Abstract
Purpose: The Breast Imaging Reporting and Data System (BI-RADS) lexicon used in reporting breast imaging has several categories with specific positive predictive values for breast cancer. Among those, BI-RADS 4 is associated with a wider range of risk for breast cancer, which makes the decision for biopsy difficult. The study aim was to determine the malignancy rate and clinical outcomes of BI-RADS 4 lesions in Hospital Universiti Sains Malaysia (HUSM) for a period of five years.Methods: This was a retrospective study of patients diagnosed by mammographic or ultrasonographic findings with BI-RADS 4 breast lesions in HUSM, Kelantan from July 2015 to June 2020. Data were collected from the medical records and an electronic database. Patients with BI-RADS 4 lesions who underwent biopsy and had a known tissue diagnosis were included in this study. The data was used to calculate the malignancy rate and associated positive predictive factors for breast cancer associated with BI-RADS 4 lesions.Results: From the mammography and ultrasonography performed at HUSM from July 2015 to June 2020, a total of 256 lesions were categorized as BI-RADS 4. However, only 198 BI-RADS 4 lesions underwent biopsy and were included in the study. Of these 198 lesions, 26.8% were malignant on histopathological examination of the biopsy samples. Simple logistic regression analysis showed that age, diabetes mellitus, hypertension, number of parity, and certain mammogram findings were significantly associated with breast cancer. Invasive breast cancer was the most common type. Fibrocystic disease was the most common benign pathology, followed by fibroadenoma.Conclusion: The malignancy rate of BI-RADS 4 lesions in HUSM was similar to previously reported rates. A thorough evaluation of positive predictive factors and careful selection of patients for biopsy in BI-RADS 4 lesions will minimize unwanted biopsies and associated patient anxiety, in addition to reducing the health care burden.
Highlights
Among Malaysian women, breast cancer is the most common cancer and accounts for 31% of all cancers [1]
The Breast Imaging Reporting and Data System (BI-RADS) lexicon developed by the American College of Radiology (ACR) is used to predict the risk of breast malignancy for lesions detected by both mammography and ultrasonography [3] and to standardize the diagnostic features, terminology, and subsequent management recommendations
This was a five-year retrospective study among patients who underwent mammography and/or ultrasonography breast assessments and was found to have BI-RADS 4 lesions at Hospital Universiti Sains Malaysia (HUSM)
Summary
Among Malaysian women, breast cancer is the most common cancer and accounts for 31% of all cancers [1]. Mammography and ultrasonography are the most efficient screening tools for early detection of breast cancer and to reduce the morbidity and mortality associated with breast cancer [2]. Recent advancements in both ultrasonography and mammography and the widespread use of these imaging modalities have positive impacts on the management of breast cancer and have negative effects. The detection of clinically asymptomatic lesions and the need for biopsy to confirm the pathology contribute to psychological distress among affected patients [2]. The Breast Imaging Reporting and Data System (BI-RADS) lexicon developed by the American College of Radiology (ACR) is used to predict the risk of breast malignancy for lesions detected by both mammography and ultrasonography [3] and to standardize the diagnostic features, terminology, and subsequent management recommendations. The uncertain probability of benign and malignant outcomes of BI-RADS 4 lesions challenges clinicians when choosing between surveillance and biopsy as the step of
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