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Cancer Resources > Cancer News > Cancer News from Reuters > Reuters Cancer News > 2007 > May
Borderline breast core needle histology requires further evaluation
Will Boggs, MD
Last Updated: 2007-05-04 13:45:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) - One-third of breast core needle biopsy (CNB) specimens with borderline histology prove to be malignant, according to a report in the April 23rd issue of the British Journal of Cancer.
"We want physicians to keep in mind that a CNB diagnosis of a borderline (B3) lesion is not 'negative' for cancer, and, on the contrary, it is flagging that a further management/treatment step is needed," Dr. Nehmat Houssami and Dr. Stefano Ciatto told Reuters Health.
Dr. Houssami and Dr. Ciatto, from Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy and colleagues investigated outcomes for more than 300 women who had B3 breast CNB histology, indicating lesions of uncertain malignant potential.
Among the 279 women with B3 histology who underwent excisional biopsy, 61 showed ductal carcinoma in situ and 37 showed invasive carcinoma, the researchers report. The remaining 181 were benign.
Malignancy was most likely for core needle histology showing lobular intraepithelial neoplasia (60.9%) and least likely for core needle histology showing phyllodes tumor (12.5%), the results indicate.
The most frequent B3 lesion in the series was atypical ductal hyperplasia, and its presence was associated with a 44.7% positive predictive value of malignancy in excisional biopsies.
"When counseling a woman with a 'B3' CNB result, it is important that physicians do not excessively reassure the woman, since the 'B3' result is alerting us that the test is in fact 'abnormal' and more needs to be done to exclude a cancer," Drs. Houssami and Ciatto advised. "This should be balanced with some reassurance that approximately 1 in 3 will be malignant on excision (so it is more likely that the outcome will be benign)."
The added: "Research is needed to help modify our current approach of surgical management for almost all borderline core needle histology, thus minimizing unnecessary surgery in the majority of women with B3 on CNB who have benign disease."
Br J Cancer 2007;96:1253-1257.
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