Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred?

Abstract

Background: When a palpable breast mass is detected, a biopsy is usually performed even if the mass reveals probably benign morphologic features on imaging, as there is relatively little data reporting the outcome of such breast masses. Purpose: To determine the negative predictive value for sonographic evaluation of palpable breast masses with probably benign morphology, and to assess whether follow-up may be an acceptable alternative to immediate biopsy. Material and Methods: Of the 1399 sonograms of palpable masses from January 2004 to September 2005, there were 397 patients with masses of probably benign morphology. This study included 274 of these patients (age range 12–64 years, mean age 34 years) with 312 palpable masses that were pathologically confirmed by fine-needle aspiration ( n=7), ultrasound (US)-guided core needle biopsy ( n=180), or surgical biopsy ( n=125). The false-negative rate, negative predictive value (NPV), and 95% confidence interval (CI) were calculated using the SPSS statistical software package for Windows, version 12.0. A P value <0.05 was considered statistically significant. Results: Of the 312 masses, there were 310 benign lesions and two malignancies, resulting in a false-negative rate of 0.6% (NPV 99.4%, P value=0.0432, 95% CI 0.0–1.5%). Conclusion: The negative predictive value of sonography for palpable breast masses with probably benign morphology is high (99.4%). Therefore, short-term imaging follow-up can be an acceptable alternative to immediate biopsy, similar to the management of nonpalpable probably benign lesions (BI-RADS category 3).

Follow-up versus tissue diagnosis in bi-rads category 3 solid breast lesions at sonography: cost-consequences analysis

“…Graf et al (3) detected multiplicity in 7.6% of 409 women in their study. Park et al (11) found multiple BI-RADS 3 masses on US in 23 of 274 women. Multiplicity, especially multiple bilateral category 3 masses, has been shown to decrease the likelihood of malignancy of circumscribed masses detected on mammography.…”

“…In follow-up studies, BI-RADS category 3 masses have generally been assessed using a combination of mammography and US (2,6,11). However, this combination may not always be available in practice.…”

Ultrasonography alone for diagnosis of breast cancer in women under 40

“…18 The negative predictive value of sonography for palpable noncalcifi ed breast masses with probably benign morphology is high at 99.4% (with a false negative rate therefore of just 0.6%). 19 This has led researchers to suggest that such lesions could be managed in a similar fashion to non-palpable BI-RADS 3 lesions, with short-term imaging follow-up as opposed to immediate biopsy. 19,20 The sensitivity of ultrasonography is not age dependent as with mammography.…”

Diagnostic and therapeutic procedures in adolescents and young adults with changes of the breast

“…Zaniechanie dalszych procedur diagnostycznych można rozważyć u osób, u których na podstawie badania przedmiotowego i USG nie potwierdzono obecności zmian w piersi, oraz u chorych ze zmianami (zarówno palpacyjnymi, jak i niepalpacyjnymi), które w kolejnych badaniach ultrasonograficznych mają charakter prostej torbieli lub niepodejrzanych zmian litych o śred-nicy poniżej 1 cm [21,22].…”