Ultrasonographic features and clinical implications of benign palpable breast lesions in young women

A Nomogram for Enhancing the Diagnostic Effectiveness of Solid Breast BI-RADS 3-5 Masses to Determine Malignancy Based on Imaging Aspects of Conventional Ultrasonography and Contrast-Enhanced Ultrasound

BACKGROUND

To establish and validate a nomogram model, which can incorporate clinical data, and imaging features of ultrasound (US) and contrast-enhanced ultrasound (CEUS), for improving the diagnostic efficiency of solid breast lesions.

PATIENTS AND METHODS

A total of 493 patients with solid breast lesions were randomly divided into training (n = 345) and validation (n = 148) cohorts with a ratio of 7:3 and, clinical data and image features of US and CEUS were reviewed and retrospectively analyzed. The breast lesions in both the training and validation cohorts were analyzed using the BI-RADS and nomogram models.

RESULTS

Five variables, including the shape and calcification features of conventional US, enhancement type and size after enhancement features of CEUS, and BI-RADS, were selected to construct the nomogram model. As compared to the BI-RADS model, the nomogram model demonstrated satisfactory discriminative function (area under the receiver operating characteristic [ROC] curves [AUC], 0.940; 95% confidence interval [CI], 0.909 to 0.971; sensitivity, 0.905; and specificity, 0.902 in the training cohort and AUC, 0.968; 95% CI, 0.941 to 0.995; sensitivity, 0.971; and specificity, 0.867 in the validation cohort). In addition, the nomogram model showed good consistency and clinical potential according to the calibration curve and DCA.

CONCLUSION

The nomogram model could identify benign from malignant breast lesions with good performance.

Utility of Ultrasound Imaging Features in Diagnosis of Breast Cancer

Background Currently, breast cancer (BC) is considered one of the most prevalent cancer worldwide in women and represents a global health challenge. Early diagnosis is the keystone in the management of BC patients. This study aims to assess the utility of ultrasonography (US) features of malignancy in the diagnosis of BC. Methods This retrospective cross-sectional study involved the electronic records of 326 female patients who were diagnosed with BC. A cross-tabulation test was performed to identify the association between the presence of each US feature (yes/no), and the final US diagnosis (benign/malignant). The strength of association of each feature was measured using the odds ratio (OR) which was assumed to be significant when > 1, with a 95% confidence interval (CI). Results The mean age of the female patients involved in this study was 45.36 ±12.16 years old (range, 17-90 years). Cross-tabulation test showed a significant association between the malignancy tumor and the irregular shape of the lesion (p < 0.001, OR=7.162, CI 2.726-18.814), non-circumscribed margins (p < 0.001, OR = 9.031, CI 3.200-25.489), tissue distortion (p < 0.001, OR = 18.095, CI 5.944-55.091), and the lymph node enlargement (p < 0.001, OR = 5.705, CI 2.332-13.960). Conclusion US imaging features of malignancy have a high sensitivity and positive predictive value for detection of the BC. However, the specificity of breast US imaging features is much lower because of the overlapping features in benign and malignant breast lesions. Breast lesions with an irregular shape, not circumscribed irregular or spiculated margins, hypo-echogenicity, tissue distortion, and those with lymphadenopathy have the highest likelihood of malignancy despite the low specificity. US is a highly valuable, safe, and affordable imaging modality with high diagnostic accuracy for BC.

ACR BI-RADS Category 3 Lesions in Women Younger Than 30: Follow-up Outcomes and Factors Associated With Biopsy

OBJECTIVE

Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years.

METHODS

We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed.

RESULTS

Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up.

CONCLUSIONS

BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months.

A review on methods for diagnosis of breast cancer cells and tissues

Breast cancer has seriously been threatening physical and mental health of women in the world, and its morbidity and mortality also show clearly upward trend in China over time. Through inquiry, we find that survival rate of patients with early‐stage breast cancer is significantly higher than those with middle‐ and late‐stage breast cancer, hence, it is essential to conduct research to quickly diagnose breast cancer. Until now, many methods for diagnosing breast cancer have been developed, mainly based on imaging and molecular biotechnology examination. These methods have great contributions in screening and confirmation of breast cancer. In this review article, we introduce and elaborate the advances of these methods, and then conclude some gold standard diagnostic methods for certain breast cancer patients. We lastly discuss how to choose the most suitable diagnostic methods for breast cancer patients. In general, this article not only summarizes application and development of these diagnostic methods, but also provides the guidance for researchers who work on diagnosis of breast cancer.

Evaluation of Palpable Breast Abnormalities

A palpable breast abnormality is one of the most common presenting clinical breast complaints. Although the majority of palpable abnormalities are benign, they are among the most common presenting symptoms of breast cancer, and those breast cancers detected symptomatically tend to have poorer prognosis than their screen-detected counterparts. Clinical breast examination is a vital part of the workup of palpable abnormalities. However, as physical exam features of most masses are not reliable for categorization of malignancy, imaging evaluation is necessary. Choice of imaging modality, which includes diagnostic mammography and breast ultrasound, is dependent upon patient age. Ultrasound is the primary imaging modality for evaluation of palpable masses in women younger than 30 years of age because of its high negative predictive value and sensitivity and lack of ionizing radiation. For women aged 30-39 years, ultrasound or mammography can be performed as the initial imaging evaluation, with ultrasound maintaining a high sensitivity in women younger than 40 years old. Mammography, often followed by ultrasound, is the recommended imaging evaluation sequence for women aged 40 and older. Utilization of advanced imaging modalities for evaluation of the palpable area of concern is not supported by evidence.

The breast lesion excision system procedure: An optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety

Objectives:

To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety.

Methods:

A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyıl University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded.

Results:

All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed.

Conclusion:

The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.

Role of BI-RADS Ultrasound Subcategories 4A to 4C in Predicting Breast Cancer

BACKGROUND

The Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) categorization revised in 2013 by the American College of Radiology resulted in unquestionable standardization of reports and confirmed category 3 and 5 as benign and malignant lesions, respectively. In contrast, suspected images (category 4) have subcategorization criteria, although theses have been detailed difficult to apply. The aim of the present study was to determine the role of the US 4A to 4C BI-RADS subcategories in predicting malignancy.

PATIENTS AND METHODS

We performed a cross-sectional study of diagnostic tests to estimate the performance of the US BI-RADS categorization to clearly differentiate benign from malignant lesions. A total of 975 US examinations performed at the Hospital Femina, Grupo Hospitalar Conceição teaching hospitals from January 2012 through March 2015 were included in the present study. The US BI-RADS lexicon was used to classify the examination findings. Suspicious lesions underwent core needle biopsy, and the US and histology reports were compared to determine the performance using receiver operating characteristic curves.

RESULTS

Overall, the BI-RADS US categorization showed good discriminating accuracy with a receiver operating characteristic curve of 91% (95% confidence interval [CI], 88%-93%). However, BI-RADS subcategory 4b had a positive predictive value of 25% (95% CI, 20%-31%) and subcategory 4A had a positive predictive value of only 6% (95% CI, 3.5%-9.8%).

CONCLUSION

Our results have shown that US BI-RADS subcategories 4A and 4B are clearly unfit for use in screening tests, because they cannot rule out the need for biopsy. Therefore, management will not be improved by subcategorizing category 4, because all suspicious lesions will still require definite biopsy.

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions

PURPOSE

Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings could provide additional information that would help determine further diagnostic steps in breast lesions.

MATERIALS AND METHODS

We conducted a retrospective study by exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimally invasive breast biopsy (MIBB) from January 2002 to December 2011.

RESULTS

The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%, respectively. In 506 BI-RADS 3 lesions, histology revealed 15 malignancies (2.4% malignancy rate), which corresponds to a false-negative rate (FNR) of 2.6%. Clinical evaluation and patient requests critically influenced the further diagnostic procedure, thereby prevailing over the recommendation given by the BI-RADS 3 classification.

CONCLUSION

Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures such as short-term follow-up or MIBB in patients with lesions classified as US-BI-RADS 3.

Advancements in Imaging Technology for Detection and Diagnosis of Palpable Breast Masses

Breast cancer is the most commonly diagnosed cancer among women worldwide and the most common cause of cancer death in women. The most common presentation of breast cancer is the presence of a palpable mass, whether noted by the patient during breast self-examination or noted during clinical breast examination. There are a variety of imaging modalities now available for the evaluation of a palpable abnormality. A thorough understanding of the indications, risks, and benefits can help the clinician guide the patient through an appropriate, comprehensive imaging work up.