Can Cut-Off-Values for Tumor Size or Patient Age in Breast Ultrasound Reduce Unnecessary Biopsies or is it all About Bi-rads?– A Retrospective Analysis of 763 Biopsied T1-Sized Lesions

Abstract

AbStr AC tAims and Objectives To assess whether it is possible to establish a size cut-off-value for sonographically visible breast lesions in a screening situation, under which it is justifiable to obviate a biopsy and to evaluate the grayscale characteristics of the identified lesions. Materials and Methods Images of sonographically visibleand biopsied breast lesions of 684 patients were retrospectively reviewed and assessed for the following parameters: size, shape, margin, lesion boundary, vascularity, patient's age, side of breast, histological result, and initial BI-RADS category. Statistical analyses (t-test for independent variables, ROC analyses, binary logistic regression models, cross-tabulations, positive/negative predictive values) were performed using IBM SPSS (Version 21.0).Results Of all 763 biopsied lesions, 223 (29.2 %) showed a malignant histologic result, while 540 (70.8 %) were benign. Although we did find a statistically significant correlation of malignancy and lesion size (p = 0.031), it was not possible to define a cut-off value, under which it would be justifiable to obviate a biopsy in terms of sensitivity and specificity (AUC: 0.558) at any age. Lesions showing the characteristics of a round or oval shape, a sharp delineation and no echogenic rim (n = 112) were benign with an NPV of 99.1 %.Conclusion It is not possible to define a cut-off value for size or age, under which a biopsy of a sonographically visible breast lesion can be obviated in the screening situation. The combination of the 3 grayscale characteristics, shape (round or oval), margin (circumscribed) and no echogenic-rim sign, showed an NPV of 99.1 %. Therefore, it seems appropriate to classify such lesions as BI-RADS 2.

Risk factors for axillary lymph node metastases in clinical stage T1-2N0M0 breast cancer patients

“…Cases where there was an obscure or fuzzy boundary that made it difficult to identify whether the tumor extended to the subcutaneous or interstitial adipose tissue and were enveloped or there were tissue overlaps that caused artifacts on imaging were defined as “obscure boundary”. [17,23] Other US parameters such as tumor size, tumor quadrant locations (TQLs), and tumor distance from the nipple were collected. Samples of different LB are shown in Figure 2a–c.…”

Diagnostic Accuracy of Full-Field Digital Mammography and Digital Breast Tomosynthesis in the Evaluation of Breast Lesions

“…However, a few [7.4%] lesions of <1 cm which was malignant were picked up by DBT and were missed on FFDM. There was an increased risk of malignancy with an increase in the size of the lesion [12]. DBT has a better detection rate of lesions of size < 1 cm [13].…”