Outcomes of solid palpable masses assessed as BI-RADS 3 or 4A: a retrospective review

Patterson, Stephanie K.; Neal, Colleen H.; Jeffries, Deborah O.; Joe, Annette I.; Klein, Katherine A.; Bailey, Janet E.; Pinsky, Renee W.; Paramagul, Chintana; Watcharotone, Kuanwong

doi:10.1007/s10549-014-3109-1

Cited by 19 publications

(16 citation statements)

References 32 publications

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“…Our nomogram of the low-risk group was able to help 95.4% of patients avoid a biopsy, based only on a few essential factors, i.e., family history of breast cancer, US imaging features, and calcifications on MG imaging. A study by Patterson et al showed that breast cancer risk was higher in women aged >40 with BI-RADS 4A US lesions; however, this was not observed in our study (20). In the multivariate analyses, 6 variables were found to be independent predictors for malignant diagnosis, including a family history of breast cancer, US imaging features (i.e., margin, shape, orientation, lymph nodes), and calcifications on MG imaging.…”

Section: Discussioncontrasting

confidence: 89%

A new nomogram for predicting the malignant diagnosis of Breast Imaging Reporting and Data System (BI-RADS) ultrasonography category 4A lesions in women with dense breast tissue in the diagnostic setting

Yang¹,

Hu²,

Shen³

et al. 2021

Quant Imaging Med Surg

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Background: Biopsy has been recommended for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions. However, the malignancy rate of category 4A lesions is very low (2-10%). Therefore, most biopsies of category 4A lesions are benign, and the results will generally cause additional health care costs and patient anxiety. Methods: A prediction model was developed based on an analysis of 418 BI-RADS ultrasonography (US) category 4A patients at Sun Yat-sen Memorial Hospital. Univariate and multivariate logistic regression analyses were applied to identify significant variables for inclusion in the final nomogram. The predictive accuracy and discriminative ability were evaluated using the concordance index (C-index) and calibration curves. An independent cohort of 97 patients from the Second Affiliated Hospital of Guangzhou Medical University was used for external validation. Results: The independent risk factors from the multivariate analysis for the training cohort were family history of breast cancer (OR =4.588, P=0.004), US features [margin (OR =2.916, P=0.019), shape (irregular vs. oval, OR =2.474, P=0.044; round vs. oval, OR =1.935, P=0.276), parallel orientation vs. not parallel (OR =2.204, P=0.040)], low suspicious lymph nodes (OR =7.664, P=0.019), and suspicious calcifications on mammography (MG) (OR =6.736, P=0.001). The C-index was good in the training [0.813, 95% confidence interval (95% CI), 0.733 to 0.893] and validation cohorts (0.765, 95% CI, 0.584 to 0.946). The calibration curves showed optimal agreement between the nomogram prediction and actual observations for the probability of malignancy. Also, the cutoff score was set to 100 for discriminating high and low risk. The model performed well in discerning different risk groups.Conclusions: We developed a well-discriminated and calibrated nomogram to predict the malignancy of BI-RADS US category 4A lesions in dense breast tissue, which may help clinicians identify patients at lower or higher risk.

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Section: Discussioncontrasting

confidence: 89%

A new nomogram for predicting the malignant diagnosis of Breast Imaging Reporting and Data System (BI-RADS) ultrasonography category 4A lesions in women with dense breast tissue in the diagnostic setting

Yang¹,

Hu²,

Shen³

et al. 2021

Quant Imaging Med Surg

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“…In this age group, biopsy rather than followup is recommended in newly diagnosed breast lesions. This is because increasing age is a risk factor for developing breast cancer, as others have suggested [25,26]. Our data indicate that significantly fewer women with BI-RADS 5 lesions had a positive family history compared to women with BI-RADS 3 lesions.…”

supporting

confidence: 55%

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions

Ackermann

Schoenenberger

Zanetti-Dällenbach

2016

Ultrasound International Open

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Purpose: Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings could provide additional information that would help determine further diagnostic steps in breast lesions. Materials and Methods: We conducted a retrospective study by exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimally invasive breast biopsy (MIBB) from January 2002 to December 2011. Results: The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%, respectively. In 506 BI-RADS 3 lesions, histology revealed 15 malignancies (2.4% malignancy rate), which corresponds to a false-negative rate (FNR) of 2.6%. Clinical evaluation and patient requests critically influenced the further diagnostic procedure, thereby prevailing over the recommendation given by the BI-RADS 3 classification. Conclusion: Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures such as short-term follow-up or MIBB in patients with lesions classified as US-BI-RADS 3.

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“…These results are comparable to the study done by Patterson et al (2014) which showed no cancer in BIRADS 3 group on biopsy and the lesions showed stability on follow up imaging. The study done by Raza et al, (2008), although did show cancer in the BIRADS 3 masses, the number was very small (0.8%) and all were diagnosed on initial 6-month follow-up examination, also they were less than 1 cm in size and without positive axillary nodes.…”

Section: Discussionsupporting

confidence: 88%

Probably Benign Solid Breast Lesions on Ultrasound: Need for Biopsy Reassessed

Fatima

Masroor

Khanani

2018

Asian Pac J Cancer Prev

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Objective: To determine the negative predictive value of ultrasound for breast masses with probably benign morphology, and to assess whether follow-up may be an acceptable alternative to biopsy. Methods: After Institutional Review Board approval, all solid breast masses categorized as probably benign (American College of Radiology Breast Imaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and having either tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillance were included. Result: A total of 157 lesions in 40 patients constituted the study population. The mean patient age was 31.3 years (range, 20-56 years). Seventeen of these 157 lesions underwent tissue diagnosis with no invasive breast cancer. Out of the remaining 140 lesions, 115 were stable on imaging for 24 months or more. The rest 25 were deemed benign because of decrease in size on follow up (n=1), non-recommendation of further imaging by the second radiologist on follow up ultrasound (n= 13) or presence of benign tissue diagnosis in the largest lesion (n=11). Conclusion: Ultrasound has 100% negative predictive value for breast lesions with probably benign morphology, whether palpable or not. Follow up is an appropriate option to immediate biopsy of such lesions keeping in mind that noncompliance with surveillance may be a potential problem.

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Outcomes of solid palpable masses assessed as BI-RADS 3 or 4A: a retrospective review

Cited by 19 publications

References 32 publications

A new nomogram for predicting the malignant diagnosis of Breast Imaging Reporting and Data System (BI-RADS) ultrasonography category 4A lesions in women with dense breast tissue in the diagnostic setting

A new nomogram for predicting the malignant diagnosis of Breast Imaging Reporting and Data System (BI-RADS) ultrasonography category 4A lesions in women with dense breast tissue in the diagnostic setting

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions

Probably Benign Solid Breast Lesions on Ultrasound: Need for Biopsy Reassessed

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