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ARTÍCULO ORIGINAL Subestimación diagnóstica en lesiones B3 Luisina Heredia María Paz Pulido Débora Quintana Martina Cantando Francisca Kuhn Camila Ramundo
Resumen Introducción Las lesiones de potencial maligno incierto (B3) son un grupo
heterogéneo de anormalidades mamarias con riesgo variable de
malignidad. Incluyen hiperplasia ductal atípica(HDA), atipia
epitelial plana(AEP), neoplasia lobulillar, lesiones papilares(LP),
tumores phyllodes benignos (TP) y cicatriz radiada. Su manejo es un
desafío debido a la subestimación diagnóstica variable. Se buscan
alternativas a la escisión quirúrgica, como la biopsia asistida por
vacío, para reducir la subestimación y evitar procedimientos
innecesarios.Objetivos Evaluar distintas variables que puedan contribuir a dicha subestimación. Materiales y métodos Se realizó un estudio retrospectivo con 17 pacientes con lesiones B3 sometidas a biopsia percutánea y cirugía posterior entre enero de 2017 y febrero de 2024. Se analizaron variables clínico-patológicas y anatomopatológicas. Resultados Del total, 8 (47%) presentaron HDA en la biopsia, 7 (41,2%) LP, 1 (5,9%) AEP y 1 (5,9%) TP. Los hallazgos de las piezas quirúrgicas fueron 6 (35,3%) carcinomas ductales in situ, 7 (41,1%) LP, 2 (11,8%) HDA, 1 (5,9%) AEP y 1 (5,9%) TP. De nuestras pacientes, un 35% (n=6) presentó subestimación diagnóstica en la biopsia percutánea. Discusión Conclusiones El 35% de nuestras pacientes con lesiones B3 presentaron subestimación diagnóstica en biopsia percutánea, especialmente en HDA (62,5%). Se sugiere considerar la escisión quirúrgica y seguir investigando estrategias diagnósticas.
Abstract Introduction Lesions of uncertain malignant potential (B3) are a heterogeneous group of breast abnormalities with varying risk of malignancy. They include atypical ductal hyperplasia (ADH), squamous epithelial atypia (SEA), lobular neoplasia, papillary lesions (PL), benign phyllodes tumors (BPT), and radiated scarring. Their management is challenging due to variable diagnostic underestimation. Alternatives to surgical excision, such as vacuum-assisted biopsy, are being sought to reduce underestimation and avoid unnecessary procedures. Objectives To analyze the diagnostic underestimation of B3 lesions at Clínica Pueyrredón Mar del Plata. To evaluate different variables that may contribute to this underestimation. Materials and Methods A retrospective study was conducted with 17 patients with B3 lesions who underwent percutaneous biopsy and subsequent surgery between January 2017 and February 2024. Clinicopathological and pathological variables were analyzed. Results Of the total, 8 (47%) had HDA on biopsy, 7 (41.2%) had PF, 1 (5.9%) had PSA, and 1 (5.9%) had PT. Surgical specimen findings were 6 (35.3%) ductal carcinoma in situ, 7 (41.1%) had PF, 2 (11.8%) HDA, 1 (5.9%) PSA, and 1 (5.9%) PT. Of our patients, 35% (n=6) had diagnostic underestimation on percutaneous biopsy. Discussion B3 lesions may present diagnostic underestimation in percutaneous biopsies. In this study, 35% of patients had diagnostic underestimation, primarily in core biopsies, with 62.5% in HDA and 14.3% in LP. Conclusions Thirty-five percent of our patients with B3 lesions had diagnostic underestimation in percutaneous biopsy, especially in HDA (62.5%). We suggest considering surgical excision and further investigating diagnostic strategies.
Palabras clave: Biopsia - Patología - Mama Keywords: Biopsy - Pathology - Breast Fecha de recepción: 28/04/2025 Fecha de aceptación: 27/05/2025
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