ACR BI‐RADS Category 3 Lesions in Women Younger Than 30: Follow‐up Outcomes and Factors Associated With Biopsy

Abstract

Objective-Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years.Methods-We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed.Results-Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up.Conclusions-BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months.

Analysis of the accuracy of ultrasound elastography and BI-RADS classification of breast masses located within the superficial fat layer of the glands

“…The BI-RADS classification is widely used worldwide ( 7 - 9 ). BI-RADS classification criteria are as follows ( 7 , 8 ): category 1: no clinical signs and no abnormal findings on ultrasonography; category 2: malignant probability of 0%; category 3: probability of malignancy <3%; category 4a: probability of malignancy of 3–10%; category 4b: probability of malignancy of 11–50%; category 4c: probability of malignancy of 51–94%; and category 5: malignant probability ≥95%.…”

“…Given the widespread use of breast ultrasound, the Breast Imaging Reporting and Data System (BI-RADS) has been widely used and standardized to guide the management of breast disease (6,7). Numerous studies have reported that breast ultrasound BI-RADS classification is effective for the differential diagnosis of benign and malignant breast masses (7)(8)(9). However, only about 15% of breast tumors in BI-RADS category 4 are malignant, while the majority of benign breast tumors suffer from unnecessary biopsy or surgery, which requires more accurate diagnostic methods (10).…”