J Breast Cancer.  2015 Jun;18(2):181-186. 10.4048/jbc.2015.18.2.181.

Synchronous BI-RADS Category 3 Lesions on Preoperative Ultrasonography in Patients with Breast Cancer: Is Short-Term Follow-Up Appropriate?

• Lee S
• Jung Y
• Bae Y

• KMID: 2374534
• DOI: http://doi.org/10.4048/jbc.2015.18.2.181

Abstract

PURPOSE
Breast ultrasonography (US) has been widely used in the preoperative examination of patients with breast cancer. Breast Imaging Reporting and Data System (BI-RADS) category 3 (C3) lesions (probably benign) are regarded as having a low probability of malignancy (< or =2%). The purposes of this study were to verify the malignancy rates for synchronous BI-RADS C3 lesions in patients with breast cancer and consider appropriate management strategies for these lesions.
METHODS
Between January 2010 and January 2013, a total of 161 patients underwent surgery in our institute for breast cancer and synchronous BI-RADS C3 lesions. In the US reports, we found records of 219 synchronous BI-RADS C3 nodules in 161 patients. They were excised during surgery for breast cancer management. Stepwise logistic regression analysis was used to identify predictors of malignancy for synchronous BI-RADS C3 lesions.
RESULTS
The rate of malignancy among the 219 BI-RADS C3 lesions was 9.6%. In simple logistic regression analysis, the size of the primary tumor (p<0.001), pathologic T (pT) stage (p=0.002), and progesterone receptor (PR) status of the primary tumor (p=0.029) were significant predictive factors. In multiple logistic regression analysis, the pT stage and PR status of the primary tumor remained significant predictors (p=0.004 and p=0.003, respectively), and human epidermal growth factor receptor 2 (HER2) was identified as another significant factor (p=0.006).
CONCLUSION
In patients with breast cancer who are scheduled for surgery, needle biopsy or excision should be considered for synchronous BI-RADS C3 lesions identified on preoperative US when the primary tumor has the following risk factors: large size, high PR expression, and HER2 positivity.

Keyword

Breast diseases; Breast neoplasms; Multiple primary neoplasms; Predictive value of tests; Ultrasonography

MeSH Terms

Biopsy, Needle
Breast
Breast Diseases
Breast Neoplasms*
Follow-Up Studies*
Humans
Information Systems
Logistic Models
Neoplasms, Multiple Primary
Predictive Value of Tests
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Risk Factors
Ultrasonography*
Ultrasonography, Mammary
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Reference

1. Moon WK, Noh DY, Im JG. Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 2002; 224:569–576.

2. Berg WA, Gilbreath PL. Multicentric and multifocal cancer: whole-breast US in preoperative evaluation. Radiology. 2000; 214:59–66.

3. Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound: a retrospective review. Cancer. 1995; 76:626–630.

4. Lo JY, Markey MK, Baker JA, Floyd CE Jr. Cross-institutional evaluation of BI-RADS predictive model for mammographic diagnosis of breast cancer. AJR Am J Roentgenol. 2002; 178:457–463.

5. Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor of malignancy. Radiology. 1999; 211:845–850.

6. Berg WA, D’Orsi CJ, Jackson VP, Bassett LW, Beam CA, Lewis RS, et al. Does training in the Breast Imaging Reporting and Data System (BI-RADS) improve biopsy recommendations or feature analysis agreement with experienced breast imagers at mammography? Radiology. 2002; 224:871–880.

7. Sickles EA. Probably benign breast lesions: when should follow-up be recommended and what is the optimal follow-up protocol? Radiology. 1999; 213:11–14.

8. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS). 4th ed. Reston: American College of Radiology;2003.

9. Sickles EA. Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 1991; 179:463–468.

10. Sickles EA. Nonpalpable, circumscribed, noncalcified solid breast masses: likelihood of malignancy based on lesion size and age of patient. Radiology. 1994; 192:439–442.

11. Varas X, Leborgne F, Leborgne JH. Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology. 1992; 184:409–414.

12. Graf O, Helbich TH, Fuchsjaeger MH, Hopf G, Morgun M, Graf C, et al. Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 2004; 233:850–856.

13. Yasmeen S, Romano PS, Pettinger M, Chlebowski RT, Robbins JA, Lane DS, et al. Frequency and predictive value of a mammographic recommendation for short-interval follow-up. J Natl Cancer Inst. 2003; 95:429–436.

14. Vizcaíno I, Gadea L, Andreo L, Salas D, Ruiz-Perales F, Cuevas D, et al. Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 2001; 219:475–483.

15. Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S, Leborgne F. Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 2002; 179:691–695.

16. Rosen EL, Baker JA, Soo MS. Malignant lesions initially subjected to short-term mammographic follow-up. Radiology. 2002; 223:221–228.

17. Graf O, Helbich TH, Hopf G, Graf C, Sickles EA. Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy? Radiology. 2007; 244:87–93.

18. Mainiero MB, Goldkamp A, Lazarus E, Livingston L, Koelliker SL, Schepps B, et al. Characterization of breast masses with sonography: can biopsy of some solid masses be deferred? J Ultrasound Med. 2005; 24:161–167.

19. 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; 248:773–781.

20. Park YM, Kim EK, Lee JH, Ryu JH, Han SS, Choi SJ, et al. Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 2008; 49:1104–1111.

21. Rahbar G, Sie AC, Hansen GC, Prince JS, Melany ML, Reynolds HE, et al. Benign versus malignant solid breast masses: US differentiation. Radiology. 1999; 213:889–894.

22. Hong AS, Rosen EL, Soo MS, Baker JA. BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 2005; 184:1260–1265.

23. Lehman C, Holt S, Peacock S, White E, Urban N. Use of the American College of Radiology BI-RADS guidelines by community radiologists: concordance of assessments and recommendations assigned to screening mammograms. AJR Am J Roentgenol. 2002; 179:15–20.

24. Kwak JY, Kim EK, Park HL, Kim JY, Oh KK. Application of the breast imaging reporting and data system final assessment system in sonography of palpable breast lesions and reconsideration of the modified triple test. J Ultrasound Med. 2006; 25:1255–1261.

25. Kim EK, Ko KH, Oh KK, Kwak JY, You JK, Kim MJ, et al. Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography. AJR Am J Roentgenol. 2008; 190:1209–1215.

26. Allred DC, Harvey JM, Berardo M, Clark GM. Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol. 1998; 11:155–168.

27. Wolff AC, Hammond ME, Schwartz JN, Hagerty KL, Allred DC, Cote RJ, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol. 2007; 25:118–145.

28. Edge SB. American Joint Committee on Cancer. American Cancer Society. American College of Surgeons. AJCC Cancer Staging Manual. 7th ed. New York: Springer;2010.