Is there a high-risk mammographic pattern in b3 lesions?

Introduction: Breast lesions of uncertain malignant potential (B3) include different histopathological subtypes. Vacuum assisted biopsy (VAB) excision and surveillance have been more recently proposed as a valid alternative to the more traditional surgical approach. A significant association between radiological findings and malignancy in excision biopsy has not been proved as yet. Aim of this paper is to find a prevalent mammographic pattern for each histological B3 subtype in order to identify a “high-risk mammographic pattern”. Methods and materials: We retrospectively included all B3 patients referred from spontaneous screening to the Breast Radiology Service at the University Hospital of Sassari, Italy, from January 2012 to June 2018. All patients underwent a mammography and a histological characterization. Six different mammographic patterns and six histological subtypes were identified. Results: 69 patients were enrolled. Median (IQR) age was 50 (44-57) years; the majority of lesions was localized in the left breast (37, 53.6%). Clustered microcalcifications was the most prevalent mammographic pattern in our series, whereas ADH was the most common histological subtype. A prevalent mammographic pattern was found within each pathological subtype (p-value=0,02). Discussion: B3 subtypes, whose cellular atypia is the characteristic feature, showed clustered microcalcifications as their prevalent mammographic pattern (“high-risk mammographic pattern”). In this context, the VAB biopsy is likely to change the management of B3 lesions, assuming a therapeutic role too and, thus, reducing both biological and economic costs. Larger and multicentric studies are necessary to find a generalizable mammographic pattern for the lesser common B3 histological subtypes.