Clinical Guidelines from the 2025 International Symposium on Breast Diseases of Inland São Paulo: Imaging Assessment and Management of B3 Breast Lesions
DOI:
https://doi.org/10.29289/2594539420250031Keywords:
breast cancer, magnetic resonance imaging, vacuum-assisted excision, B3 lesions, dense breasts, high risk screeningAbstract
Objective: To establish evidence-based clinical guidelines from the 2025 International Symposium on Breast Diseases of Inland São Paulo (SIMIP 2025), addressing four key axes of breast cancer diagnosis and management: indications for preoperative magnetic resonance imaging (MRI), vacuum-assisted excision (VAE) for B3 lesions (breast lesions of uncertain malignant potential), supplemental imaging for dense breasts, and the preferred imaging modality (contrast-enhanced mammography [CEM] or MRI) for high-risk women. Methods: Each axis was presented in evidence-based lectures, followed by debates and anonymous electronic voting by 100 specialists. Consensus was defined as ≥75% agreement. Results: Preoperative MRI was recommended for selected cases (100% in favor), including invasive lobular carcinoma, dense breasts, and occult carcinoma. VAE for B3 lesions received 98% support, except for phyllodes tumors and papillary lesions with atypia. Supplemental imaging for dense breasts was unanimously endorsed (64% preferred MRI, 36% voted for ultrasound). For high-risk women, MRI was chosen by 100%, with CEM as an alternative. Conclusion: The guidelines reinforce MRI for selected preoperative cases and high-risk screening, emphasize VAE as an effective approach for managing B3 lesions, and advocate for supplemental imaging (preferably MRI) for dense breasts, with multidisciplinary decision-making.
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Copyright (c) 2026 Eduardo Carvalho Pessoa, Fabio Bagnoli, Marcelo Madeira, Joaquim Teodoro Araujo Neto, Giuliano Tosello, Fabricio Brenelli, Beatriz Geronymo, Daniel de Araujo Buttros, Bruna Salani Mota, Henrique Lima Couto, Benedito de Sousa Almeida Filho, Gustavo Machado Badan, Augusto Tufi Hassan
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