Risk of Malignancy in Palpable Solid Breast Masses Considered Probably Benign or Low Suspicion

Abstract

The incidence of malignancy in palpable solid breast masses classified as BI-RADS 3 or 4A in this study was less than 2%. In young women, surveillance rather than biopsy is appropriate for BI-RADS 3 palpable lesions. Palpability does not merit a BI-RADS 4A classification in solid masses with otherwise benign-appearing morphologic features, particularly in young women.

Breast Imaging-Reporting and Data System (BI-RADS) classification in 51 excised palpable pediatric breast masses

“…Historically, palpability has been a major reason why adult breast masses have been excised. In more modern literature, this practice of biopsying any palpable breast mass has been called into question, particularly for palpable lesions with benign ultrasound features [22]. Additionally, it has been documented in the adult literature that although lesions may have benign sonographic features, radiologists may prefer to classify lesions as BI-RADS 4A because of palpability, and BI-RADS 3 classification may also be given for benign appearing lesions on sonography [22].…”

“…In more modern literature, this practice of biopsying any palpable breast mass has been called into question, particularly for palpable lesions with benign ultrasound features [22]. Additionally, it has been documented in the adult literature that although lesions may have benign sonographic features, radiologists may prefer to classify lesions as BI-RADS 4A because of palpability, and BI-RADS 3 classification may also be given for benign appearing lesions on sonography [22]. The reported probability of malignancy in BI-RADS 4 lesions ranges from 2% to 95% with palpable lesions noted to have a lower rate of malignancy [11,26]; however, all lesions with a BI-RADS 4 classification in our study were benign.…”

“…While BI-RADS-US classification has been used to determine malignancy risk and guide management and follow up in adult patients, further data investigating the use of BI-RADS-US criteria in the pediatric and adolescent breast are needed. Prior studies validating the predictive value of breast ultrasound have included no pediatric patients [13][14][15][16][17][18][19][20][21] or predominantly adult populations [6,22,23]. The purpose of the current investigation is to correlate the use of BI-RADS-US classification in preoperative ultrasound with pathology on surgical excision biopsy in a pediatric population.…”

How to approach breast lesions in children and adolescents

“…Although in the past most palpable solid breast masses underwent biopsy despite benign features, we now know that short term followup of solid masses with probably benign sonographic features is a safe alternative to biopsy in the absence of atypical features or rapid enlargement [26][27][28][29]. A palpable breast mass meeting the criteria for a probably benign lesion at ultrasound has less than 1% chance of being malignant in multiple series for all age groups [26][27][28][29], and the chance of such a lesion being malignant in a pediatric patient is even lower. In a developing pediatric breast which is prone to iatrogenic injury, biopsy of a mass with typically benign sonographic features should be avoided in favor of periodic imaging surveillance.…”

Feasibility of spatial frequency-domain imaging for monitoring palpable breast lesions

“…2 For mammographic or sonographic findings considered "probably benign" (BI-RADS III), repeated imaging at 6 month intervals is usually recommended for nonpalpable lesions. 3 However, the presence of a palpable breast lesion is often considered indication for immediate biopsy 2,4 (despite evidence that palpable lesions displaying "probably benign" features have a rate of true malignancy comparable to that of nonpalpable lesions [4][5][6] ), which indicateds the need for a noninvasive method of frequent monitoring of these lesions. Frequent monitoring of breast lesions is also of interest for patients undergoing neoadjuvant chemotherapy, 7 to predict therapy outcome earlier than is possible with mammography and ultrasound.…”