BI-RADS Grade Research Articles

Volumetric breast density evaluation using fully automated Volpara software, its comparison with BIRADS density types and correlation with the risk of malignancy

BackgroundMammography is currently the modality of choice for mass screening of breast cancer, although its sensitivity is low in dense breasts. Besides, higher breast density has been identified as independent risk factor so it has been conceptualized that women with dense breasts should be encouraged for supplemental screening. In this study, we aimed to estimate the distribution of volumetric breast density using fully automated Volpara software and to analyze the level of agreement between volumetric density grades and Breast Imaging Reporting and Data System (BI-RADS) density grades. We also aim to estimate the distribution of breast cancer in different VDG and to find a correlation between VDG and risk of malignancy.ResultsVDG-c was most common followed by VDG-b and BIRADS grade B was commonest followed by grade C. The density distribution was found inversely related to the age. Level of agreement between VDG and BIRADS grades was moderate (κ = 0.5890). Statistically significant correlation was noted between VDG-c and d for risk of malignancy (p < 0.001).ConclusionDifficulties associated with the use of BI-RADS density categories may be avoided if assessed using a fully automated volumetric method. High VDG can be considered as independent risk factor for malignancy. Thus, awareness of a woman’s breast density might be useful in determining the frequency and imaging modality for screening.

Breast lesions excised via vacuum-assisted system: could we get any clues for B3 lesions before excision biopsy?

BackgroundThe purpose of this study was to determine the validity of the ultrasound features as well as patient characteristics assigned to B3 (uncertain malignant potential) breast lesions before vacuum-assisted excision biopsy (VAEB).MethodsThis study population consisted of 2245 women with breast-nodular abnormalities, which were conducted ultrasound-guided VAEB (US-VAEB). Patient’s clinical and anamnestic data and lesion-related ultrasonic feature variables of B3 captured before US-VAEB were compared with those of benign or malignant cases, using histopathological results as a benchmark.ResultsThe proportions of benign, B3 and malignant breast lesions diagnosed post-US-VAEB were 88.5, 8.2 and 3.4% respectively. B3 high frequent occurred in BI-RADS-US grade 3 (7.7%), grade 4a (11.0%) and grade 4b (9.1%). The overall malignancy underestimation rate of B3 was 4.4% (8/183). Malignant lesions were found mostly in the range of BI-RADS grade 4b (27.3%), grade 4c (33.3%) and grade 5 (100%). Multivariate binary logistic regression analyses (B3 vs benign) showed that non-menopausal patients (95% CI 1.628–8.616, P = 0.002), single (95% CI 1.370–2.650, P = 0.000) or vascularity (95% CI 1.745–4.150, P = 0.000) nodules in ultrasonic features were significant risk factors for B3 occurrences. In addition, patients elder than 50 years (95% CI 3.178–19.816, P = 0.000), unclear margin (95% CI 3.571–14.119, P = 0.000) or suspicious calcification (95% CI 4.010–30.733, P = 0.000) lesions were significantly associated with higher risks of malignant potentials for B3 cases (malignant vs B3).ConclusionThe results of this study indicate that ultrasound findings and patients’ characteristics might provide valuable information for distinguishing B3 lesions from benign breast abnormalities before VAEB, and help to reduce malignancy underestimation of B3.

Red flags for the differential diagnosis of granulomatous mastitis: a case report

BackgroundGranulomatous mastitis (GM) is a rare benign chronic inflammatory breast disease. GM presents as a heterogeneous illness with variable clinical presentations, and its diagnosis is usually made by exclusion. There are no guidelines for the treatment of GM. This manuscript describes the management of a patient with GM, initially unsuccessfully treated outside our clinic under a diagnosis of mastitis. The patient’s history, physical examination, and needle biopsy flagged the patient’s findings as nonmalignant; however, imaging studies indicated a tumor. Differential diagnosis became a critical element of her care. This case report represents a valuable resource to foster more assertive clinical practice in managing patients with GM. The case coordination and its course were led by a team from an outreach clinic that provides health care services to underserved communities in the state of Michigan.Case presentationA 41-year-old G1P1 Hispanic female immigrant from Central America presented with a rare breast disease, granulomatous mastitis. A similar presentation occurred 5 years before pregnancy when she had an episode of pain and swelling in the left breast, which resolved spontaneously. She sought our services after being diagnosed with mastitis that was unsuccessfully treated. Physical examination revealed a nodular mass in the outer quadrants of the left breast without regional lymphadenopathy. Needle biopsy showed fibrohistiocytic and florid inflammatory reactions, with no evidence of invasive carcinoma. However, this result was inconsistent with the degree of abnormality revealed by the mammogram (BI-RADS grade 5), ultrasound, and physical examination. Full incisional biopsy revealed cystic neutrophilic GM. The surgical procedure, antibiotics, and corticosteroids resulted in a successful combination to secure the stable control of the symptoms and progression of this rare benign breast disease to date.ConclusionsThis patient’s case highlights the importance of integrated communication among front-line primary care and other health care professionals to reduce the risk of invasive procedures and avoid institutional costs. GM is a rare disease. We raised the manifold red flags in which the multiple professional chains recruited to care for this patient were concerning for advanced breast cancer. The lack of experience and evidence-based medicine contributed to the contradictory interpretation of the findings on GM's diagnosis.

Breast cancer screening in urban Beijing, 2014-2019

Objective: To analyze the current status of breast cancer screening among females in Urban Beijing Cancer Screening Program, 2014-2019. Methods: Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program, women residences aged 40 to 69 were recruited from 80 streets in six districts of Beijing (Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan District) using cluster sampling method. General demographic information and potential risk factors, results of clinical examination and follow-up outcomes of the target population (diagnosed breast cancer or not) were collected using epidemiological questionnaire, risk evaluation, clinical examination using ultrasound and (or) joint screening with mammography and follow-up, respectively. Proportion of high-risk cases evaluated by the questionnaire, recall rate, proportion of cases with BI-RADS grade 3 and BI-RADS grade 4/5, proportion of the cases with stage 0 or I, incidence rate and cumulative incidence rate were calculated. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) among females who experienced different screening scenario. Results: A total of 53 916 women with the age of (57.2±7.3) completed high-risk assessment were included into analysis. The proportion of overweigh and obesity were 40.90% (22 053 cases) and 15.34% (8 270 cases), respectively. A total of 17 535 cases (32.52%) were evaluated as positive case detected by the questionnaire. The clinical recall rate was 47.64% (8 353 cases) among the high-risk females. The positive rate detected by ultrasound or mammography alone was 1.84% and 4.00%, while the suspicious positive detection rates were 14.50% and 17.83%, respectively. The positive rate and suspicious positive rate detected by joint screening using ultrasound and mammography were 5.44% and 27.74% respectively. In total, 252 cases were diagnosed with breast cancer after an average of 2.68 years follow-up. The incidence rate and cumulative incidence rate of breast cancer were 174.34/100 000 person years and 470/100 000, respectively. The early detection rate was 68.6% among the residences who received clinical examination. Compared with the negative residence evaluated by the questionnaire, the positive cases has a 55% higher risk of diagnosed with breast cancer (HR=1.55, 95%CI:1.20-2.00); Cases that recognized by baseline ultrasound and mammography joint screening as BI-RADS 4/5 and BI-RADS 3 have higher risk of diagnosed with breast cancer than that of with the results of BI-RADS 1-2, with the HR of 12.60 (95%CI:6.49-24.47) and 1.89 (0.93-3.83), respectively. Conclusion: Females with high risk of breast cancer in Beijing have a better recall rate of receiving the clinical screening examination. Joint using ultrasonography and mammography in breast cancer screening can improve the positive detection rate among high risk females.

A comparative study on ultrasound-guided elite, Mammotome, and core needle biopsy for diagnosing malignant breast masses.

IntroductionThe present study aims to clarify the advantages and disadvantages of elite biopsy, to provide a reference for selecting the puncture method.Material and methodsA total of 802 patients with a BI-RADS grade ≥ 4, as evaluated by the molybdenum target, and measurable lesions revealed by colour Doppler ultrasound, who were admitted at our department from January 2017 to January 2018, were enrolled in the present study. These patients were randomly divided into three groups: elite, Mammotome and core needle biopsy groups. The pathological underestimation rate, diagnostic accordance rate, haematoma incidence rate, and costs of these three biopsy methods were compared.ResultsThe difference in diagnostic accordance rates between the elite biopsy group and core needle biopsy group was statistically significant (98.9% vs. 94.7%, p = 0.003), as well as between the Mammotome biopsy group and core needle biopsy group (99.6% vs. 94.7%, p < 0.001). The difference in pathological underestimation rates between the elite biopsy group and core needle biopsy group was statistically significant (7.2% vs. 37.3%, p < 0.001), as well as between the Mammotome biopsy group and core needle biopsy group (1.6% vs. 7.2%, p < 0.001). The difference between the Mammotome biopsy group and elite biopsy group was not statistically significant. The incidence of haematoma in the Mommotome, elite, and core needle groups was 15.9%, 13%, and 21.7%, respectively (13% vs. 21.7%, p = 0.021).ConclusionsElite biopsy has a low rate of pathological underestimation and low incidence of haematoma, can improve the breast conserving rate, and has an affordable cost. As a biopsy method with high accuracy, safety, and economy, elite biopsy can be widely used in clinics.

Optical imaging of the breast: evaluation of deoxyhemoglobin concentration alteration in 166 patients with suspicious breast lesions

BackgroundWe investigated the performance of optical imaging evaluating deoxyhemoglobin concentration alteration (DeHCA) in breast tissues.MethodsWe enrolled all consecutive patients from January 2015 to October 2016 with clinically suspicious and/or BI-RADS grade 3–5 lesions at mammography or ultrasound (US). Patients underwent optical imaging (ComfortScan) to evaluate for DeHCA. The reference standard was pathology from a surgical specimen for malignant lesions, pathology from a surgical specimen or core needle biopsy for benign lesions, and negative follow-up for contralateral negative breasts. Non-parametric statistics, receiver operating characteristic, and linear discrimination analyses were performed.ResultsOf 334 enrolled patients, 168 (50%) were excluded for technical problems and 166 (50%) (median age 52 years) were analyzed totaling 331 breasts and 176 lesions. Of these, 75 were benign (median size 19 mm) and 101 malignant (median size 20 mm). The median DeHCA score in malignant lesions (0.95, interquartile range [IQR] 1.00–0.87) was higher (p < 0.001) than in benign lesions (0.80, IQR 0.95–0.70). Using the optimal cutoff (0.85), DeHCA score was less accurate than mammography, US, and their combination, with 78% sensitivity, 52% specificity, 40% positive predictive value (PPV), and 85% negative predictive value (NPV); using a 0.8 cutoff, sensitivity reached 93% and NPV 91%, but specificity fell to 32% and PPV to 37%. The accuracy of DeHCA score linearly combined with mammography or US was higher than that of DeHCA score alone (p < 0.001) and not significantly higher than that of mammography or US alone.ConclusionsDeHCA score was significantly higher in malignant than in benign lesions, but its accuracy was significantly lower than that of mammography or US. Future refinements are needed.

Outcome analysis of breast diseases screening in 773 women in Tangshan area

Objective To analysis the occurrence status of breast disease in married women in Tangshan area, and to provide basis for early prevention of breast cancer in this region. Methods 773 married women in Tangshan area were given mammography examination. The tissue biopsy or surgical treatment was recommended for patients with above grade 3 of breast imaging reporting and data system (BI -RADS) classification to obtain pathological diagnosis. Results In 773 women, 482 cases (62.35 %) were diagnosed as BI-RADS grade 2 or below, 256 cases (33.12 %) were BI-RADS grade 3, 33 cases (4.27 %) were BI-RADS grade 4, 2 cases (0.26 %) were BI-RADS grade 5. The distribution of each BI-RADS grade among different age group was statistically significant (χ2 = 17.90, P < 0.001), 35 cases got pathological diagnosis by biopsy or surgical treatment, including 30 cases of mammary gland hyperplasia, 3 cases of breast fibroadenoma, and 2 cases of breast cancer. Conclusion Women's mammography screening is important for the prevention and early detection of mammary gland diseases. Key words: Breast neoplasms; Women; Mammography; Mass screening

Mammographic findings in locally advanced breast carcinoma treated with neoadjuvant chemotherapy.

e12538 Background: Breast Cancer (BC) is a heterogeneous disease. Mammograpy images of BC has been associated with tumor features. We evaluated relationship between radiologic features of pre-neoadjuvant chemotherapy (NAC) lesions and clinico pathological tumor features. Methods: We evaluated mammography films and clinicopathological information of BC patient who received NAC followed by tumor resection at Instituto Nacional de Enfermedades Neoplásicas from 2000 to 2011. Results: 495 BC cases were selected. Most cases were staged in clinical Tumor size stage 4 (48.2%) and node stage 1 (58.7%); and had a GIII histological grade (51.2%). Breast density (BD) was classified as BIRADS grade 1 in 17%, grade 2 in 22%, grade 3 in 35% and grade 4 in 25.3%. High BD has been associated to younger age (p&lt;0.001) and obesity (p=0.012). An association between mammographic rounded shape and triple-negative (TN) phenotype was found (p=0.002). An association between the dusty microcalcification and HER2 group as well as between the casting and the TN BC group (p=0.001) is found. NAC included anthracyclines and taxanes in 422 (85.4%) cases. Four and 5 Miller Payne pathologic response (pR) in the primary lesion and absence of axilary lymph nodes involvement were found in14.8% of the whole population, and in 10.5% of luminal cases, 17.7% of HER2- enriched and 23% of TN BC. pCR was associated to patient age (p&lt;0.001), tumor grade (p&lt;0.001) and high breast density (p=0.001), as well as better DFS (p=0.05). Conclusions: Radiographic images are related to tumor features in pre-NAC BC cases. pCR is associated to high density breast as well as previously described clinicopathological features.