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Abstract：
The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.
摘要：
乳腺B3病变的异质性组具有不同的恶性潜能和进展风险。由于自2018年上一次共识以来已经发表了几项关于B3病变的研究，第三届国际共识会议讨论了六个最相关的B3病变（非典型导管增生（ADH），扁平上皮异型（FEA），经典小叶瘤形成（LN），放射状疤痕(RS),乳头状病变（PL）无异型，和叶状肿瘤（PT）），并提出了诊断和治疗方法的建议。在展示每个B3病变的当前数据后，由33名专家和主要意见领袖组成的国际和跨学科小组对芯针活检(CNB)和真空辅助活检(VAB)后的进一步治疗建议进行了投票.在CNB上诊断为B3病变的情况下，在ADH和PT中推荐OE，而在其他B3病变中，真空辅助切除被认为是替代OE的等效方法。在ADH中，大多数小组成员（76％）建议在VAB诊断后进行开放切除术（OE），而在成像上完全去除VAB后的观察结果被34%接受。在LN,大多数小组（90％）首选完全去除VAB后的观察结果。RS的结果相似（82%），PL（100%），和FEA（100％）。在良性PT中，一小部分（55％）还建议在完全去除VAB后进行观察。VAB和随后的主动监测可以取代大多数B3病变的开放式手术干预(RS，FEA,PL,PT,和LN）。与以前的建议相比，在经典的LN中，降级策略的趋势越来越大。由于升级为恶性肿瘤的风险更高，OE仍然是诊断ADH后的首选方法。
