PB.31: B3 lesions and vacuum-assisted biopsy: a national survey to gauge current practice

Introduction

Breast screening detects asymptomatic abnormalities which occasionally on biopsy are classified indeterminate (B3). Such lesions have malignant potential and traditionally are subject to open diagnostic excision biopsy. Vacuum-assisted biopsy (VAB) offers larger representative tissue sampling, and may act as a therapeutic measure completely excising the lesion. The use of VAB in the NHSBSP varies widely. Currently there are no relevant national guidelines to streamline practice.

Methods

A survey was sent to 80 screening units throughout England, comprising seven questions concerning the use of VAB for B3 lesions.

Results

Fifty-four responses (67.5%) were received. Twenty-two per cent of units do not perform VAB, 55% perform first-line and 77.8% second-line VAB. For B3 lesions without atypia, 68% would proceed to second-line VAB whilst 25% advocate open diagnostic excision following initial (14G) core. Management of B3 lesions with atypia was more discordant, with the majority of units opting for second-line VAB for FEA, ALH and LCIS, and second-line diagnostic excision for radial scars, ADH (atypical intraductal proliferation) and papillomas with atypia. Following first-line VAB, most units would proceed to diagnostic excision rather than second-line VAB.

Conclusion

Management of B3 lesions varies significantly across screening units. There is no concordance in the use of VAB for diagnosis or management of B3 lesions. Whilst there is a trend toward second-line VAB for atypias, significant numbers still opt for diagnostic excision. Consensual national guidelines to standardise and guide management would provide equity of care for this difficult management entity.