J Korean Soc Radiol.  2013 Jul;69(1):71-77. 10.3348/jksr.2013.69.1.71.

Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy?

• Kim HY
• Chang YW

• KMID: 2002893
• DOI: http://doi.org/10.3348/jksr.2013.69.1.71

Abstract

PURPOSE
To investigate whether sonographic findings can predict malignancy in complex echoic breast masses using the Breast Imaging Reporting and Data System (BI-RADS) lexicon and to demonstrate the need for biopsy recommendations for all complex breast masses.
MATERIALS AND METHODS
135 pathologically proven complex echoic masses detected on sonography were identified. We retrospectively reviewed the sonographic findings according to the BI-RADS lexicon which include shape, margin, orientation, lesion boundary, posterior acoustic features, and vascularity. The sonographic findings were correlated with the pathology and mammographic findings. Differentiation between the sonographic appearance of benign and malignant complex cystic lesions was evaluated using the chi-square test or the Mann-Whitney U test.
RESULTS
59.3% (80/135) were benign lesions and 40.7% (55/135) were malignant lesions. Malignant lesions were correlated with irregular (p < 0.001), nonparallel (p = 0.023), noncircumscribed (p < 0.001), echogenic halo (p < 0.001), increased vascularity (p = 0.001) and large size (p = 0.002) compared to benign lesions. However, 12.7% (7/55) of benign looking complex cystic masses were proved to be malignant. All seven lesions had malignant microcalcifications or abnormality on mammography.
CONCLUSION
Using the sonographic BI-RADS lexicon can be useful for differentiating between malignant and benign complex cystic breast masses. Notably, 12.7% of the complex cystic lesions showing a benign appearance on sonography were pathologically proven malignant. Therefore, radiologist should recommend biopsy for complex cystic lesions.

MeSH Terms

Acoustics
Biopsy
Breast
Breast Neoplasms
Information Systems
Orientation
Retrospective Studies

Figure

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  Fig. 1 A 42-year-old women with palpable mass. A. Sonography shows about 5.4 cm sized, round, non parallel, noncircumscribed, complex echoic mass with posterior acoustic enhancement. B. Color Doppler image shows increased vascularity of the mass. Pathology revealed infiltrative ductal carcinoma.

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  Fig. 2 A 52-year-old women with palpable mass. A. Sonography shows about 2 cm sized, oval, parallel, circumscribed complex echoic mass with posterior acoustic enhancement. B. Color Doppler image shows no increased vascularity of the mass. Pathology revealed papillary carcinoma.

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  Fig. 3 A 43-year-old women with palpable mass. A. Sonography shows oval, parallel, circumscribed, complex echoic mass with posterior acoustic enhancement. B. Mammography revealed partial obscured hyperdense mass in left upper inner quadrant. Pathology revealed infiltrative ductal carcinoma.

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