Positive predictive value of breast cancer in the lesions categorized as BI-RADS category 5.

OBJECTIVE: To determine positive predictive value (PPV) of the breast imaging reporting and data systems (BI-RADS) category 5 mammogram and ultrasound (US) in the diagnosis of breast cancer in the study center and correlation between clinical, mammographic and US findings, and breast cancer. MATERIAL AND METHOD: Four hundred and ninety seven patients with BI-RADS category 5 who underwent mammograms and US at the Breast diagnostic center, Ramathibodi Hospital from January, 1, 2002 to December 31, 2004 were enrolled into the present study. Selected clinical information, mammographic and US findings, and histopathological diagnosis were retrospectively reviewed. RESULTS: Breast cancer was found in 467 of 497 patients, giving a PPV of 94%. Invasive ductal carcinoma was the most common malignancy (89.5%). Fibrocystic change was the most common benign pathology found in the remaining patients. Discrete mass was the most frequently encountered lesion detected on mammography and US, followed by mass containing calcifications. Patients with advanced age, having a clinically palpable breast mass, with mammographic and US evidence of mass containing calcifications showed significant statistical association with breast cancer. CONCLUSION: PPV of BI-RADS category 5 lesions in the present study was comparable to other published studies. Although the probability of malignancy was very high, a small number of patients had benign pathologies. Preoperative histopathologic diagnosis is necessary before definitive treatment.

Breast cancer underestimation rate of atypical ductal hyperplasia diagnosed by core-needle biopsy under imaging guidance.

OBJECTIVE: To evaluate breast cancer underestimation rate of atypical ductal hyperplasia (ADH) diagnosed by core-needle biopsy (CNB) under imaging guidance in Ramathibodi Hospital and to determine the difference between the malignant and benign groups in terms of clinical and imaging characteristics. MATERIAL AND METHOD: The pathological records of 1521 patients who underwent CNB under imaging guidance were reviewed. Thirty-nine patients diagnosed with ADH were enrolled into the present study. Clinical data, imaging features, biopsy technique and result of excisional biopsy as well as follow-up data were retrospectively reviewed. RESULTS: Of 39 ADH cases, eight (20.5%) were found to have malignancy on subsequent excisional biopsy. The majority of these were ductal carcinoma in situ (DCIS) (62.5%). Lesion categorized as category 5 according to BI-RADS (Breast imaging reporting and data system) was the only feature which was statistically different between the benign and malignant groups. No statistically significant difference was found between the benign and malignant groups in terms of age, personal and family history of breast cancer, clinical finding, mammographic lesion type, size of lesion, image-guided technique and percentage of lesion removal. CONCLUSION: The underestimation rate of ADH in the present study was comparable to other studies. The finding of Bl-RADS category 5 in patients with ADH diagnosed from CNB is a strong indication for subsequent excisional biopsy.

Nondiagnostic core needle biopsy of the breast under imaging guidance: result of rebiopsy.

OBJECTIVE: To determine the rate and the clinical application of recommendation for repeat biopsy after core needle biopsy (CNB) under imaging guidance and to determine the result of rebiopsy. MATERIAL AND METHOD: A retrospective review was performed in 1,306 consecutive women who underwent core needle biopsy under imaging guidance at the breast diagnostic center, the Faculty of Medicine, Ramathibodi Hospital from October 1997 to March 2004. RESULTS: Among 1,306 patients, there were 44 patients (3.37%) who had undergone rebiopsy. The three most common reasons for recommendation of rebiopsy were discordant imaging and pathology, atypical ductal hyperplasia and inadequate specimen. The authors found 12 malignancies subsequently found in rebiopsy (27.3%). The most common reason for rebiopsy in this group was inadequate specimen. CONCLUSION: Core needle biopsy under imaging guidance is a minimally invasive diagnostic tool and promises high accuracy and reliability. However, some patients need rebiopsy to exclude hidden malignancy. The cooperation between the radiologists, surgeons and pathologists are prudent for giving the best care to the patients.