BACKGROUND: Breast lesions of uncertain malignant potential, also known as B3 lesions, represent a heterogeneous group of tumors with variable malignancy risk. Surgical excision should be considered depending on clinical, radiological and histological features, family history and following informed consent. The aim of the present paper is to evaluate the positive predictive value (PPV) of diagnosis of malignancy in surgically excised B3 lesions in order to identify possible predictive upgrade criteria. We mainly focused on disclosing the concordance rate between tissue biopsy and final surgical pathology and correlation between radiology and pathology. METHODS: Between January 2018 and December 2021, 83 patients undergoing ultrasound guided tru-cut needle biopsy or VABB with a B3 diagnosis and surgical excision following multidisciplinary discussion were retrospectively reviewed in our Breast Unit. RESULTS: Out of a total of 83 cases with a B3 diagnosis before surgery, atypical ductal hyperplasia accounted for 29/83 cases(34.93%) and the most part of patients presented nodular lesions (n = 34/83, 40.96%). Among the 15 cases of malignancy detected after surgery, micro calcifications were registered in 53.3% of patients on mammography (n = 8/15). CONCLUSION: We assessed the correlation between radiological and pathological criteria in order to guide risk stratification and ensure adequate patient management. Correspondence between histological diagnosis, imaging and type of diagnostic biopsy were evaluated. No statistically significant predictors were identified for the parameters assessed in our study.