Is routine biopsy of sonographically benign breast lesions in black African women under 40 years of age recommended?

Abstract

Breast lesions that appear benign on ultrasound examination continue to be biopsied, and no relevant data from Africa exist. To determine the histological spectrum of sonographically benign lesions measuring >3 cm in women in Johannesburg, South Africa, by age and population group, and establish associations between the histological findings and the size of the lesion and the patient's HIV status and family history. Biopsy results of breast masses that appeared benign on ultrasound were reviewed and the prevalence of histological subtypes was determined according to HIV status and family history. The Kruskal-Wallis test and separate logistic regression analysis were used for determining associations with size. Sixty-eight of a total of 13 112 patients seen over a 3.5-year-period were included;. There were 73 lesions, of which 65 (89.0%) were benign and 8 (11.0%) malignant. The most common lesions were fibroadenomas (60.3%) and breast carcinomas (6.8%). Size did not predict malignancy (p=0.22). Family history and HIV status were not significant. A high proportion (11.0%) of lesions that appeared benign on ultrasound were malignant. The size of the lesion did not correlate with histological subtype or malignancy. Further research, including training of ultrasonographers in using the Breast Imaging Reporting and Data System (BIRADS) ultrasound lexicon, standardisation of technique with assistance from established users and possibly double reading for a period, is needed to determine whether there is a true high prevalence of malignancy in sonographically benign breast lesions in our community.