PREDICTIVE VALUES OF BREAST IMAGING REPORTING AND DATA SYSTEM CATEGORY 3 BREAST MASSES SUBMITTED TO PERCUTANEOUS BIOPSY BY ULTRASONOGRAPHY
Keywords:
breast neoplasms, diagnosis, biopsy, ultrasonographyAbstract
Introduction: Breast Imaging Reporting and Data System (BI-RADS) classification allows standardization of breast masses findings, with a recommendation for individualized management. Because of their high frequency, masses classified as 3, probably benign, arouse interest in improving their characterization and in establishing the most appropriate behavior. Objective: Firstly, to demonstrate the positive and negative predictive values of the BI-RADS 3 classification of solid masses submitted to percutaneous biopsy by ultrasonography. Secondly, to suggest a different ultrasound follow-up conduct in these findings. Methods: We retrospectively studied 480 BI-RADS 3 masses, submitted to a biopsy under vacuum or core biopsy, with a conclusive histopathological result considered the gold standard. Results: From 480 masses in 396 patients, 473 were benign and 7 malignant. The positive predictive value for malignancy of category 3 masses was 1.5% (7/480), and the negative predictive value was 98.5%. Conclusion: In view of the low probability of cancer, it is recommended the performance of directed ultrasonography (second look) of masses classified as BI-RADS 3 performed by a specialist in breast radiology before the indication of an invasive procedure, what would substantially reduce the number of unnecessary biopsies, patient’s anxiety, as well as costs and possible related complications. This will increase the possibility for the specialist to spend more time on really necessary and targeted examinations, better defining cases of follow-up (annual or biannual) of the indication of investigation in specific cases.
Downloads
References
Mendelson EB, Bohm-Velez M, Berg WA, Whitman GJ, Feldman MI, Madjar H, et al. ACR BI-RADS ultrasound. In: D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA, editors. ACR BI-RADS Atlas: Breast Imaging Reporting and Data System. Reston: American College of Radiology; 2013.
Lee KA, Talati N, Oudsema R, Steinberger S, Margolies LR. BI-RADS 3: Current and Future Use of Probably Benign. Curr Radiol Rep. 2018;6(2):5. https://doi.org/10.1007/s40134-018-0266-8
Jang JY, Kim SM, Kim JH, Jang MJ, Yun BL, Lee JY, et al. Clinical significance of interval changes in breast lesions initially categorized as probably benign on breast ultrasound. Medicine. 2017;96(12):e6415. https://doi.org/10.1097/MD.0000000000006415
Alimoglu E, Bayraktar SD, Bozkurt S, Ceken K, Kabaalioglu A, Apaydin A, et al. Follow-up versus tissue diagnosis in BI-RADS category 3 solid breast lesions at US: a cost-consequence analysis. Diagn Interv Radiol. 2012;18(1):3-10. https://doi.org/10.4261/1305-3825.DIR.4462-11.1
Kim SY, Han BK, Kim EK, Choi WJ, Choi Y, Kim HH, et al. Breast Cancer Detected at Screening US: Survival Rates and Clinical-Pathologic and Imaging factors Associated with Recurrence. Radiology. 2017;284(2):354-64. https://doi.org/10.1148/radiol.2017162348
Calas MJG, Koch HA, Dutra MVP. Ultra-sonografia mamaria: avaliacao dos criterios ecograficos na diferenciacao das lesoes mamarias. Radiol Bras. 2007;40(1):1-7. http://dx.doi.org/10.1590/S0100-39842007000100003
Calas MJG, Almeida RMVR, Gutfilen B, Pereira WCA. Interobserver concordance in the BI-RADS classification of breast ultrasound exams. Clinics. 2012;67(2):185-9. https://dx.doi.org/10.6061%2Fclinics%2F2012(02)16
Lee S, Jung Y, Bae Y. Synchronous BI-RADS Category 3 Lesions on Preoperative Ultrasonography in Patients with Breast Cancer: Is Short-Term Follow-Up Appropriate? J Breast Cancer. 2015;18(2):181-6. https://doi.org/10.4048/jbc.2015.18.2.181
Borders MH, Cheng L, Fitzpatrick KA, Krupinski EA. Patient Compliance in the Setting of BI‐RADS Category 3: What Factors Impact Compliance With Short‐Term Follow‐Up Recommendations? Breast J. 2016;23(1):77-82. https://doi.org/10.1111/tbj.12687
Gruber R, Jaromi S, Rudas M, Pfari G, Riedl CC, Flory D, et al. Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3). Eur J Radiol. 2013;82(3):398-403. https://doi.org/10.1016/j.ejrad.2012.02.004
Moon HJ, Kim MJ, Yoon JH, Kim EK. Follow-up interval for probably benign beast lesion on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol. 2018;59(9):1045-50. https://doi.org/10.1177/0284185117745906
Kapsimalakou S, Waldmann A, Katalinic A, Grande-Nagel I, Fischer D, Barkhausen J, et al. Follow-up of probably benign lesions in non-screening breast diagnostics. Arch Gynecol Obstet. 2014;290(3):543-51. https://doi.org/10.1007/s00404-014-3233-5
Sickles EA. Probably benign breast lesions: when should follow-up be recommended and what is the optimal follow-up protocol? Radiology. 1999;213(1):11-4. https://doi.org/10.1148/radiology.213.1.r99oc4611
Chala L, Endo E, Kim S, Castro F, Moraes P, Cerri G, et al. Grayscale sonography of solid breast masses: diagnosis of probably benign masses and reduction of the number of biopsies. J Clin Ultrasound. 2007;35(1):9-19. https://doi.org/10.1002/jcu.20298
Elverici E, Zengin B, Barca AN, Yilmaz PD, Alimli A, Araz L. Interobserver and intraobserver agreement of sonographic BIRADS lexicon in the assessment of breast masses. Iran J Radiol. 2013;10(3):122-7. https://dx.doi.org/10.5812%2Firanjradiol.10708
Graf O, Helbich TH, Hopf G, Graf C, Sickles EA. Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy? Radiology. 2007;244(1):87-93. https://doi.org/10.1148/radiol.2441060258
Berg WA, Zhang Z, Cormack JB, Mendelson EB. Multiple Bilateral Circumscribed Masses at Screening Breast US: Consider Annual Follow-up. Radiology. 2013;268(3):673-83. https://doi.org/10.1148/radiol.13122251
Kim K, Song MK, Kim E-K, Yoon JH. Clinical application of S-Detect to breast masses on ultrasonography: a study evaluating the diagnostic performance and agreement with a dedicated breast radiologist. Ultrasonography. 2017;36(1):3-9. https://doi.org/10.14366/usg.16012
Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 1995;196(1):123-34. https://doi.org/10.1148/radiology.196.1.7784555
Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology. 2013;269(3):701-12. https://doi.org/10.1148/radiol.13122829
Nam SY, Ko EY, Han B-K, Shin JH, Ko ES, Hahn SY. Breast Imaging Reporting and Data System Category 3 Lesions Detected on Whole-Breast Screening Ultrasound. J Breast Cancer. 2016;19(3):301-7. https://dx.doi.org/10.4048%2Fjbc.2016.19.3.301
Park YM, Kim EK, Lee JH, Ryu JH, Han SS, Choi SJ, et al. Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 2008;49(10):1104-11. https://doi.org/10.1080/02841850802438504
Ha SM, Chae EY, Cha JH, Shin HJ, Choi WJ, Kim HH. Growing BI-RADS category 3 lesions on follow-up breast ultrasound: malignancy rates and worrisome features. Br J Radiol. 2018;91(1087):20170787. https://doi.org/10.1259/bjr.20170787
Badan GM, Roveda Junior D, Ferreira CAP, Ferreira FAT, Fleury EFC, Campos MSCA, et al. Valores preditivos positivos das categorias 3, 4 e 5 do Breast Imaging Reporting and Data System (BI-RADS®) em lesoes mamarias submetidas a biopsia percutanea. Radiol Bras. 2013;46(4):209-13. http://dx.doi.org/10.1590/S0100-39842013000400006
Raza S, Chikarmane SA, Neilsen SS, Zorn LM, Birdwell RL. BIRADS 3, 4, and 5 lesions: value of US in management: followup and outcome. Radiology. 2008;248(3):773-81. https://doi.org/10.1148/radiol.2483071786
Abdullah N, Mesurolle B, El-Khoury M, Kao E. Breast Imaging Reporting and Data System Lexicon for US: Interobserver Agreement for Assessment of Breast Masses. Radiology. 2009;252(3):665-672. https://doi.org/10.1148/radiol.2523080670
Shin JH, Han BK, Ko EY, Choe YH, Nam SJ. Probably benign breast masses diagnosed by sonography: is there a difference in the cancer rate according to palpability? AJR Am J Roentgenol. 2009;192(4):W187-91. https://doi.org/10.2214/AJR.08.1404
Calas MJG, Almeida RMVR, B. Gutfilen B, Pereira WCA. Intraobserver interpretation of breast ultrasonography following the BI-RADS classification. Eur J Radiol. 2010;74(3):525-8. https://doi.org/10.1016/j.ejrad.2009.04.015
Kim SJ, Chang JM, Cho N, Chung SY, Han W, Moon WK. Outcome of breast lesions detected at screening ultrasonography. Eur J Radiol. 2012;81(11):3229-33. https://doi.org/10.1016/j.ejrad.2012.04.019
Ackermann S, Schoenenberger C-A, Zanetti-Dallenbach R. Clinical Data as an Adjunct to Ultrasound Reduces the False- Negative Malignancy Rate in BI-RADS 3 Breast Lesions. Ultrasound International Open. 2016;2(3):E83-9. https://dx.doi.org/10.1055%2Fs-0042-110657
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Leticia Pereira Gonçalves, Mariana Loureiro Lemos, Maria Julia Gregorio Calas
This work is licensed under a Creative Commons Attribution 4.0 International License.
