{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:47:56Z","timestamp":1760237276041,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,3,26]],"date-time":"2020-03-26T00:00:00Z","timestamp":1585180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objective: The aim of this study was to externally validate the feasibility and robustness of a risk-stratification score for B3 lesions based on clinical, pathological, and radiological data for improved clinical decision making. Methods: 129 consecutive histologically confirmed B3 lesions diagnosed at ultrasound-guided biopsy at our institution were included in this retrospective study. Patient- and lesion-related variables were independently assessed by two blinded breast radiologists (R1, R2), by assigning each feature a score from 0 to 2 (maximum sum-score of 5). Sensitivity, specificity, positive and negative predictive values were calculated at two different thresholds (\u22651 and 2). Categorical variables were compared using Chi-squared and Fisher exact tests. The diagnostic accuracy of the score to distinguish benign from malignant B3 lesions was assessed by receiver operating characteristic (ROC) analysis. Results: Surgery was performed on 117\/129 (90.6%) lesions and 11 of these 117 (9.4%) lesions were malignant. No cancers were found at follow-up of at least 24 months. Area under the ROC-curve was 0.736 (R1) to 0.747 (R2), with no significant difference between the two readers (p = 0.5015). Using a threshold of \u22651, a sensitivity, specificity, PPV, and NPV of 90%\/90% (R1\/R2), 39%\/38% (R1\/R2), 11%\/12% (R1\/R2) and 97%\/98% (R1\/R2) were identified. Both readers classified 47 lesions with a score \u22641 (low risk of associated malignancy). Of these, only one malignant lesion was underdiagnosed (Ductal carcinoma in situ-G1). Conclusions: In our external validation, the score showed a high negative predictive value and has the potential to reduce unnecessary surgeries or re-biopsies for ultrasound-detected B3-lesions by up to 39%.<\/jats:p>","DOI":"10.3390\/diagnostics10040181","type":"journal-article","created":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T09:04:38Z","timestamp":1585299878000},"page":"181","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["External Validation of a Risk Stratification Score for B3 Breast Lesions Detected at Ultrasound Core Needle Biopsy"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2226-4587","authenticated-orcid":false,"given":"Cristina","family":"Grippo","sequence":"first","affiliation":[{"name":"Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pooja","family":"Jagmohan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Clauser","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2505-4753","authenticated-orcid":false,"given":"Panagiotis","family":"Kapetas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annabel M.","family":"St\u00f6ger","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3755-5398","authenticated-orcid":false,"given":"Pascal A. T.","family":"Baltzer","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/j.1365-2559.2011.03786.x","article-title":"Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia","volume":"58","author":"Rakha","year":"2011","journal-title":"Histopathology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1046\/j.1365-2559.2003.01582.x","article-title":"Excision biopsy findings of patients with breast needle core biopsies reported as suspicious of malignancy (B4) or lesion of uncertain malignant potential (B3)","volume":"42","author":"Lee","year":"2003","journal-title":"Histopathology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.breast.2010.12.003","article-title":"Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): A large multi-institutional study in Italy","volume":"20","author":"Bianchi","year":"2011","journal-title":"Breast"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s10549-018-05071-1","article-title":"Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)","volume":"174","author":"Rageth","year":"2018","journal-title":"Breast Cancer Res. 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