Sonographic Characteristics and Pathology Correlation of Breast Imaging Reporting and Data System (BI-RADS) Category 4 Lesions

Authors

Poonum Khan, Aga Khan UniversityFollow
Imrana Masroor, Aga Khan UniversityFollow
Muhammad S. Alam, King Faisal Specialist Hospital,Saudi Arabia
Abdus Salam, Khyber Teaching Hospital, Peshawar
Yasir Ali, Nazareth Hospital, Philadelphia, USA
Muhammad Salman Khan, University of Texas Health Science Houston, USA

Document Type

Article

Department

Radiology

Abstract

Introduction: The Breast Imaging-Reporting and Database System (BI-RADS) category 4 is designated for breast lumps that do not display the typical features of malignancy but still raise enough suspicion to warrant a recommendation for a biopsy, as malignancy cannot be ruled out through imaging alone. The main objective of this study was to investigate the sonographic characteristics and pathology correlation of BI-RADS 4 breast lesions and determine the positive predictive rate of BI-RADS 4 lesions in diagnosing breast cancer, using histopathology as the gold standard.
Methods: This was a cross-sectional study conducted at the Department of Radiology, Aga Khan University Hospital in Karachi, spanning from May 2021 to August 2022, with a duration of 15 months. The study focused on female patients over the age of 18 who presented with suspicious breast lesions on ultrasound. Both mammography and ultrasound-guided core needle biopsy were performed on these patients, followed by a detailed histopathological evaluation of the biopsy specimens. To calculate the positive predictive value (PPV), true positive cases were identified through both histopathology and ultrasonography.
Results: A total of 227 cases were categorized as BI-RADS 4 lesions, with the patients' mean age being 47.8 ± 14.3 years (range: 17 - 88). Among the biopsied lesions, 101 cases were confirmed to be true positive for breast malignancies, resulting in a PPV for malignancy of 44.9%. Conversely, there were 124 false positive cases out of the 227 BI-RADS 4 category lesions (54.63%). The primary indication for presentation was a breast lump, and out of the 101 confirmed malignant cases, 70 (69.3%) were associated with malignancy.
Conclusion: BI-RADS 4 can be utilized to assess suspicious breast lumps; however, for more reliable results and to avoid false negatives, histopathological confirmation should complement the imaging findings.

Comments

Pagination are not provided by the author/publisher.

Publication (Name of Journal)

Journal of Medical Science

DOI

https://www.cureus.com/articles/209082-sonographic-characteristics-and-pathology-correlation-of-breast-imaging

Recommended Citation

Khan, P., Masroor, I., Alam, M. S., Salam, A., Ali, Y., Khan, M. S. (2023). Sonographic Characteristics and Pathology Correlation of Breast Imaging Reporting and Data System (BI-RADS) Category 4 Lesions. Journal of Medical Science, 15(12).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/512