The incidence of cancer in high-risk breast lesions—improved diagnostics and optimized treatment
Valter Åkerman, Andrada RömeAbstract
Introduction
B3 breast lesions constitute a heterogeneous group with uncertain malignant potential. While most lesions are benign, a subset is upgraded to ductal carcinoma in situ (DCIS) or invasive carcinoma at surgical excision. Identifying predictors of malignant upgrade is crucial to optimize patient management and avoid over- or undertreatment. This study aimed to assess the rate of malignant upgrade among patients with B3 lesions at Skåne University Hospital and to identify demographic, radiologic, and pathological factors associated with upgrade.
Methods
This retrospective study included 199 patients who underwent surgical excision for B3 lesions between January 2022 and December 2023 at the Department of Surgery, Skåne University Hospital, Malmö. Demographic, radiologic, and pathological data were retrieved from medical records. Statistical analyses were performed using SPSS, applying chi-square tests and logistic regression to evaluate associations with malignant upgrade.
Results
The overall upgrade rate to DCIS or invasive carcinoma at surgical excision was 19.1%. Increasing age and postmenopausal status were significantly associated with malignant upgrade. Surprisingly, benign ultrasound classification (U1–U2) was linked to higher upgrade rates. Additionally, vacuum-assisted biopsy (VAB) was significantly associated with malignant outcome.
Discussion
B3 breast lesions carry a considerable risk of underlying malignancy. Demographic factors, ultrasound findings, and biopsy method were all significantly associated with malignant upgrade. These results underline the importance of a multidisciplinary approach integrating clinical, radiologic, and pathological information in the management of B3 lesions. Further studies should focus on subtype-specific risk stratification and clarify the role of minimally invasive diagnostic strategies to support individualized treatment decisions.