BI-RADS 3 lesions in North Indian population: Their outcome and how to proceed for follow-up

Background: Breast Imaging Reporting and Data System (BI?RADS) classification for breast lesions was proposed for uniformity in categorizing breast lesions. While BI?RADS 1, 2 and 4–6 categories are straightforward, BI?RADS 3 is an intermediate category lesion with significantly different meanings and findings for mammography, ultrasound, and magnetic resonance imaging and is diagnostically challenging. Our study aims to determine the frequency and the malignancy rate of BI?RADS category 3 lesions detected on ultrasound breast and digital X?ray mammography by doing follow?ups at 6, 12, and 24 months of imaging. Materials and Methods: This ambispective study was conducted in the Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, from October 2020 to October 2022, which included 55 patients referred for digital X?ray and breast ultrasound. All BI?RADS category 3 in the initial sonomammography and digital X?ray mammography were included in the study and were followed up for final diagnosis and outcome either by pathological analysis or follow?up using sonomammography and digital X?ray mammography for a maximum of 24 months. Results: Fifty?five patients were categorized into the benign or malignant category from the results of tissue diagnosis or via follow?up. Fifty?four patients (98.18%) showed benign lesions, and one (1.82%) got malignant lesions. In the majority, 31 (56.36%) patients, the mean follow?up time was 6 months, followed by 12 months 10 (18.18%). Follow?up was 24 months in only 1 out of 55 patients (1.82%). The mean value of time to follow?up (months) of study subjects was 6 ± 4.6 with a median (25th–75th percentile) of 6. Conclusion: Short?term interval follow?up in BI?RADS category: three patients are enough to detect early breast malignancy, and this will avoid unnecessary tissue diagnosis (invasive procedure) in benign lesions. In our study, the malignancy yield in the follow?up of BI?RADS 3 was 1.82% (<2%).

Correlación entre BI-RADS 4 y resultados histopatológicos en lesiones atípicas de mama

Introducción: Las lesiones atípicas de la glándula mamaria afectan a un total de 20 000 mujeres en el mundo. La categorización BI-RADS 4 se considera indefinida y tiene variación considerable a malignidad hasta con cinco años de seguimiento. Objetivo: Establecer la correlación entre los informes BI-RADS 4 y hallazgos histopatológicos en mujeres con diagnóstico de patología atípica de mama que aceden a la consulta de Ginecología y Obstetricia del Hospital Provincial General Docente de Riobamba, Ecuador. Método: Se realizó un estudio de tipo analítico correlacional, retrospectivo, no experimental, de corte transversal en el periodo enero-diciembre de 2021, en 78 pacientes de 20 a 70 años. Los datos fueron tomados de las historias clínicas. Para la validez de pruebas se usó pruebas estadísticas tipo Ji cuadrado de correlación con intervalos de confianza del 95 % e índice de error del 5 %. Resultados: El principal factor de riesgo observado fue la edad ≥40 años (26,92 %), seguido de: deformidad mamaria (20,51 %), y recurrencia de nódulos (15,38 %). En relación a las subcategorías del informe BI-RADS 4, se observó que el tipo C fue la de mayor prevalencia con 39 casos (50 %). Predominó la hiperplasia ductal con el 44,87 % y la fue de un 95,83 % con una especificidad del 70 %. Hubo una significación asintónica de 0,001 entre BI-RADS 4 y resultados histopatológicos. Conclusiones: Las lesiones subcategorizadas como BI-RADS 4C tienen mayor probabilidad de malignizar debido a que se asocian principalmente a hiperplasia ductal, siendo esta el principal cáncer mamario en mujeres mayores de 40 años.

Introduction: Atypical lesions of the mammary gland affect a total of 20,000 women worldwide. The BI-RADS 4 categorization is considered indefinite and has considerable variation to malignancy with up to five years of follow-up. Objective: To establish the correlation between BI-RADS 4 reports and histopathological findings in women with a diagnosis of atypical breast pathology who attend the Gynecology and Obstetrics consultation of the Hospital Provincial General Docente de Riobamba, Ecuador. Method: A correlational, retrospective, non-experimental, cross-sectional analytical study was carried out in the period January-December 2021, in 78 patients aged 20 to 70 years. The data were taken from the medical records. For the validity of the tests, Chi-square correlation statistical tests were used with 95% confidence intervals and an error rate of 5%. Results: The main risk factor observed was age ≥40 years (26.92%), followed by: breast deformity (20.51%), and recurrence of nodules (15.38%). In relation to the subcategories of the BI-RADS 4 report, it was observed that type C was the most prevalent with 39 cases (50%). Ductal hyperplasia predominated with 44.87% and was 95.83% with a specificity of 70%. There was an asymptomatic significance of 0.001 between BI-RADS 4 and histopathological results. Conclusions: Lesions subcategorized as BI-RADS 4C are more likely to become malignant because they are mainly associated with ductal hyperplasia, this being the main breast cancer in women over 40 years of age.

Introdução: Lesões atípicas da glândula mamária afetam um total de 20.000 mulheres em todo o mundo. A categorização BI-RADS 4 é considerada indefinida e apresenta variação considerável para malignidade com até cinco anos de acompanhamento. Objetivo: Estabelecer a correlação entre os laudos BI-RADS 4 e os achados histopatológicos em mulheres com diagnóstico de patologia mamária atípica que atendem na consulta de Ginecologia e Obstetrícia do Hospital Provincial General Docente de Riobamba, Equador. Método: Estudo correlacional, retrospectivo, não experimental, transversal, analítico, foi realizado no período de janeiro a dezembro de 2021, em 78 pacientes com idade entre 20 e 70 anos. Os dados foram retirados dos prontuários médicos. Para a validade dos testes foram utilizados testes estatísticos de correlação qui-quadrado com intervalos de confiança de 95% e taxa de erro de 5%. Resultados: O principal fator de risco observado foi idade ≥40 anos (26,92%), seguido de: deformidade mamária (20,51%) e recorrência de nódulos (15,38%). Em relação às subcategorias do relatório BI-RADS 4, observou-se que o tipo C foi o mais prevalente com 39 casos (50%). A hiperplasia ductal predominou com 44,87% e foi de 95,83% com especificidade de 70%. Houve significância assintomática de 0,001 entre o BI-RADS 4 e os resultados histopatológicos. Conclusões: Lesões subcategorizadas como BI-RADS 4C têm maior probabilidade de se tornarem malignas porque estão associadas principalmente à hiperplasia ductal, sendo este o principal câncer de mama em mulheres com mais de 40 anos.

Imaging and pathological discordance amongst the plethora of breast lesions in breast biopsies

Introduction: Imaging-guided breast tissue biopsy has become an acceptable alternative to open surgical biopsy for nonpalpable breast lesions. Discussion of abnormal results of the correlation between imaging and pathological findings can be very challenging as it can assist in decision-making with regard to the further treatment options by arriving at a comprehensive diagnosis. Materials and Methods: This was a retrospective study. Radiological data from imaging-guided breast biopsies of 500 patients during a 6-year period was collected and classified by a specialist radiologist as per the BI-RADS format. Histopathology reports were studied and discordance analyzed. Results: A total of 500 cases were reviewed. Approximately 33% (168) cases fell into the BI-RADS 3 category, 24.4% (122) into the BI-RADS 4, and 37% (187) into BI-RADS 5 categories. Approximately 50% (n = 250) cases were benign, 2.6% (13) belonged to the high-risk category, and 47.4% (237) were malignant. The number of discordant cases was 12 (2.4%), mostly due to technical factors. Sensitivity of biopsies to detect malignancy was 85%, specificity was 96%, and accuracy of biopsy in diagnosing cancer was 90%. Discussion: The "triple assessment" is the most sensitive method for detecting early breast cancer. An effective communication pathway must be established between a clinician, radiologist, and pathologist for surgical excision in discordance as it carries a high prevalence of carcinoma in these lesions. Conclusion: In discordant cases, either due to abnormal results of imaging or of abnormal pathological findings, the final decision is based on two concordant findings, out of the three parameters. This involves a multidisciplinary breast conference and an active participation by the pathologist.

Application of Breast Ultrasound Imaging Report and Data System classification in diagnosis of special types of breast cancer / 中华超声影像学杂志

Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.

Application Value of Conventional Ultrasound Classification and Contrast-Enhanced Ultrasound in Non-Mass Breast-Like Lesions / 肿瘤防治研究

Objective To investigate the application value of conventional ultrasound typing and contrast-enhanced ultrasound (CEUS) in non-mass breast like lesions (NMLs). Methods A total of 50 patients (50 lesions) who were pathologically confirmed to have breast NMLs in Tianjin Fifth Central Hospital. The corresponding relationship between conventional ultrasound typing of NMLs and BI-RADS classification was analyzed, and CEUS was performed on breast NMLs to compare the diagnostic value of combined BI-RADS and CEUS. Results The NMLs conventional ultrasound classified Ⅰa and Ⅱa lesions corresponded to BI-RADS classification 4a; Ⅲ and Ⅳ lesions corresponded to BI-RADS classification 4b; Ⅰb and Ⅱb lesions corresponded to BI-RADS classification 4c. A statistically significant correlation was observed between the expansion of lesion range and the presence of "crab foot sign" in benign and malignant lesions after the enhancement (P < 0.05). Pearson correlation analysis showed that enlarged lesion area, "crab foot sign, " peak intensity, and area under the curve were associated with malignant breast NMLs. The diagnostic value of CEUS combined with BI-RADS was higher than that of conventional ultrasound BI-RADS. Conclusion NMLs conventional ultrasonographic classificationsⅠa andⅡa have the lowest malignant risk, whereas classifications Ⅰb and Ⅱb have the highest value. The expansion of lesion range and the presence of "crab foot sign" after enhancement are helpful for rapid differentiation of benign and malignant NMLs.

Mastitis granulomatosa: una simuladora de cáncer, un gran reto diagnóstico y terapéutico / Granulomatous mastitis: a cancer simulator, a great diagnostic and therapeutic challenge

Resumen ANTECEDENTES: La mastitis granulomatosa idiopática es un padecimiento benigno de la glándula mamaria sumamente raro, simulador de cáncer de mama. Las manifestaciones clínicas más significativas son: nódulo palpable, cambios en la coloración de la piel y mastalgia. Para integrar su diagnóstico se requiere el apoyo de estudios auxiliares de imagen, sin que por ello deje de ser imprescindible la toma de biopsia para establecer el diagnóstico definitivo. No existen pautas de tratamiento debidamente establecidas, pero sí de tratamiento farmacológico y quirúrgico, ésta última se reserva para casos de recidivas, que son frecuentes. CASO CLÍNICO: Paciente de 35 años, nuligesta; acudió a consulta debido a la aparición de un tumor palpable en la glándula mamaria derecha, de siete meses de evolución, con cambios en la coloración y retracción del pezón. La mastografía y ecografía catalogaron el tumor en BI-RADS 5. La biopsia con aguja de corte y citología integraron el diagnóstico de mastitis granulomatosa idiopática. Se indicó tratamiento farmacológico y el tumor desapareció espontáneamente. CONCLUSIONES: La mastitis granulomatosa es una enfermedad rara y de diagnóstico complejo. Para cada paciente habrá un protocolo diferente para evitar el sobretratamiento. Su pronóstico es bueno, a pesar de ser un simulador de cáncer de mama. El tratamiento aún es ambiguo, pero en primera instancia se recomiendan los corticosteroides o inmunosupresores y la cirugía se reserva para casos de recidivas.

Abstract BACKGROUND: Idiopathic granulomatous mastitis is an extremely rare benign entity of the mammary gland, simulating breast cancer. The most significant clinical manifestations are: palpable nodule, skin discoloration changes and mastalgia. The diagnosis requires the support of auxiliary imaging studies, although a biopsy is essential to establish the definitive diagnosis. There are no well-established treatment guidelines, but there are guidelines for pharmacological and surgical treatment, the latter is reserved for cases of recurrence, which are frequent. CLINICAL CASE: A 35-year-old nulligesta patient came for consultation due to the appearance of a palpable tumor in the right mammary gland, of 7 months of evolution, with changes in color and nipple retraction. The mastography and ultrasound catalogued the tumor in BI-RADS 5. The biopsy with cutting needle and cytology integrated the diagnosis of idiopathic granulomatous mastitis. Pharmacological treatment was indicated, and the tumor disappeared spontaneously. CONCLUSIONS: Granulomatous mastitis is a rare disease with a complex diagnosis. For each patient there will be a different protocol to avoid overtreatment. Its prognosis is good, despite being a breast cancer simulator. Treatment is still ambiguous but, in the first instance, corticosteroids or immunosuppressants are recommended and surgical treatment is reserved for cases of recurrence.

Valor predictivo positivo de las punciones de mama realizadas bajo guía ecográfica en el Hospital Universitario Austral - Buenos Aires - Argentina / Positive Predicitive Value of Breast Biopsy performed under Ultrasound guidance at Austral University Hospital ­ Buenos Aires - Argentina

Objetivo: determinar la calidad y efectividad del trabajo realizado en el Centro Mamario del Hospital Universitario Austral, mediante la correlación entre las diferentes categorizaciones del BI-RADS, el resultado de la anatomía patológica y el cálculo del respectivo VPP. Correlacionar los resultados con los obtenidos a nivel internacional. Material y método: se realizó una revisión de todas las biopsias guiadas por ultrasonido, se seleccionaron aquellas pacientes estudiadas con algún método de diagnóstico por imágenes en el Centro Mamario del Hospital Universitario Austral y cuya categorización final de BI-RADS fuera de 4 o 5, entre junio de 2014 y mayo de 2017. Los resultados de la anatomía patológica fueron divididos en 3 categorías (benigno, maligno y alto riesgo) Resultados: de una total de 491 pacientes 223 correspondieron a la subcategoría 4a, 69 pacientes a la subcategoría 4b, 85 pacientes a la subcategoría 4c y 114 pacientes a la categoría 5. En las subcategorías 4a y 4b predominaron las lesiones benignas y en la subcategoría 4c y categoría 5 predominaron las lesiones malignas. Los VPP para cáncer de mama obtenidos fueron de 7%, 48%, 84% y 98% para las subcategorías 4a, 4b, 4c y categoría 5 respectivamente. Conclusiones: la investigación demostró que los resultados de los VPP, la calidad y efectividad del trabajo realizado en el Centro Mamario del Hospital Universitario Austral se encuentran dentro de los parámetros internacionales.

Objetive: to determine the quality and effectiveness of the work carried out in the Breast Center of the Austral University Hospital, through the correlation between the different categorizations of the BI-RADS, the result of the pathological anatomy and the calculation of the respective VPP. Correlate the results with those obtained internationally. Material and method: a review of al ultasound-guided biopsies was performed, those patients studied with some diagnostic imaging method were selected in the Breast Center of the Austral University Hospital and whose final categorization of BI-RADS was 4 or 5, between june 2014 and may 2017. The results of the pathological anatomy were divided into 3 categories (bening, malignant and high risk). Results: from a total of 491 patients, 223 corresponded to subcategory 4a, 69 patients to subcategory 4b, 85 patiens to subcategory 4c and 114 patients to category 5. In subcategories 4a and 4b benign lesions predominated and in subcategory 4c and category 5, malignant lesions predominated. The VPP for breast cáncer obtained were 7%, 48%, 84% and 98% for subcategories 4a, 4b, 4c y category 5 respectively. Conclusions: the investigation showed that the results of the PPV, the quality and effectiveness of the work carried out in the Breast Center of the Autral University Hospital are within the international parameters.

Positive Predictive Value of Sonographic BI-RADS Final Assessment Categories for Breast Lesions

@#Introduction: We want to evaluate the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of BI-RADS ultrasound, as well as PPV and NPV of BI-RADS ultrasound lexicon. Methods: A total of 517 ultrasound-guided breast biopsy cases were performed within three years. A total of 324 cases remained after 193 cases were excluded from this study. The sensitivity, specificity, accuracy, PPV and NPV of overall BI-RADS and PPV for each BI-RADS categories were calculated from the data when compared with histopathological examination (HPE) finding. One observer evaluated four criteria of BI-RADS ultrasound lexicon; margin, echogenicity, posterior artefact and internal echo from static sonographic images to determine the PPV and NPV of sonographic BI-RADS lexicon based on HPE correlation. Results: There were 236 (72.8%) benign and 88 (27.1%) malignant lesions. The overall BI-RADS has a sensitivity of 93.18%, specificity of 66.95%, accuracy of 74.07% with PPV and NPV of 51.25% and 96.34% respectively. The PPV of each BI-RADS categories were; BI-RADS 2 (9.09%), BI-RADS 3 (3.27%), BI-RADS 4 (39.02%) and BI-RADS 5 (91.89%). The highest predictive value for malignancy was irregular margin (52.3%) and for benign was well-defined margin (89.7%). Criteria for margin and posterior artefact had a significant association with HPE (p<0.0001) in differentiating between malignant and benign breast lesions in breast ultrasound. Conclusion: Overlapping benign and malignant sonographic breast lesion descriptors tend to influence radiologist’s decision to overcall final BI-RADS categories. The margin and posterior artefact are the important criteria in BI-RADS lexicon in differentiating benign and malignant breast lesion.

Le cancer de sein diagnostiqué chez l'homme à Kinshasa: à propos de 4 cas / NA

Même si les seins des hommes sont moins développés que ceux des femmes, La littérature mondiale note que le cancer du sein chez l'homme intervient dans moins de 1 % des cas des cancers, et traditionnellement les hommes avec cancer du sein présentent un risque spécial de développer un autrecancer. Les métastases du cancer du sein sont prioritairement au niveau des os avec 62 %. Les causes du cancer du sein chez l'homme demeurent encore inconnues, toutefois les facteurs de risque qui sont documentés concernent les antécédents familiaux du cancer de sein, une prédisposition génétique dans environ 15 % de cas de cancer du sein chez l'homme, liée à une mutation génétique héritée du gène BRCA2. Durant une année (2020), nous avons reçu 4 patients avec cancer de sein au Centre d'imagerie médicale Kokolo à Kinshasa, 3 patients résidants à Kinshasa et un patient venu de la province voisine du Kongo Central; et les investigations sonographiques nous ont permis de classer ces masses tumeur maligne, d'où l'indication de la microbiopsie écho guidée. Cette dernière nous permis de conclure au carcinome infiltrant et l'immunohistochimie nous a permis de classer ces masses en Luminal à cause de la positivité des récepteurs ostrogéniques, les rendant éligibles au schéma tamoxifène. Le cancer de sein est donc aussi une réalité chez l'homme congolais de Kinshasa et du Kongo Central.

Even if men's breasts are less developed than those of women, World literature notes that breast cancer in men occurs in less than 1% of cancer cases, and traditionally men with breast cancer have a special risk of developing another cancer. Breast cancer metastases are primarily in the bones with 62%. The reasons of breast cancer in men are still unknown, however the risk factors that are documented relate to a family history of breast cancer, a genetic predisposition in about 15% of breast cancer cases in humans, linked a genetic mutation inherited from the BRCA2 gene. During the year 2020, we received 4 male patients with breast cancer at the Kokolo Medical Imaging Center in Kinshasa, 3 patients residing in Kinshasa and one patient from the neighboring province of Kongo Central; and sonographic investigations allowed us to classify these malignant tumor masses, hence the indication for echo-guided microbiopsy

Relación entre hallazgos imageonológicas y resultados histopatológicos de lesiones mamarias biopsiadas con aguja gruesa / Relation between imaging findings and histopathological results of breast lesions that required biopsy

Objetivos El objetivo principal del siguiente trabajo es relacionar los hallazgos imagenológicos con los resultados histopatológicos de lesiones mamarias que requirieron biopsia. El primer objetivo secundario es evaluar el grado de subestimación de aquellas lesiones de riesgo a las que se le realizó Biopsia Radioquirúrgica (brq). El segundo objetivo secundario es conocer la sensibilidad y especificidad del bi-rads como método de diagnóstico para nuestra muestra. Material y método Se incluyeron 403 pacientes que fueron biopsiadas en el Centro de Diagnóstico y Tratamiento de Enfermedades Mamarias (cedytem) de la Ciudad de Santa Fe, en el período de tiempo comprendido entre el 1/1/15 y el 31/12/17. Los nódulos fueron punzados bajo guía ecográfica y las microcalcificaciones, asimetrías y distorsiones arquitecturales bajo guía estereotáxica. La concordancia entre los hallazgos imagenológicos e histopatológicos fue analizada teniendo en cuenta la clasificación de Parikh y Tickman. Resultados Se constató una buena relación entre las categorías bi-rads y la probabilidad de malignidad de las lesiones acorde a lo establecido por el Colegio Americano de Radiólogos (acr). Se observó un 100% de concordancia entre las lesiones categorizadas como benignas (bi-rads 3) y un 97% entre las categorizadas como malignas (bi-rads 5). Las lesiones categorizadas en el grupo de moderada a alta sospecha de malignidad (bi-rads 4B y bi-rads 4C) que resultaron benignas fueron reevaluadas para decidir nuevo control en 6 meses, repetir la biopsia o indicar la realización de brq. Se diagnosticaron 17 lesiones de riesgo (4,2%), de las cuales 12 fueron reevaluadas con brq, evidenciando un porcentaje de subestimación del 42%. Conclusiones A partir de los datos obtenidos, se calculó una sensibilidad del bi-rads como método de diagnóstico del 95% y una especificidad del 74%

Objectives The primary aim of the following work is to relate the imaging findings to the histopathological results of breast lesions that required biopsy. The second aim is to evaluate the degree of underestimation of those risk lesions that underwent a radio-surgical biopsy. The last objective is to know the sensibility and specificity of bi-rads as a diagnosis method for our sample. Materials and method This work included four hundred and three patients who were biopsied at Center for the Diagnosis and Treatment of Breast Diseases (cedytem) in the city of Santa Fe, in the time period between 1/1/15 and 12/31/17. The nodules were punctured under ultrasound guidance while microcalcifications, asymmetries and architectural distortions under stereotactic guidance. Results A good relationship was observed between the bi-rads categories and the probability of malignancy of the lesions according to what is established by the American College of Radiologists (acr). The imaging-histopathological findings correlation was evaluated taking into account the classification of Parikh and Tickman. A 100% correlation was observed between lesions categorized as benign (bi-rads 3), and 97% among those categorized as malignant (bi-rads 5). The lesions categorized as moderate or high suspicion of malignancy (birads 4B and bi-rads 4C) which turned out to be benign were re-evaluated to decide on having a new control in 6 months, repeating the biopsy or indicating the radio-surgical biopsy. Seventeen risk lesions (4.2%) were diagnosed of which twelve were reassessed with radio-surgical biopsy, evidencing an underestimation percentage of 42%. Conclusions Based on the data obtained, it was calculated for our sample a 95% sensitivity of the bi-rads and a 74% of specificity as a diagnostic method.

Ultrasonographic features and pathological diagnosis of breast disease with ultrasound classification as BI-RADS 4a / 中华内分泌外科杂志

Objective To summarize the characteristics of BI-RADS 4a breast diseases under ultrasonic examination referring to patients' clinical data and pathological reports.Methods 82 patients who were firstlydiagnosed and treated in the Affiliated Hospital of Jiangnan University were included.The ultrasonograms were retrospectively reviewed along with the correlated pathological and clinical findings.Results 48 (58.5％) cases were benign,among which fibroadenoma was the most common.34 cases (41.4％) were malignant,among which invasive ductal carcinoma was the most common.68 of the 82 cases were neoplastic disease (82.9％),6 (9.8％)were inflammatory disease,and 8(7.3％) were adenosis.Conclusions The patients who are graded BI-RADS 4a by ultrasonic examination may have completely different diseases.Beyond the most common benign diseases,few of them are malignancies with atypical,even ambiguous sonographic features.Therefore,in clinical practice,sonologists should set appropriate parameters of ultrasonic devices appropriately,and evaluate the sonographic features carefully,in order to make the correct grading and diagnosis.While for clinicians,it is necessary to learn to read the ultrasonographic features along with patients' manifestations,and finally reduce the misdiagosis and missed diagnosis of such diseases.

Combination of BI-RADS for ultrasound and shear wave elastography in differential diagnosis of benign and malignant breast lesions / 上海交通大学学报（医学版）

Objective • To explore the value of the 2013 version of the ultrasound breast imaging reporting and data system (BI-RADS) classification diagnostic criteria combined with ultrasound shear wave elastography (SWE) to identify benign and malignant breast lesions. Methods • A total of 175 solid breast masses in 155 women were examined with ultrasound, and were judged to be benign or malignant by BI-RADS classification criteria. Then all the masses were examined with shear wave elastography (SWE), to obtain shear wave quantitative parameters of benign and malignant breast lesions, the pathological results were used as the gold standard to construct the receiver operating characteristic (ROC) curve of the subjects, which were used to compare the diagnostic value of the two methods alone and in combination. Results • The area under curve (AUC) of the BI-RADS classification diagnostic criteria, the Emax value, and the combination of the two methods to differential diagnosis of benign and malignant breast nodules were 0913, 0.884 and 0.957, respectively. Through pairwise comparison, there was significant difference in AUC between the two methods alone and their combination (BI-RADS classification vs. combination: Z=2.883, P=0.002; SWE vs. combination: Z=4.081, P=0.000). Conclusion • The combination of BI-RADS classification and SWE technology can improve the diagnostic accuracy of breast lesions.

Combination of BI-RADS for ultrasound and shear wave elastography in differential diagnosis of benign and malignant breast lesions / 上海交通大学学报（医学版）

Objective · To explore the value of the 2013 version of the ultrasound breast imaging reporting and data system (BI-RADS) classification diagnostic criteria combined with ultrasound shear wave elastography (SWE) to identify benign and malignant breast lesions. Methods · A total of 175 solid breast masses in 155 women were examined with ultrasound, and were judged to be benign or malignant by BI-RADS classification criteria. Then all the masses were examined with shear wave elastography (SWE), to obtain shear wave quantitative parameters of benign and malignant breast lesions, the pathological results were used as the gold standard to construct the receiver operating characteristic (ROC) curve of the subjects, which were used to compare the diagnostic value of the two methods alone and in combination. Results · The area under curve (AUC) of the BI-RADS classification diagnostic criteria, the Emax value, and the combination of the two methods to differential diagnosis of benign and malignant breast nodules were 0913, 0.884 and 0.957, respectively. Through pairwise comparison, there was significant difference in AUC between the two methods alone and their combination (BI-RADS classification vs. combination: Z=2.883, P=0.002; SWE vs. combination: Z=4.081, P=0.000). Conclusion · The combination of BI-RADS classification and SWE technology can improve the diagnostic accuracy of breast lesions.

BI-RADS classification and gray level histogram of malignant mammary tumors in bitches / Classificação BI-RADS e histograma dos níveis de cinza de tumores mamários malignos em cadelas

Mammary tumor is the most frequent among the tumors that affect canine females, with relevant importance in veterinary medicine. The objective of this study was to determine the image characteristics of mammary tumors in female dogs, and compare different ultrasonographic techniques for neoplastic evaluation. During the experiment, 30 bitches with presence of nodular lesion in the mammary gland were used. Initially females were submitted to clinical and laboratory evaluations, and subsequent to the ultrasound examination of the tumor mass, as well as abdominal ultrasound and thoracic x-ray for the metastasis investigation. Quantitative analysis by histogram of the gray levels and categorization of the tumor masses by the BI-RADS system were performed. Later, the bitches were submitted to surgical resection of the tumors, where samples of the neoplastic tissue were collected for histopathological analysis. Carcinoma in mixed tumor showed a higher rate (33.3%), and the malignancy degree of epidermal tumors were classified in grade 1 (n=9), grade 2 (n=12) and grade 3 (n=3). Malignancy degree showed positive correlation with BI-RADS (r=0.55; P<0.05) and with the parameter echotexture - histogram base width (r=0.42, P<0.05). BI-RADS graduation also showed a positive correlation with the echotexture parameters (standard deviation of average echogenicity r=0.66, P<0.05 and base width r=0.55, P<0.05). It was concluded that the BI-RADS method in combination with the echotexture of tumors, can be used to evaluate mammary tumors in dogs and establish the planning of treatment.(AU)

Entre os tumores que acometem cadelas a neoplasia mamária é a de maior incidência, apresentando relevante importância na medicina veterinária. Este trabalho teve o objetivo de determinar as características ultrassonográficas de neoplasias mamárias em cadelas, e comparar diferentes técnicas ultrassonográficas de avaliação tumoral. Durante a realização deste experimento, foram utilizadas 30 cadelas com presença de lesão nodular em glândula mamária. Inicialmente as fêmeas foram submetidas a avaliações clínicas e laboratoriais, e subsequentemente à realização de exame ultrassonográfico da massa tumoral, assim como ultrassom abdominal e raio x torácico para a pesquisa de metástase. Foram realizadas a análise quantitativa por histograma dos níveis de cinza e categorização das massas tumorais pelo sistema BI-RADS. Posteriormente as cadelas foram submetidas à ressecção cirúrgica dos tumores, onde foram coletadas amostras do tecido neoplásico para análise histopatológica. O carcinoma em tumor misto foi o tipo tumoral de maior incidência (33.3%), e a graduação de malignidade dos tumores epiteliais foram classificadas em grau 1 (n=9), grau 2 (n=12) e grau 3 (n=3). A graduação demonstrou correlação positiva com a categorização BI-RADS (r=0,55; P<0,05) e com o parâmetro de ecotextura - largura de base do histograma (r=0,42; P<0,05). A graduação BI-RADS também demonstrou uma correlação positiva com os parâmetros de ecotextura (desvio padrão da média da ecogenicidade r=0,66; P<0,05 e largura de base r=0,55; P<0,05). Conclui-se que o método de categorização BI-RADS, assim como os parâmetros de ecotextura dos tumores, podem ser usados para avaliação de neoplasia mamária em cadelas e assim auxiliar no planejamento de tratamento de cada caso.(AU)

Es todavía útil la biopsia radioquirúgica en hospitales de bajo recursos / Radio-surgical biopsy is still useful in low-income hospitals

Introducción El cáncer de mama es la primera causa de muerte por cáncer en Argentina, por lo cual su detección en estadio subclínico es imprescindible. Para esto, la mamografía y su clasificación (bi-rads) son un instrumento invaluable para elegir las pacientes que serán sometidas a estudios invasivos. Objetivo El objetivo del siguiente estudio fue evaluar la utilidad de la biopsia radioquirúgica (brq) en comparación con la punción aspiración asistida por vacío en el hospital Municipal de Morón. Material y método Se realizó un estudio retrospectivo observacional en 97 pacientes sometidas a punciones tipo Mammotome y a biopsias radioquirúrgicas: 76 brq y 21 Mammotome. Resultados En las brq se hallaron 65% de lesiones benignas, 12% de lesiones infiltrantes y 22% de lesiones proliferativas. En las pacientes sometidas a Mamotomme se encontraron 67% de lesiones benignas, 12% de lesiones malignas y 22% de lesiones proliferativas. La necesidad de nuevas re-biopsias por discordancia entre la anatomía patológica y las imágenes fue similar. La necesidad de una segunda intervención fue del 33% para ambos casos (segunda cirugía en caso de brq y primera cirugía para Mammotome). Los tiempos entre la primera cirugía y la finalización del tratamiento quirúrgico fueron considerablemente menores en la rama Mammotome. En el caso de brq, el tiempo fue de 110 días para pacientes con una sola intervención y de 140 días en pacientes con dos intervenciones. En las pacientes cuyo diagnóstico se hizo mediante Mammotome, el tiempo fue de 87 días si solo recibieron una intervención y 127 días si fueron sometidas a dos intervenciones. Conclusiones Si bien en hospitales de bajo recursos podríamos pensar al costo de Mammotome como un gasto extra, la comparación con la biopsia radioquirúgica nos muestra que el gasto es menor, con el beneficio de la disminución en el tiempo de tratamiento. Por esto, si bien la biopsia radioquirúgica es de uso frecuente y todavía muy útil en hospitales de bajos recursos, debemos esforzarnos para realizar convenios de trabajo con centros de diagnóstico que cuenten con esta útil herramienta

Introduction Breast cancer is the leading cause of cancer death in Argentina, so their detection in subclinical stage is essential. For this, mammography and breast imaging and Reporting Data System (bi-rads) are an invaluable tool for choosing patients will undergo invasive studies. Objective The objective of the following study was to compare the usefulness of the radio-surgical biopsy (brq) in comparison to the vacuum assisted aspiration puncture in the Municipal Hospital of Moron. Materials and method A retrospective observational study was performed on 97 patients submitted to Mamotomme punctures and radio-surgical biopsies: 76 brq and 21 Mammotome. Results In brq, 65% were benign lesions, 12% infiltrating lesions and 22% proliferative lesions. In the patients submitted to Mammotome, 67% of benign lesions, 12% of malignant lesions and 22% of proliferative lesions were found. The need for new biopsies due to discordance between the pathological anatomy and the images was similar. The need for a second intervention was 33% for both cases (second surgery in brq and first surgery for Mammotome). The time between the first surgery and the end of the surgical treatment was considerably shorter in the Mammotome branch. In the case of brq, the time was 110 days for patients with one intervention and 140 days for patients with two interventions. In patients whose diagnosis was made using Mammotome, the time was 87 days if they only received one intervention and 127 days if they underwent two interventions. Conclusions Although in low income hospitals we could think of the cost of Mammotome as an extra expense; the comparison with the radio-surgical biopsy shows that the expenditure is lower, with the benefit of a decrease in time at treatment. Therefore, while the brq is frequently used and still very useful in low-income hospitals, we must strive to make working agreements with diagnostic centers that have this useful tool

Positive predictive value of nonpalpable breast lesions according to bi-rads® classification / Valor preditivo positivo das lesões mamárias não palpáveis utilizando a classificação BI-RADS®

Introduction: Breast cancer is the neoplasm that most affects women in Brazil and the world, and its incidence has increased steadily over the last decade. Due to screening mammography programs, according to age group, the mortality rate of breast cancer has decreased by 31%. With the increase in the number of screening examinations, there has also been increase in the number of suspicious lesions diagnosed and, consequently, increase in the indication and performance of breast biopsies. With the help of the categorizations that the American College of Radiology published, according to the Breast Imaging Reporting and Data System (BI-RADS®), it was possible to standardize the reports and descriptions of breast lesions, both in mammography and ultrasound, facilitating decision-making in regard to suspicious lesions. Objective: To evaluate the positive predictive value (PPV) of nonpalpable breast lesions biopsied in the Radiodiagnostic Service of Hospital Naval Marcílio Dias. Method: A retrospective and analytical study of 88 patients submitted to stereotaxic guided mammary biopsies from December 2015 to December 2016 with suspected diagnosis of malignant lesions, classified by mammographic BI-RADS in categories 4 and 5 and later correlation with the histopathological reports. Results: PPV was high for category 5 lesions, and for category 4 lesions PPV was low and progressively increased with the subcategories. Conclusion: BI­RADS categorization is an effective predictor for the risk of malignancy in suspicious mammographic lesions.

Introdução: O câncer de mama é a neoplasia que mais acomete mulheres no Brasil e no mundo e sua incidência vem aumentando progressivamente ao longo dessa última década. Devido aos programas de rastreamento mamográfico, de acordo com a faixa etária, a taxa de mortalidade por câncer de mama diminuiu em 31%. Com o aumento do número de exames de rastreamento houve aumento, também, da quantidade de lesões suspeitas diagnosticadas e, consequentemente, um aumento na indicação e realização de biópsias mamárias. Com o auxílio das categorizações que o American College of Radiology publicou, segundo o Breast Imaging Reporting and Data System (BI-RADS®), foi possível padronizar os laudos e as descrições das lesões mamárias, tanto na mamografia quanto na ultrassonografia, facilitando a tomada de decisão perante a lesões de aspecto suspeito. Objetivo: Avaliar o valor preditivo positivo (VPP) das lesões mamárias não palpáveis nas quais foi realizada biópsia no Serviço de Radiodiagnóstico do Hospital Naval Marcílio Dias. Método: Estudo retrospectivo e analítico de 88 pacientes submetidas a biópsias mamárias guiadas por estereotaxia no período de dezembro de 2015 a dezembro de 2016 com diagnóstico suspeito de lesões malignas, classificadas no BI-RADS® mamográfico em categorias 4 e 5, com posterior correlação com os laudos histopatológicos. Resultados: Foi encontrado alto valor preditivo positivo na categoria cinco e, nas lesões classificadas como categoria quatro, o VPP foi menor, aumentando progressivamente com as subcategorias. Conclusão: A categorização BI-RADS® é um preditor eficaz para o risco de malignidade nas lesões suspeitas na mamografia.

Identification of Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Breast Cancer: A Retrospective Study

OBJECTIVE: To determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer. MATERIALS AND METHODS: We reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27–79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins. RESULTS: In univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076). CONCLUSION: Non-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.

The value of ultrasound classification in BI-RADS category 4 of breast complex cystic masses / 中华肿瘤杂志

Objective@#To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards.@*Methods@#The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation.@*Results@#There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively).@*Conclusion@#Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.

Significance of age in the ultrasound interpretation of BI-RADS 3 and 4A breast lumps / 医学研究生学报

ObjectiveBoth BI-RADS 3 and 4A breast lumps have certain effects on the clinician's decision of proper treatment. The purpose of this study was to compare the ultrasonic BI-RADS classification and pathological results of breast lumps in patients of different ages, and explore the significance of age in ultrasound interpretation of BI-RADS 3 and 4A breast lumps.MethodsWe selected 728 patients with breast lumps treated in our hospital from Jun. 2014 to Dec. 2017 as research objects. According to different ages, the patients were divided into juvenile group (7-17 years old) , young group (18-40 years old), middle-aged group (41-65 years old) and aged group (> 65 years). Comparison was made between ultrasound results and pathological results and among the incidences of breast malignant masses of BI-RADS 3 and 4A grade of different ages to analyze possible factors that might affect the benign and malignant breast lumps of BI-RADS 3 and 4A.ResultsA total number of 728 patients was included in this study. Compared with pathological results, the rate of malignant breast tumors in BI-RADS 3 and 4A gradually increased with age. As to BI-RADS 3 breast lumps, the malignant rate of BI-RADS 3(6.54%) in aged group was higher than those of juvenile group(0.00%), young group (0%), middle-aged group (0.95%) and the differences were of statistical significance (P<0.05). As to BI-RADS 4A breast lumps, the malignant rate of juvenile group(0%) was lower than those of young group (2.06%), middle-aged group(6.54%) and aged group(25.39%), and the malignant rate in the elderly group was higher than those of the other groups(P<0.05). Logistic results showed age (OR=1.21,95%CI:1.07~1.36) and weight (OR=3.87,95%CI:1.24~12.81) were risk factors for breast cancer.ConclusionAge plays an important role in the ultrasound interpretation of BI-RADS 3 and 4A breast lumps. For young people, clinical assessment of BI-RADS 4A breast lumps by ultrasound can be properly degraded. While for elderly people, clinical assessment of BI-RADS 3 and 4Abreast lumps can be properly upgraded.

Clasificación BI-RADS y resultado de biopsia en pacientes con patología mamaria / BI-RADS Classification and Biopsy Results in Patients with Breast Pathology

El objetivo de la investigación fue establecer la asociación entre los hallazgos de la clasificación BI-RADS y los resultados de la biopsia definitiva en pacientes con patología mamaria. Se seleccionaron 368 pacientes con algún tipo de patología mamaria que ameritara la realización de la mamografía y biopsia estereotáctica de la lesión que asistieron al Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. Se evaluaron características de las pacientes, clasificación BI-RADS y los resultados de la biopsia definitiva. La edad promedio de las pacientes fue de 62,4 +/- 8,9 años. Basado en el diagnóstico patológico final, 216 lesiones (58,6 %) fueron catalogadas como benignas, 142 lesiones (38,6 %) como malignas y 10 lesiones (2,7 %) como premalignas. La clasificación BI-RADS final para las pacientes estudiadas fue: 34 pacientes (9,2 %) incluidas en la categoría 3, 219 pacientes (59,5 %) incluidas en la categoría 4 y 105 pacientes (28,8 %) incluidas en la categoría 5. Se observó que existe una asociación significativa entre las categorías de la clasificación BI-RADS con las lesiones mamarias malignas (p < 0,05). Se concluye que existe una asociación significativa entre los hallazgos de la clasificación BI-RADS y los resultados de la biopsia definitiva en pacientes con patología mamaria.

The objective of research was to establish de association between findings of BI-RADS classification and biopsy results in patients with breast pathology. Three hundred and sixty eighth patients with any kind of breast pathology who submitted to mammography and estereotactic biopsy of lesion who assisted to Hospital Central Dr. Urquinaona, Maracaibo, Venezuela were selected. Patient characteristics, Bi-RADS classification and result of definitive biopsy were evaluated.Mean age of patients was 62.4 +/- 8.9 years-old. Based on final pathological diagnosis, 216 lesions (58,6 %) were considered as benign, 142 lesions (38,6 %) as malignant and 10 lesions (2,7 %) as pre-malignant. Final BI-RADS classification for studied patients was: 34 patients (9,2 %) were included in category 3, 219 patients (59.5%) were included in category 4 and 105 patients (28,8 %) were included in category 5. There was observed a significant association between BI-RADS category classification with malignant breast lesions (p < 0.05). It is concluded that there is a significant association between findings in BI-RADS classification and the results of definitive biopsies in patients with breast pathology.