How Should Be the Approach to the Breast Mass According to the Radiological BI-RADS Classification? A Comparison with Histopathological Results

Abstract

Purpose: BI-RADS 3 and 4 constitute the most debated group of the BI-RADS classificationused in the evaluation of breast masses. The aim of the present study was to compare radiologicaland histopathological results of the patients who were radiological determined as BI-RADS 3,4 or 5, and who underwent biopsy, and to review proper approach to such lesions.Methods: The medical charts of the patients who were found to have a breast mass on physicalexamination and/or using radiological investigation between January 2011 and August 2013,and who were classified as BI-RADS 3, 4 or 5 using ultrasonography, mammography, and/ormagnetic resonance imaging, and who subsequently underwent biopsy examination wereretrospectively reviewed.Results: A total of 97 patients were included in the study. Of the cases in BI-RADS 3 group,11% had malignant lesion, 58.8% of the patients in the BI-RADS 4 group had malignant lesion,and all patients in the BI-RADS 5 group had malignant lesion. When the patients in BI-RADS4 were divided into subgroups, the rate of malignant was 23% in the 4A group and 88% in the4C group. Conclusion: The lesions in BI-RADS 3 group often have benign character, but it must beremembered that they may be rarely malignant lesions. In BI-RADS 4 group, the lesions in 4Ahave low malignancy potential and the lesions in 4C group have extremely high malignancypotential

Keywords

• BI-RADS,breast cancer,histopathology

RADYOLOJİK OLARAK BI-RADS SINIFLAMASINA GÖRE MEMEDEKİ KİTLELERE YAKLAŞIM NE OLMALI? HİSTOPATOLOJİK SONUÇLARLA KARŞILAŞTIRMA

Abstract

Amaç: Memedeki kitlelerin değerlendirilmesinde kullanılan BI-RADS sınıflamasının en çoktartışılan grubunu BI-RADS 3 ve 4 oluşturmaktadır. Bu çalışmada, radyolojik olarak BI-RADS3, 4 ve 5 grubunda değerlendirilen ve biyopsi yapılan hastaların radyolojik ve histopatolojiksonuçlarını karşılaştırmanın yanı sıra bu kitlelere uygun yaklaşımı tekrar gözden geçirmeyiamaçladık.Yöntem: Ocak 2011 ile Ağustos 2013 tarihleri arasında memede fizik muayene ve/veyaradyolojik olarak kitle saptanan; ultrasonografi, mamografi yada manyetik rezonansgörüntülemeden biri yada birkaçı yapılan hastalardan radyolojik olarak BI-RADS 3, 4 yada 5olan ve biyopsi yapılan hastaların dosyaları retrospektif olarak incelendi.Bulgular: Toplam 97 olgu çalışmaya dahil edildi. BI-RADS 3 kategorideki olguların %11’imalign, BI-RADS 4’ün %58.8’i malign iken BI-RADS 5 lezyonların hepsi maligndi. BI-RADS4 alt gruplarına ayrıldığında 4A’ da malignite oranı %23 iken 4C de %88 idi. Sonuç: BI-RADS 3 lezyonlar genellikle benign karekterdedir, nadiren de olsa bunların malignolabileceği akılda tutulmalıdır. BI-RADS 4 kategorideki lezyonlarda 4A’da malignite potansiyelidüşük, 4C’de ise oldukça yüksektir

Keywords

• BI-RADS,meme kanseri,histopatoloji

References

1. Gazioğlu D, Büyükaşık O, Hasdemir AO, Kargıcı H. BI-RADS 3 ve 4 Meme Lezyonlarına Yaklaşım: Hangi Olgulara Biyopsi Yapılmalı?. İnönü Üniversitesi Tıp Fakültesi Dergisi. 2009;16(1):19-24.
2. Gao J, Zhang O, Xu J, Guo L, Li X. Clinical significance of serum miR-21 in breast cancer compared with CA153 and CEA. Chin J Cancer Res. 2013;25(6):743-748.
3. Koç O, Erkan E, Sarı YS, Üzüm G, Şahin O, Haşlak A, Erdem Huq G, Tunalı V. Meme Kitlelerine Yaklaşımda Eksizyonel Biyopsinin Yeri: 142 Hastada Biyopsi Patoloji Sonuçları. İstanbul Tıp Dergisi. 2008:3;130-133.
4. Han BK, SchnaU MD, Oreı SG, Rosen M. Outcome of MRI- guided breast biopsy. AJR Am J Roentgenol. 2008;9(6):798-804.
5. Nakano S, Sakamoto H, Ohtsuka M, Mibu A, Sakata H, Yamamoto M. Evaluation and indications of ultrasound- guided vacuum-assisted core needle breast biopsy. Breast Cancer. 2007;14(3):292-296.
6. American College of Radiology. Breast imaging reporting and data system, breast imaging atlas. 4th ed. Reston, Va: American College of Radiology, 2003.
7. Tardivon AA, Athanasiou A, Thibault F, El Khoury C. Breast Imaging and reporting data system (BI-RADS ): Magnetic Resonance imaging. EJ of Radiology. 2007;61:212-215.
8. DorriusR.M. Pijnappel, P.E. Sijens, M.C. Jansen van der Weide, M. Oudkerk. The negative predictive value of breast Magnetic Resonance Imaging in noncalcified BI-RADS 3 lesions. European Journal of Radiology. 2012; 81(2):209-213

9. Carder PJ, Garvican J, Haigh I, Liston JC. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 2005;46(3):320-327.
10. Feoli F, Paesmans M, Van Eeckhout P. Fine needle aspiration cytology of the breast: impact of experience on accuracy, using standardized cytologic criteria. Acta Cytol. 2008;52(2):145- 151.
11. Ozdemir A, Voyvoda NK, Gultekin S, Tuncbilek I, Dursun A, Y amac D. Can core biopsy be used instead of surgical biopsy in the diagnosis and prognostic factor analysis of breast carcinoma? Clin Breast Cancer. 2007;7(10):791-795.
12. Giess CS, Lisa Zorn Smeglin, Jack E. Meyer, Julie A. Ritner, Robyn L. Birdwell. Risk of Malignancy in Palpable Solid Breast Masses Considered Probably Benign or Low Suspicion. J Ultrasound Med. 2012;31:1943–1949
13. Kim EK, Ko KH, Oh KK, Kwak JY, You JK, Kim MJ, Park BW. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR. 2008;190:1209–1215
14. Kerlikowske K, Smith Bindman R, Ljung BM, Grady D. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med. 2003;139:274-284.
15. Raza S , Chikarmane SA, Neilsen SS, Zorn LM, Birdwell RL. BI-RADS 3, 4, and 5 lesions: value of US in management-- follow-up and outcome. Radiology. 2008;248(3):773-781.
16. Mendelson EB, Baum JK, Berg WA, Merritt CR, Rubin E. Ultrasound. In: Breast Imaging Reporting and Data System (BI-RADS). 4th ed. Reston, VA: American College of Radiology; 2003;1–82.
17. Sosthene M, Meye JF, Ngou-Mve JP, Mendome G, Mounanga M. Nonpalpable breast lesions: correlation of the BI-RADS classification and histological findings. Sante. 2006;3:179- 183.
18. Hye Jeong L, Eun Kyung K, Min Jung K, Ji Hyung Y, Ji Young L, Dae Ryong K, Ki Keun O. Observer variability of BI-RADS for breast ultrasound. Eur J Radiol. 2008; 65:293- 298.
19. Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor of malignancy. Radiology. 1999;211:845-850.
20. Lazarus E, Mainiero MB, Schepps B, Koelliker L, Livingston S. BI-RADS Lexicon for US and mammography: Interobserver variability of Positive Predictive Value. Radiology. 2006;292:385-391.
21. Sanders MA, Roland L, Sahoo S. Clinical implications of subcategorizing BI-RADS 4 breast lesions associated with microcalcification: a radiologypathology correlation study. Breast J. 2010;16:28–31.
22. Vincenti K, Feigin K, Liberman L. Breast Imaging Reporting and Data System (BI-RADS) 4 subcategories 4a, 4b, 4c: frequency and cancer rate. AJR. 2011;196:A1–A3.
23. Wu SG, He ZY, Sun JY, Li FY, Lin Q, Guo L, Lin HX. Serum levels of CEA and CA15-3 in different molecular subtypes and prognostic value in Chinese breast cancer. The Breast. 2014;23(1):88-93
24. Lee JS, Park S, Park JM, Cho JH, Kim SI, Park BW. Elevated levels of preoperative CA 15-3 and CEA serum levels have independently poor prognostic significance in breast cancer. Ann oncol. 2013;24(5):1225-1231
25. Hirko KA, Soliman AS, Hablas A, Seifeldin İA, Ramadan M, Banerjee M, Harford JB, Chamberlain RM, and Merajver SD. Trends in Breast Cancer Incidence Rates by Age and Stage at Diagnosis in Gharbiah, Egypt, over 10 Years (1999–2008). Journal of Cancer Epidemiologye. 2013;(2013):7 pages
26. Kil WH, Cho EY, Kim JH, Nam SJ, Yang JH. Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy? Breast. 2008;17(3):258-262.
27. Hukkinen K, Kivisaari L, HeikkiUi PS, Von Smitten K, Leidenius M. Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup ın breast cancer. Acta Oncol. 2008;47(6):1037-1045.