Abstract
Objective:To determine the negative predictive value of ultrasound for breast masses with probably benign morphology, and to assess whether follow-up may be an acceptable alternative to biopsy.Methods:After Institutional Review Board approval, all solid breast masses categorized as probably benign (American College of Radiology Breast Imaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and having either tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillance were included.Result:A total of 157 lesions in 40 patients constituted the study population. The mean patient age was 31.3 years (range, 20-56 years). Seventeen of these 157 lesions underwent tissue diagnosis with no invasive breast cancer. Out of the remaining 140 lesions, 115 were stable on imaging for 24 months or more. The rest 25 were deemed benign because of decrease in size on follow up (n=1), non-recommendation of further imaging by the second radiologist on follow up ultrasound (n= 13) or presence of benign tissue diagnosis in the largest lesion (n=11).Conclusion:Ultrasound has 100% negative predictive value for breast lesions with probably benign morphology, whether palpable or not. Follow up is an appropriate option to immediate biopsy of such lesions keeping in mind that noncompliance with surveillance may be a potential problem.
Highlights
Sonography, in addition to mammography, has become a standard breast imaging tool in the past couple of decades because of significant improvements in equipment as well as clinical experience resulting in improved accuracy of assessing breast lesions (Costantini et al, 2006; Giess et al, 2012).It is widely available, tolerated and free from adverse effects of radiation or contrast medium (Chae et al, 2016).Earlier, ultrasound was predominantly employed in differentiating between cystic and solid breast masses its role has expanded from characterizing the internal contents of the mass to differentiating between benign and malignant solid masses
To determine the negative predictive value of ultrasound for breast masses with probably benign morphology, and to assess whether follow-up may be an acceptable alternative to biopsy
After Institutional Review Board approval, all solid breast masses categorized as probably benign (American College of Radiology Breast Imaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and having either tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillance were included
Summary
Sonography, in addition to mammography, has become a standard breast imaging tool in the past couple of decades because of significant improvements in equipment as well as clinical experience resulting in improved accuracy of assessing breast lesions (Costantini et al, 2006; Giess et al, 2012). It is widely available, tolerated and free from adverse effects of radiation or contrast medium (Chae et al, 2016). The malignancy rate of probably benign breast lesions on US ranges between 0% and 0.8% (Raza et al, 2008; Moon et al, 2010) These results support the rationale that a short interval follow-up is an acceptable alternative to biopsy. We intend to examine the negative predictive value of US for breast masses with probably benign morphology and to assess whether follow-up US may be an acceptable alternative to immediate biopsy
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