Breast Imaging Reporting And Data System 4c Research Articles

Correlation Of Bi-Rads 4 Subcategories Breast Lesions On Tomosynthesis And Histopathological Examination With P63 Immunohistochemistry Expression.

Mammography is considered to be the gold standard for screening and detection of breast malignancies. Among different biochemical markers used to detect carcinoma of breasts, p63 has been widely popularized for its effectiveness in the detection of myoepithelial cells which are an important indicator of breast benignity. In this study, we plan to statistically analyze and correlate the Breast Imaging Reporting and Data System (BI-RADS) 4 subcategories grading on mammogram imaging with p63 immunostaining. A total of 80 patients were taken into the study within a period of two years (2016-2018) after ensuring the inclusion and exclusion criteria. They were further sorted into different BI-RADS 4 subcategories, i.e., taking into consideration X-ray mammogram and tomosynthesis findings, 57 samples were categorized as low suspicion (BI-RADS 4A), while 12 were classified as intermediate (BI-RADS 4B), and the remaining 11 samples were categorized as highly suspicious (BI-RADS 4C). Although considered to be leaning toward malignancy, a BI-RADS reading of 4 (namely 4A-low suspicion, 4B-moderate suspicion, and 4C-high suspicion for malignancy) needs further evaluation for accurate diagnosis. There have been cases within our own observation where a lesion that is highly suspicious of malignancy has turned out to be a benign finding. Further, evaluating the expression of a p63 marker can help prevent mutilating surgeries for indeterminate lesions. The present study has been conducted to study the correlation of tomosynthesis grading of lesions that has been categorized from low-to-high suspicion, with a p63 immunostaining pattern in these lesions.

Upgrade Rate and Predictive Factors for Breast Benign Intraductal Papilloma Diagnosed at Biopsy: A Meta-Analysis.

Current standard management for intraductal papilloma (IDP) diagnosed at biopsy indicates complete surgical resection, but there are increasing controversies over whether and when routine excision is indeed necessary. The aim of this study was to determine the carcinoma upgrade rate and identify the associated predictive factors for IDP diagnosed at biopsy by meta-analysis. We searched the PubMed and EMBASE databases for studies published from 2009 to 2020 that investigated the upgrade rate and predictive factors of IDP diagnosed at biopsy. A total of 7016 IDP cases diagnosed at biopsy and histologically examined after surgical excision were pooled from 44 original studies. The pooled prevalence of IDP in breast biopsy findings was 4.6% [95% confidence interval (CI) 4.4-4.7%] and the majority of IDP tumors were benign. The pooled upgrade rates to carcinoma for benign IDP and atypical IDP were 5.0% (95% CI 4.4-5.5%) and 36.0% (95% CI 32.7-39.2%), respectively. In addition, we identified 10 predictive upgrade factors for benign IDP, including Breast Imaging Reporting and Data System (BI-RADS) 5, BI-RADS 4C, mass and calcification in the mammographic finding, bloody nipple discharge, imaging-histological discordance, peripheral IDP, palpable mass, BI-RADS 4B, microcalcification, and lesion size ≥ 1cm. The upgrade rates associated with these predictive factors ranged from 7.3 to 31.1%. Surgical excision appears a reasonable recommendation for atypical IDP. Patients with benign IDP exhibiting one or more predictive factors might benefit from surgical excision, while patients with asymptomatic benign IDP without these predictive factors can be managed by imaging surveillance.

An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital Breast Imaging Unit

ABSTRACT BACKGROUND: Benign breast pathology is a common presenting complaint, and its assessment is important to characterise not to miss malignant pathology. At Helen Joseph Hospital (HJH), patients are triaged at the breast clinic according to the clinical suspicion of benign versus malignant disease. The patients are assigned a colour label based on their clinical presentation. This triage system affects waiting times between clinical examination and mammography appointments. This study aims to assess the association between clinical examination and the radiological and pathological findings of disorders deemed clinically benign, and to ascertain the spectrum of benign breast disorders encountered at HJH METHOD: A retrospective study of imaging results of patients at HJH presenting as clinically benign breast disorders from January to June 2018 was conducted. Assessed Breast Imaging-Reporting and Data System (BI-RADS) score was noted and if core biopsies were performed, their results and patient demographics were documented RESULTS: Of the 1 263 clinically benign patients presenting from January to June 2018, the radiological assessment was: BI-RADS 1: 158 (12.5%), BI-RADS 2: 685 (54.2%), BI-RADS 3: 292 (23.1%), BI-RADS 4a: 54 (4.3%), BI-RADS 4b: 29 (2.3 %), BI-RADS 4c: 21 (1.7%), BI-RADS 5: 24 (1.9%). There were 133 biopsies (including eight BI-RADS 3 patients), with 46 (3.6%) confirmed malignancies. The combined specificity of mammography and ultrasound was 65.52% (54.56-75.39%) and combined sensitivity 91.30% (79.21-97.58% CONCLUSION: There is a vast spectrum of benign conditions presenting in this population group with only 3.6% confirmed malignancies, confirming an accurate triage system utilised at the breast clinic. Radiological imaging is highly sensitive but less specific, emphasising the triad of clinical, radiological and histological assessment as the gold standard with regard to diagnosis of breast disease Keywords: clinically benign breast disease, breast imaging unit, Helen Joseph Hospital

Accuracy of mammography and ultrasonography and their BI-RADS in detection of breast malignancy.

Background:We aimed to compare the diagnostic accuracy of mammography and ultrasonography and their breast imaging-reporting and data system (BI-RADS) classification versus breast core needle biopsy (CNB) findings in distinguishing the breast masses.Methods:This cross-sectional study was conducted during 2016-2018 on female patients who were referred to a radiology center in Babol, northern Iran, for routine screening and/or for CNB. Patients underwent sonography and mammography by a senior radiologist. The breast lesions were also evaluated according to BI-RADS classification. CNB was performed on the breast masses by the same radiologist and pathological procedures were performed by an expert pathologist. Descriptive statistics were used to analyze the data.Results:In total, 213 breast masses were finally assessed, of which 107 (50.2 %) masses were benign and 106 (49.8 %) masses were malignant. The sensitivity for mammography and ultrasound alone was 72.6% and 68.9%, respectively. This rate for combined mammography and ultrasound was 84.9%. About BI-RADS classification, 28 masses were classified as BI-RADS 3, 99 as BI-RADS 4A, 4 as BI-RADS 4B, 18 as BI-RADS 4C, and 64 as BI-RADS 5. BI-RADS 4A had the highest sensitivity (70.1%) among BI-RADS categories. The highest specificity pertained to BI-RADS 3 and 5 (100%) among BI-RADS categories. Also, the highest accuracy was related to BI-RADS 5 (80.3%).Conclusion:The results of the present study showed that combined mammography and ultrasound had a higher rate of accuracy than mammography or ultrasound alone. Furthermore, the imaging methods BI-RADS classification had an acceptable positive predictive value.

EVALUATION OF DIAGNOSTIC ACCURACY OF ULTRASOUND-GUIDED SEMI-AUTOMATED CORE NEEDLE BIOPSY OF BREAST SUSPICIOUS MICROCALCIFICATIONS

Back ground: Breast microcalcifications are considered an early mammographic sign of breast cancer which are present with tiny bright spots of different morphology. In an ultrasound (US) image, the presence of microcalcifications within breast is an important indicator of malignancy.With an improved sonographic detection of microcalcification, ultrasound could be used for biopsy guidance for target sampling of tissue containing suspicious microcalcifications. If the biopsied lesions had a suspicious microcalcifications, specimen radiograph is mandatory to confirm the presence of microcalcifications in which a core containing any calcification on specimen radiography was defined as asuccessfully retrieved core. 14-G(Gauge) semi-automated core needle biopsy(CNB) device is less costly than other biopsy device. Methods:A prospective study was conducted on thirty female patients with thirty- two lesions their mean age was 48.53 years (age range, 21-75 years) radiologically classified as BIRADS (Breast Imaging Reporting and Data system) 4 (b, c) and5 from those referred to women imaging health unit in Radiology department for Sono- Mammography and those patients were referred from the inpatient wards and outpatient clinics of the surgery departments during the period from September 2018 till May 2019.All patients underwent conventional digital mammography and B-mode ultrasound examination and Ultrasound guided biopsy, specimen radiography then tissue samples were sent to histopathology department in which slide picture was done.Then (28) females done surgery and (2) patient still for follow up. Results: Radiological diagnosis of our lesions using BIRADS(Breast Imaging Reporting and Data system) categorical method were identified as two intermediate suspicious lesions (BIRADS 4B 6.3 %), twelve moderate suspicious lesions (BIRADS 4C 34.4 %), and 19 highly suggestive of malignancy lesions (BIRADS 5 59.4 %). Retrieval rate of calcifications according to specimen radiography were successfully retrieved in 30/32 lesions (93.8 %) and confirmed on specimen radiography .CNB( core needle biopsy) identified 28 lesions (87.5 %) malignant and four (12.5 %) benign lesions. Distribution of lesions according to pathological diagnosis in successful and fail retrieval group, the successful retrieval group comprised 26 malignant (22 IDC(Invasive ductal carcinoma), 2 DCIS(Ductal carcinoma Insitu), 2 ILC(Invasive Lobuler carcinoma) ) and four benign lesions.After CNB( core needle biopsy), 30 lesions underwent surgical excision and final pathology results were provided. All 24 IDC on 14-G semi-automated CNB (core needle biopsy) were confirmed to be IDC(Invasive ductal carcinoma) on final pathology. Of the two DCIS(Ductal carcinoma Insitu) on US(Ultrasound) guided CNB( core needle biopsy), one DCIS, were upgraded to IDC, the other one confirmed to be DCIS on final pathology,the two ILC were confirmed to be ILC on final pathology.Of the four benign lesions, the two ADH(Atypical Ductal hyperplasia) underwent surgical excision, finally diagnosed as DCIS,the other two benign lesions (fibroadenoma and fibroadenosis) their BIRADS assessments were category 4C and were recommended for follow-up.The overall accuracy of US-guided 14-G(Gauge) semi-automated CNB( core needle biopsy) was 90.0 % (27/32). Conclusion: The present study confirms the good retrieval rate (93.8%) of US-guided 14-G semi-automated CNB and diagnostic accuracy of (90.0%). Thus, this could be useful procedure for suspicious microcalcifications apparent on sonography.Specimen radiography proved to be a great help in deciding the accurate retrieval of microclcifications by core biopsy. It should be done in all cases of core biopsy for calcifications with marking of the core containing calcifications to be specially assessed by histopathology. We should try to do core biopsy before using VAB (Vaccum-Assisted Biobsy)for calcifications if well seen by ultrasound.

Clinical Application and Feasibility of MRI-Guided Breast Biopsy of Breast Minimal Lesions in Chinese Population.

Objectives: Some breast lesions are not visible on mammography or ultrasonography, and magnetic resonance imaging (MRI) become the only way to monitor these lesions. The purpose of this study was to evaluate the clinical application of MRI-guided biopsy and MRI-guided wire localization of breast minimal lesions in Chinese population.Methods: We evaluated 95 patients (the most patients of known in China) from August 2013 to December 2017. All the patients were scanned with a 1.5-Tesla MRI system (GE Medical Systems, America) in the prone position using a bilateral 8-channel phased-array breast coil and underwent MRI-guided wire localization or MRI-guided biopsy.Results: MRI-guided wire localization and MRI-guided biopsy were successfully performed in 87 patients with 88 lesions (100%, 88/88). After biopsy or surgery, 36 of 88 lesions (40.91%) were malignant, and 52 of 88 lesions (59.09%) were benign. Thirty-nine of 88 lesions (44.32%) were masses, and 49 of 88 (55.68%) showed non-mass enhancement. Statistical analysis showed there was no significant correlation between the malignancy rate and the type of lesion on MRI (P = 0.27). In this study, the rate of malignancy for Breast Imaging-Reporting and Data System (BI-RADS) 5 lesions was 100% (2 of 2) compared with 44.44% for BI-RADS 4C lesions (4 of 9), 42.42% for BI-RADS 4B lesions (14 of 33), and 36.36% for BI-RADS 4A lesions (16 of 44).Conclusions: MRI-guided wire localization with subsequent surgical biopsy and MRI-guided biopsy are safe and effective tools for breast minimal lesions.

Subcategorization of Ultrasonographic BI-RADS Category 4: Assessment of Diagnostic Accuracy in Diagnosing Breast Lesions and Influence of Clinical Factors on Positive Predictive Value

To evaluate the diagnostic accuracy of subcategories 4a–4c of the second edition of the Breast Imaging Reporting and Data System (BI-RADS) ultrasonography (US) lexicon, and to investigate whether clinical factors influence the positive predictive values (PPVs). Overall, 1240 breast lesions in 1227 women diagnosed on ultrasound as category 4 and with pathology were included. The PPV with 95% confidence interval (CI) was 13.6% (95% CI: 11%, 16%) in BI-RADS 4a, 50.0% (95% CI: 44%, 56%) in BI-RADS 4b and 86.0% (95% CI: 82%, 90%) in BI-RADS 4c. Patients’ age significantly affected PPVs for subcategories 4a–4c, whereas radiologists’ experience and application time had little influence on PPVs for subcategories 4a–4c. In conclusion, the diagnostic accuracies of subcategories 4b and 4c were superior to subcategory 4a. Patients’ age significantly affected PPVs for subcategories 4a–4c. Utilizing the subcategories of category 4 was a feasible method regardless of radiologists’ experience and application time.

Apparent diffusion coefficient map based radiomics model in differentiating benign from malignant entity in breast imaging-reporting and data system 4 breast lesions

Objective To investigate the diagnostic values of radiomics model based on ADC map in differentiating benign from malignant lesions in suspicious breast findings with MRI breast imaging reporting and data system (BI-RADS) category 4. Methods Eighty eight patients (36 benign and 52 malignant) with diagnosis of MRI BI-RADS 4 in our hospital from December 2014 to December 2015 were retrospectively enrolled in this study. All the patients were proved by pathology and examined by sequence of T1WI, T2WI, DWI and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), and then were further sub-categorized into BI-RADS 4A, BI-RADS 4B, or BI-RADS 4C based on DCE-MRI sequence. Thus positive predictive value (PPV) of each sub-category were calculated and ROC were used to describe its efficiency in differential diagnosis. Radiomics features based on ADC map were generated automatically from Analysis-Kinetics (GE Healthcare). Sixty three of the 88 cases randomized-selected by computer were used to establish forecasting models and other 25 cases for validation. Kruskal-Wallis test and Spearman were introduced to reduce radiomics features that were highly correlated with others. Logistic linear regression (LLR) model was constructed based on the selected features by 'glm’ function in R software and then verified by 10-fold cross validation (repeat 10 times). ROC was curved to determine the diagnostic accuracy of the model. Results The PPV of BI-RADS 4A,4B,4C were 16.7% (2/12) ,59.6% (28/47) ,75.9% (22/29) respectively. Area under curve (AUC) of ROC was 0.650, sensitivity and specificity were 76.9% and 45.9% respectively. Three hundred and ninety six radiomics features were extracted automatically by software and 5 features (size zone variability, difference entropy, zone percentage, intensity variability and inverse difference moment) were left after redundancy reduction step. Cross-validation showed the accuracy of Logistic regression model was 80.0% (20/25), AUC was 0.790, sensitivity and specificity were 81.3% and 77.8% when cut-off was 0.45. Conclusion The radiomics model could provide important reference for differentiation between benign and malignant lesions in suspicious BI-RADS 4 findings. Key words: Breast neoplasms; Magnetic resonance imaging; Radiomics

Histological Analysis of Benign Breast Imaging Reporting and Data System Categories 4c and 5 Breast Lesions in Imaging Study

PurposeThe objective of this study was to analyze the histology of breast lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4c or 5 breast lesions during the imaging evaluation, but diagnosed as benign during the histological evaluation.Materials and MethodsWe retrospectively reviewed 71 breast lesions categorized as BI-RADS 4c or 5 during imaging study, but diagnosed as benign upon histological evaluation.ResultsBreast lesions were classified into six groups upon histological analysis: intraductal papilloma (18 cases), inflammatory group (15 cases), fibroepithelial tumor (14 cases), clustered microcalcification (10 cases), minimal histological alteration (10 cases), and adenosis (4 cases). Sclerosis and architectural complexity were associated with most of the biopsies that were morphologically similar to malignancy.ConclusionAmong 71 cases categorized as 4c or 5 during the imaging study, but diagnosed as benign upon histological examination, intraductal papilloma was the most frequently identified histological lesion. These 71 cases exhibited histological characteristics of sclerosis and/or complex/complicated features that should be histologically differentiated from malignancy during evaluation.