Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy

Abstract

Objective To evaluate the BI-RADS as a predictive factor of suspicion for malignancy in breast lesions by correlating radiological with histological results and calculating the positive predictive value for categories 3, 4 and 5 in a breast cancer reference center in the city of São Paulo. Materials and Methods Retrospective, analytical and cross-sectional study including 725 patients with mammographic and/or sonographic findings classified as BI-RADS categories 3, 4 and 5 who were referred to the authors' institution to undergo percutaneous biopsy. The tests results were reviewed and the positive predictive value was calculated by means of a specific mathematical equation. Results Positive predictive values found for categories 3, 4 and 5 were respectively the following: 0.74%, 33.08% and 92.95%, for cases submitted to ultrasound-guided biopsy, and 0.00%, 14.90% and 100% for cases submitted to stereotactic biopsy. Conclusion The present study demonstrated high suspicion for malignancy in lesions classified as category 5 and low risk for category 3. As regards category 4, the need for systematic biopsies was observed.

Hyperechoic breast lesions: anatomopathological correlation and differential sonographic diagnosis

“…The analysis of sonographic characteristics has shown that non parallel orientation and non circumscribed margins are more frequently found in malignant hyperechoic nodules than in benign ones. Such results suggest that the same sonographic characteristics utilized to evaluate hypo- or isoechoic nodules (such as spiculated margins, association with microcalcifications) should be applied in cases of hyperechoic nodules to differentiate between malignant and benign lesions ( 4 , 5 ) . Additionally, the presence of focal hypoechoic areas within hyperechoic findings increases the risk of malignancy ( 2 ) .…”

Predictive values of breast imaging reporting and data system category 3 breast masses submitted to percutaneous biopsy by ultrasonography

“…In our study, in addition to limiting the access to information regarding the need for biopsy, we can also cite: the access to the previous examinations (to evaluate image stability), the family or personal history of breast cancer, the lack of correlation with the mammographic findings, and, finally, information about the follow-up of these images with benign histopathology. Badan 24 and Raza et al 25 reported a PPV of 0 and of 0.8%, respectively, for malignancy for category 3 masses. They concluded that a conservative management of BI-RADS category 3 lesions on screening breast ultrasound would be adequate in order to avoid unnecessary biopsies.…”

“…The incidence of BI-RADS 3 lesions on US has been reported between 15.7 and 32.2%, and the malignancy rate between 0 and 2.6% [16][17][18] . Due to their high frequency and low probability of cancer, by both ultrasound screening and diagnosis, these nodules arouse in the professionals dedicated to breast radiology a great interest in improving their characterization and in establishing the most appropriate conduct [7][8][9][10][11][12][13][14][18][19][20][21][22][23][24] .…”

Exames De Imagem No Rastreio E Diagnóstico Do Câncer De Mama: Ressonância Magnética Das Mamas Em Face Da Mamografia

“…A ressonância magnética de mama não é depreciada pela quantidade ou densidade do tecido fibroglandular nem por tecido cicatricial (após tumorectomia por exemplo), implantes mamários de próteses ou outros tipos de reconstrução da mama, ou mesmo por radioterapia. (73) Atualmente, questiona se muito sobre a triagem que leva ao diagnóstico de um número elevado de cânceres de mama que jamais se tornariam clinicamente evidentes e nem potencialmente letais, desta forma, o emprego do rastreamento mamográfico implica em consequente aumento de achados considerados suspeitos e da prática de biópsias para confirmação. (74) Assim, apesar da alta sensibilidade e especificidade mamográfica, o valor preditivo positivo (VPP) das biópsias realizadas aponta malignidade em apenas 15-40% dos casos.…”