Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Christoph J Rageth^{1

2}, Elizabeth A M O'Flynn³, Katja Pinker⁴, Rahel A Kubik-Huch⁵, Alexander Mundinger⁶, Thomas Decker⁷, Christoph Tausch⁸, Florian Dammann⁹, Pascal A Baltzer¹⁰, Eva Maria Fallenberg¹¹, Maria P Foschini¹², Sophie Dellas¹³, Michael Knauer¹⁴, Caroline Malhaire¹⁵, Martin Sonnenschein¹⁶, Andreas Boos¹⁷, Elisabeth Morris⁴, Zsuzsanna Varga¹⁸

Affiliations

¹ Département de Gynécologie et d'Obstétrique, Centre du sein, Hôpitaux Universitaires de Genève, Bd de la Cluse 30, 1211, Geneva 14, Switzerland. jcr@2cr.ch.
² , Ringlikerstrasse 53, 8142, Uitikon Waldegg, Switzerland. jcr@2cr.ch.
³ The Rose Centre, St George's University Hospitals NHS Foundation Trust, Perimeter Road, London, SW17 0QT, UK.
⁴ Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA.
⁵ Department of Medical Services, Institute of Radiology, Kantonsspital Baden, im Ergel, 5404, Baden, Switzerland.
⁶ Zentrum Radiologie der Niels-Stensen-Kliniken; Marienhospital Osnabrück, Bischofsstraße 1, 49074, Osnabrück, Germany.
⁷ Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, Salvador-Allende-Straße 30, 17036, Neubrandenburg, Germany.
⁸ Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland.
⁹ Interventional and Pediatric Radiology, Department of Diagnostic, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
¹⁰ Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
¹¹ Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany.
¹² Department of Biomedical and Neuromotor Sciences, Unit of Anatomic Pathology at Bellaria Hospital, University of Bologna, Via Altura 3, 40139, Bologna, Italy.
¹³ Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
¹⁴ Breast Center St. Gallen, Cantonal Hospital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland.
¹⁵ Imaging Department, Institut Curie, PSL Research University, Paris, France.
¹⁶ Division of Radiology, Breast Center Bern (Brustzentrum Bern), Klinik Engeried, Lindenhofgruppe AG, Riedweg 15, 3012, Bern, Switzerland.
¹⁷ Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
¹⁸ Institute of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland Schmelzbergstrasse 12., 8091, Zurich, Switzerland.

PMID: 30506111
PMCID: PMC6538569
DOI: 10.1007/s10549-018-05071-1

Review

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Christoph J Rageth et al. Breast Cancer Res Treat. 2019 Apr.

. 2019 Apr;174(2):279-296.

doi: 10.1007/s10549-018-05071-1. Epub 2018 Nov 30.

Authors

Affiliations

¹ Département de Gynécologie et d'Obstétrique, Centre du sein, Hôpitaux Universitaires de Genève, Bd de la Cluse 30, 1211, Geneva 14, Switzerland. jcr@2cr.ch.
² , Ringlikerstrasse 53, 8142, Uitikon Waldegg, Switzerland. jcr@2cr.ch.
³ The Rose Centre, St George's University Hospitals NHS Foundation Trust, Perimeter Road, London, SW17 0QT, UK.
⁴ Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA.
⁵ Department of Medical Services, Institute of Radiology, Kantonsspital Baden, im Ergel, 5404, Baden, Switzerland.
⁶ Zentrum Radiologie der Niels-Stensen-Kliniken; Marienhospital Osnabrück, Bischofsstraße 1, 49074, Osnabrück, Germany.
⁷ Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, Salvador-Allende-Straße 30, 17036, Neubrandenburg, Germany.
⁸ Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland.
⁹ Interventional and Pediatric Radiology, Department of Diagnostic, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
¹⁰ Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
¹¹ Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany.
¹² Department of Biomedical and Neuromotor Sciences, Unit of Anatomic Pathology at Bellaria Hospital, University of Bologna, Via Altura 3, 40139, Bologna, Italy.
¹³ Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
¹⁴ Breast Center St. Gallen, Cantonal Hospital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland.
¹⁵ Imaging Department, Institut Curie, PSL Research University, Paris, France.
¹⁶ Division of Radiology, Breast Center Bern (Brustzentrum Bern), Klinik Engeried, Lindenhofgruppe AG, Riedweg 15, 3012, Bern, Switzerland.
¹⁷ Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
¹⁸ Institute of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland Schmelzbergstrasse 12., 8091, Zurich, Switzerland.

PMID: 30506111
PMCID: PMC6538569
DOI: 10.1007/s10549-018-05071-1

Erratum in

Correction to: Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).
Rageth CJ, O'Flynn EAM, Pinker K, Kubik-Huch RA, Mundinger A, Decker T, Tausch C, Dammann F, Baltzer PA, Fallenberg EM, Foschini MP, Dellas S, Knauer M, Malhaire C, Sonnenschein M, Boos A, Morris E, Varga Z. Rageth CJ, et al. Breast Cancer Res Treat. 2019 Jul;176(2):481-482. doi: 10.1007/s10549-019-05287-9. Breast Cancer Res Treat. 2019. PMID: 31152325 Free PMC article.

Abstract

Purpose: The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations.

Methods: This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy.

Results: In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 (p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 (p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (p = 0.07)].

Conclusions: Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.

Keywords: B3 lesions; Breast; Breast surgery; Consensus; Uncertain malignant potential; Vacuum-assisted biopsy.

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Conflict of interest statement

The authors declare that they have no conflict of interest in the context of this publication.

References

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Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Affiliations

Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

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