Gray‐scale sonography of solid breast masses: Diagnosis of probably benign masses and reduction of the number of biopsies

Abstract

Purpose. To identify probably benign breast masses using gray-scale sonography and to see if this strategy could reduce the number of biopsies of breast masses.Methods. This retrospective study included 229 masses in 203 women who underwent sonographically guided percutaneous biopsy. Masses with a negative predictive value for malignancy >98% were retrospectively considered probably benign, and the potential impact of gray-scale sonography in reducing the number of biopsies if these masses were not biopsied was assessed. Assessments were performed considering all masses as a group as well as various subgroups.Results. Round, ellipsoid, or lobulated masses with 3 or fewer lobulations, circumscribed margins, a longitudinal-anteroposterior diameter ratio 1.0 and no marked hypoechogenicity, posterior acoustic shadowing, internal microcalcifications, or altered surrounding breast tissue were considered probably benign. The sensitivity of gray-scale sonography to identify this subgroup was 98%, with a negative predictive value of 99%. If these masses were not biopsied, there would be a 42% reduction in the number of biopsies considering all masses, a 36% reduction for masses classified as Breast Imaging Reporting and Data System category 4, and a 59% reduction for masses exclusively analyzed with sonography.Conclusions. It is possible to identify probably benign breast masses using gray-scale sonography, and thereby to reduce the number of biopsies performed.

Probably Benign Lesions at Screening Breast US in a Population with Elevated Risk: Prevalence and Rate of Malignancy in the ACRIN 6666 Trial

“…As with mammography, specific lesions, such as circumscribed oval masses (including those with two or three gentle lobulations), have been proposed to be probably benign (BI-RADS category 3) on baseline US images (14). BI-RADS category 3 lesions have a malignancy rate of less than 2% at mammography (15)(16)(17) and in most diagnostic US series (18)(19)(20)(21)(22); however, rates of 2.6%-8.0% have been observed (23,24). BI-RADS category…”

Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions

“…Each lesion is classified in an independent category that indicates the clinical strategy recommended, with the requirement by the second edition of the BI-RADS US lexicon that the same pattern as in the mammogram be used (Chala et al 2007;Lazarus et al 2006). There are seven categories, from 0 to 6: category 0 5 need for additional imaging; category 1 5 no finding or negative finding; category 2 5 benign lesion with no suspicious findings in the breast; category 3 5 ,2% likelihood of malignancy; category 4 5 absence of classic features of malignancy, but sufficient suspicion to recommend a biopsy, with a likelihood of malignancy from 2% to 95%; category 5 5 .95% likelihood of malignancy with classic features; category 6 5 pathologic confirmation of specific malignancy before US.…”

Interval growth of probably benign breast lesions on follow-up ultrasound: how can these be managed?

“…A solid mass with circumscribed margins, oval shape and horizontal orientation on ultrasound is reasonably categorised as a probably benign finding [1][2][3][4][5][6][7][8][9], especially in conjunction with mammography [10]. In the management of a probably benign breast lesion, short interval follow-up is recommended instead of an immediate biopsy [5] because of the low probability of malignancy, less than 2% [7,10].…”