Marotti, L. (Lorenza)

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    European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO
    (Elsevier, 2024) Zambon, M. (Marzia); Camps, J. (J.); Sardanelli, F. (Francesco); Marotti, L. (Lorenza); Schoones, J.W. (Jan W.); Catanuto, G. (Giuseppe); Smidt, M. (Marjolein); Dietz, J. (Jill); Sharma, N. (Nisha); Shaaban, A.M. (Abeer M.); Regitnig, P. (Peter); Athanasiou, A. (Alexandra); Santini, D. (Donatella); Gilbert, F. (Fiona); Varga, Z. (Zsuzsanna); Wyld, L. (Lynda); Rubio, I.T. (Isabel T.)
    Introduction Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. Methods These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. Results Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. Conclusions These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.
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    The requirements of a specialist breast centre
    (Elsevier, 2020) Erdem, S. (Sema); Ponti, A. (Antonio); Fjell, M. (Maria); Coles, C.E. (Charlotte E.); Poortmans, P. (Philip); Cardoso, F. (Fatima); Geiss, R. (Romain); Cataliotti, L. (Luigi); Costa, A. (Alberto); Goossens, M. (Mathijs); Palussiere, J. (Jean); Marotti, L. (Lorenza); Saarto, T. (Tiina); Sousa, B. (Berta); Naredi, P. (Peter); Sapino, A. (Anna); Beishon, M. (Marc); Delgado-Bolton, R. (Roberto C.); Rosselli-Del-Turco, M. (Marco); Cameron, D. (David); Oberst, S. (Simon); Skelin, M. (Marko); Kuhl, C. (Christiane); Biganzoli, L. (Laura); Die-Trill, M. (Maria); Senkus-Konefka, E. (Elzbieta); Rubio, I.T. (Isabel T.)
    This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. • The centrepiece of this article is the requirements section, comprising definitions; multidisciplinary structure; minimum case, procedure and staffing volumes; and detailed descriptions of the skills of, and resources needed by, members and specialisms in the multidisciplinary team in a breast centre. • These requirements are positioned within narrative on European breast cancer epidemiology, the standard of care, challenges to delivering this standard, and supporting evidence, to enable a broad audience to appreciate the importance of establishing these requirements in specialist breast centres.