B3 Lesions: Radiological Assessment and Multi-Disciplinary Aspects

Area of Science:

• Breast pathology
• Oncology
• Radiology

Background:

• B3 lesions are histopathologically diverse, classified as benign but of unknown biological potential.
• These lesions can indicate risk for either breast or act as non-obligatory precursors to malignancy.
• Percutaneous biopsy carries an inherent risk of underestimating the true nature of B3 lesions.

Purpose of the Study:

• To present the imaging and histopathological appearances of B3 lesions.
• To delineate the associated malignancy risk for different B3 lesion subtypes.
• To guide management decisions, including excision versus surveillance, based on risk stratification.

Main Methods:

• Review of imaging findings associated with B3 lesions.
• Analysis of histopathological features to categorize B3 lesions.
• Correlation of histopathological subtypes with malignancy risk.
• Evaluation of current international guidelines for B3 lesion management.

Main Results:

• High-risk B3 lesions (e.g., atypical ductal hyperplasia, LIN 3, atypical papillary lesions) typically require excision.
• Intermediate-risk lesions (e.g., LIN 2, flat epithelial atypia) and low-risk lesions (e.g., RSLs, non-atypical papillary lesions) have varying management recommendations.
• LIN 1 is often an incidental finding primarily serving as a risk indicator.

Conclusions:

• Management of B3 lesions requires individualized assessment considering lesion characteristics, patient risk factors, and biopsy adequacy.
• Vacuum-assisted breast biopsy (VABB) may allow for surveillance in select low-risk cases, potentially avoiding surgery.
• Further data collection and diligent evaluation are crucial for refining risk assessment and optimizing treatment strategies to prevent overtreatment.