Well-documented benign sonographic characteristics are rarely seen in malignant masses: is now the time to biopsy less?

Abstract

To determine whether malignant breast masses demonstrate any of the eight well-documented benign criteria on ultrasound (US) to ascertain whether patients that display these characteristics can safely be discharged without intervention reducing the number of unnecessary benign biopsies. A retrospective evaluation was performed of the US images of 816 histologically confirmed breast cancer cases diagnosed from 2016-2018. The malignant lesions were subdivided into seven age categories and compliance with the eight benign (Stavros) characteristics assessed. None of the 816 malignancies displayed all eight of the described benign Stavros characteristics. The combination of a smooth/well-circumscribed border and an ellipsoid shape with horizontal orientation in addition to being homogeneously isoechoic with three or less gentle lobulations was found in only 0.4% of cases (3/816). This research adds to the body of literature supporting the robust nature of the Stavros criteria and supports the non-invasive management of lesions that display all of these associated benign features on US. The presence of established benign ultrasound characteristics are very uncommonly seen in malignancies as highlighted in this study, and it is proposed than no breast cancers will display all eight criteria combined. It is suggested that adherence to the well-documented benign characteristics when assessing solid breast lesions could safely obviate the need for biopsy in women of all ages.