Assessment of Ultrasound Features and BI-RADS Categories of Malignant Breast Masses in Women ≤40.

Masoume Gity,Maryam Jafari,Asiie Olfatbakhsh,Kiara Rezaei Kalantari,Esmatsadat Hashemi,Fatemeh Sari

doi:10.34172/aim.2021.55

Abstract

To evaluate ultrasound (US) characteristics and BI-RADS (Breast imaging-reporting and data system) of malignant breast masses in women <40 years and to compare with older patients. In a retrospective, descriptive-analytical study, we assessed the US images and BI-RADS category of 78 malignant masses with a final pathology of invasive ductal carcinoma (IDC, NOS type). Overall, the most frequent US descriptors of IDC were indistinct margin (45%), irregular shaped (63.5%), posterior shadowing (38.8%), heterogeneous internal echogenicity (56.3%) and non-parallel orientation (76.3%). In this study, most malignant masses of young patients were categorized as BI-RADS 4a while in the older patients (over 40), they were mostly BI-RADS 4b and 5 with P=0.03 and odds ratio (OR) of 2.57 (95% confidence interval (CI), 0.74-8.8). In addition, the mean dimension of the mass in young cases was greater (18.3 mm) compared with older patients (13.2 mm) with P value of 0.04 and OR of 3.8 (95% CI, 1.1-13.4). Similar to previous studies, malignant masses were diagnosed in greater dimensions in younger cases which may be due to the delay in diagnosis, the rapid growth of the tumor and the absence of routine screening guidelines. Radiologists should be aware of the possibility of malignancy in palpable slightly suspicious masses (BI-RADS 4A) in young cases.

Highlights

Breast carcinoma is the most common cancer among Iranian women with an estimated rate of 8500 incident cases per year which occurs at least one decade younger than developed countries.[1,2] In recent years and in Asian countries, its prevalence has increased.[3]
While approximately 7% of all breast cancers occur in young females in the USA, such tumors are more aggressive with lower survival rate, poor outcome and more accumulated lifetime risk of recurrence.[]
Under the age of 40, mammography is not a routine screening modality, and in some studies, it has not been an effective modality for detecting breast cancer because of the high proportion of thick fibroglandular tissue which reduces the diagnostic accuracy.[13]

Summary

Introduction

Breast carcinoma is the most common cancer among Iranian women with an estimated rate of 8500 incident cases per year which occurs at least one decade younger than developed countries.[1,2] In recent years and in Asian countries, its prevalence has increased.[3]. 1.9% of young patients with breast cancer are symptomatic.[14] On the other hand, lack of standard imaging guidance for screening in younger cases (except patients with BRCA mutation) increases the missing of non-palpable cancers; some cancers are interpreted as benign lesions in different imaging modalities.[15]. The purpose of this retrospective study is to determine the US highlights and BI-RADS (Breast imaging-reporting and data system) assessment of cancerous masses detected by ultrasound (US) in younger age groups. These findings would help us detect breast cancer earlier on US, especially in young patients

Material and Methods

Results

Discussion