Revisiting the Mammographic Follow-Up of BI-RADS Category 3 Lesions

Varas, Ximena; Leborgne, José H.; Mezzera, Julieta; Jaumandreu, Sylvia; Leborgne, Félix

doi:10.2214/ajr.179.3.1790691

Cited by 168 publications

(93 citation statements)

References 17 publications

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“…The mean breast tumour size at diagnosis in the west is around 3.1 cm and more than 52% of breast cancers are localised to the breast system. Among 13 patients who underwent mammography first and then BUS, in this study, eight cases documented same findings in BUS -BIRADS category 3a [24] while in five cases BUS differed from mammography. In these cases, where BUS differed, it gave more specific diagnosis i.e.…”

Section: Discussionsupporting

confidence: 63%

Preoperative ultrasound guided needle localisation for non-palpable breast lesions

et al. 2010

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Section: Discussionsupporting

confidence: 63%

Preoperative ultrasound guided needle localisation for non-palpable breast lesions

et al. 2010

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“…Unlike mammography, in which specific criteria for probably benign lesions have been studied and established, [9][10][11][12][13][14][15][16][17] specific guidelines for what constitutes a probably benign finding on breast MRI are still lacking. Compared with mammography, there are relatively few studies examining the rate of malignancy in lesions initially assessed as probably benign on MRI, [18][19][20][21][22][23][24][25] and even fewer studies examining the utility of sonography in evaluation of lesions detected on MRI.…”

Section: Discussionmentioning

confidence: 99%

Utility of Targeted Sonography in Management of Probably Benign Breast Lesions Identified on Magnetic Resonance Imaging

Lourenço

Chung

Mainiero

2012

Journal of Ultrasound in Medicine

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he first edition of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for magnetic resonance imaging (MRI) was released in 2003 and standardizes terminology used in reporting breast MRI examinations. The BI-RADS 3 category, probably benign findings, is used for lesions with "high probability of being benign," but the American College of Radiology acknowledges, "At the present time, most approaches are intuitive." 1 Given the relative lack of long-term data and lack of firm guidelines for what constitutes a probably benign finding on MRI, additional research is necessary to optimize patient treatment. Additionally, although targeted sonography has been shown to be useful in managing suspicious lesions detected on breast MRI 2-5 and unsuspected lesions detected initially on MRI, 6 ORIGINAL RESEARCHObjectives-The purpose of this study was to determine the utility of targeted sonography in the management of probably benign breast lesions detected on magnetic resonance imaging (MRI).Methods-A total of 4370 consecutive contrast-enhanced breast MRI examinations from March 1, 2004, to March 1, 2009, were retrospectively reviewed. The study was Health Insurance Portability and Accountability Act compliant and Institutional Review Board approved. When targeted sonography was recommended for a Breast Imaging Reporting and Data System (BI-RADS) category 3 examination, results of the sonography and any subsequent breast pathologic examinations were recorded. The frequency of identifying the MRI-detected lesions and the rate at which the BI-RADS category was changed by sonography were calculated for mass and non-mass-like lesions.Results-Of the 4370 examinations, 349 (8%) had BI-RADS 3 findings in 346 patients. One hundred eighteen lesions underwent targeted sonography for evaluation of 85 masses and 33 areas of non-mass-like enhancement. Of these 118 lesions, 54 (46%) were seen on sonography. No cancers were detected on sonography in the areas of nonmass-like enhancement. Two of the 85 masses (2.4%) evaluated with targeted sonography had a malignant diagnosis before initiation of follow-up.Conclusions-Selective use of targeted sonography, particularly in masses, may help identify some malignancies before initiating short-interval follow-up for MRI-detected BI-RADS 3 lesions.

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“…However, this approach has resulted in higher cancer detection yields in females who are at increased risk of breast cancer at the expense of increased false-positivity rates. 2,3 Although it may be appropriate to monitor Breast Imaging Reporting and Data System® (BI-RADS) 3 (American College of Radiology, Reston, VA) (probably benign) lesions radiologically owing to their low cancer risk (0.3-1.7%), [4][5][6][7][8] biopsy has long been the standard approach in BI-RADS 4 or BI-RADS 5 lesions. The reported risk of malignancy for BI-RADS 5 lesions is .95%, while a wide variation in reported incidence of malignancy is noted in BI-RADS 4 lesions (from 2% to 95%).…”

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Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

Sarıca¹,

Uluc²

2014

BJR

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Objective: Biopsy has long been the standard approach in Breast Imaging Reporting and Data System® (BI-RADS) 4 or BI-RADS 5 (American College of Radiology, Reston, VA) lesions despite a wide variation in reported incidence of malignancy in BI-RADS 4 lesions. This study examined the diagnostic value of breast MRI as well as its ability to decrease unnecessary biopsies in patients with solid breast lesions who had an indication for biopsy. Methods: In this retrospective study, 277 breast lesions with a documented histological diagnosis as established by ultrasound-guided biopsy were included. All patients were female, and biopsy was performed owing to a BI-RADS score of 4 or 5 on ultrasonography. In addition, all patients had undergone MRI before biopsy. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting malignancy were calculated.Results: When all lesions were analysed, sensitivity, specificity, NPV and PPV of MRI in detecting malignancy were 94.2%, 56.1%, 90.7% and 68.1%, respectively. When only ultrasonographic BI-RADS 4 lesions are considered, the corresponding figures were as follows: 90.9%, 56.7%, 93.8% and 46.4%, respectively. False-negative rate of MRI for the latter group of lesions was 2.6%. 42% of unnecessary biopsies were avoided in sonographic BI-RADS 4 lesions. Conclusion: Despite promising results obtained in this study, dynamic MRI currently does not seem to be effective in ruling out the need for biopsy in the assessment of sonographic BI-RADS 4 lesions. However, advanced MRI techniques may assist in improving possible benefits of MRI in this patient group.

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Revisiting the Mammographic Follow-Up of BI-RADS Category 3 Lesions

Abstract: Compared with the findings from the 1987-1989 study, the frequency of BI-RADS category 3 lesions has remained stable; patient compliance for follow-up has increased; and the positive predictive value of category 3 lesions for cancer has decreased from 1.7% to 0.4% (p = 0.04).

Cited by 168 publications

References 17 publications

Preoperative ultrasound guided needle localisation for non-palpable breast lesions

Preoperative ultrasound guided needle localisation for non-palpable breast lesions

Utility of Targeted Sonography in Management of Probably Benign Breast Lesions Identified on Magnetic Resonance Imaging

Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

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