Risk factors of breast malignant lesions in patients with ultrasound BI-RADS 3, 4a and 4b undergoing Mammotome minimally invasive surgery

Abstract

Background To sort out the basic data and imaging examination results of the patients who underwent the Mammotome minimally invasive surgery, and explore the high-risk underlying factors related to cancerization, in order to optimize the minimally invasive surgery population, and reduce the malignant rate. Methods A total of 1188 female patients who came to our hospital from November 2016 to August 2021 for the Mammotome minimally invasive surgery were analyzed retrospectively. According to the inclusion criteria, the clinical data of 1158 patients and 2164 lesions were finally obtained. We summarized the benign and malignant lesions of BI-RADS category 3, BI-RADS category 4a and BI-RADS category 4b by conventional ultrasound, and got 1562, 578 and 24 lesions respectively. By analyzing the clinical basic data, imaging features and pathological diagnosis of patients, the differences between benign and malignant lesions of these three types were evaluated. Results The malignant rates of BI-RADS category 3, BI-RADS category 4a and BI-RADS category 4b patients who underwent the Mammotome minimally invasive surgery were 0.6%(9/1562), 6.4%(37/578) and 8.3%(2/24) respectively. According to statistics, the age of patients with BI-RADS category 3 is generally younger than that of patients with category 4a and category 4b. Comparing all the three types of lesions in pairs, we found that there were statistical differences in the presence or absence of blood flow signals and the status of calcified lesions, among which category 4b blood flow signal accounted for the highest proportion. Among the category 3 of lesions, we also found that the age of menarche in patients with malignant lesions is younger compared with benign lesions. In category 4a lesions, the patients with malignant lesions were older and mainly concentrated between 40 and 50 years old, and the maximum diameter of the lesions was larger. Whether it is category 3 or category 4a malignant lesions, mammography shows that the incidence of category 4a and multifocal calcification is higher. Conclusion Combined with the clinical data and imaging examination results, BI-RADS category 3 patients have excellent results in choosing Mammotome minimally invasive surgery. Patients with BI-RADS category 4a should be alert to the following factors, including age between 40 and 50, older menarche age, lesion site in the outer upper quadrant, mammography grade of 4a or above, and presence of calcification. Minimally invasive surgery is not recommended for patients diagnosed as BI-RADS category 4b.