes of which 59 had a final malignant outcome (30.8%). Following MDT discussion, 60/191 B3 lesions were subjected to a second biopsy (25.5%) and one lesion a third biopsy. These yielded a malignant diagnosis in 11 (18.3%) cases. Lesions successfully upgraded to malignancy included three microcalcification (MCC), three masses, three masses with MCC and one cyst with solid elements. Cancers diagnosed on second biopsies were one invasive ductal, one invasive papillary carcinoma and nine ductal carcinoma in situ (DCIS). All second biopsies were performed using a vacuum device with the initial biopsy method being 14G core biopsy in eight cases and vacuum-assisted in three cases. Second biopsies were therefore equally useful in upgrading MCC and masses and especially useful for DCIS.

Conclusions

Second-time image-guided biopsies can successfully yield a definitive malignant diagnosis in B3 lesions (18.3%) and thus enable therapeutic rather than diagnostic surgery to be undertaken. Second biopsies are equally useful in the management of MCC, masses and masses with MCC.