Unusual Breast Neoplasm with Diagnostic and Management Challenges

Correlation Between Ultrasound BI-RADS 4 Breast Lesions and Fine Needle Cytology Categories in a Sample of Iraqi Female Patients

Background: Breast cancer is the most common malignancy in female and the most registered cause of women’s mortality worldwide. BI-RADS 4 breast lesions are associated with an exceptionally high rate of benign breast pathology and breast cancer, so BI-RADS 4 is subdivided into 4A, 4B and 4C to standardize the risk estimation of breast lesions.

The aim of the study: to evaluate the correlation between BI-RADS 4 subdivisions 4A, 4B & 4C and the categories of reporting FNA cytology results.

Patients and Methods: A case series study was conducted in the Oncology Teaching Hospital in Baghdad from September 2018 to September 2019. Included patients had suspicious breast findings and given BI-RADS 4 (4A, 4B, or 4C) in the radiological report accordingly. Fine needle aspiration was performed under the ultrasound guide and the results were classified into five categories. The biopsy was performed for suspicious, malignant or equivocal FNA findings.

Results: This study included 158 women with BIRADS 4 breast lesions with the mean age of (44.6 years); There was a highly significant association between BI-RADS 4 breast lesion and FNA results (p<0.001); 51.9% of BI-RADS IV-C had C5 FNA results. There was a highly significant association between BI-RADS 4 lesion and the final diagnosis (p<0.001); 41.2% of BI-RADS 4 B had a malignant breast lesion, while 37.3% of BIRADS 4 C had a malignant lesion.

Conclusion: A clear relationship was observed between BI-RADS 4 subcategories and the fine needle aspiration cytology subgroups. BI-RADS 4-B is helpful in the discrimination between benign and malignant breast lesions; furthermore BI-RADS 4C has more acceptable validity in the diagnosis of breast malignancy. Therefore, BI-RADS subcategories are encouraged to be included and mentioned in the ultrasound report for more accurate estimation of the lesion nature.