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Correlation of ultrasound, cytological, and histological features of 110 benign BI‐RADS categories 4C and 5 nonpalpable breast lesions. The Institut Curie's experience
Author(s) -
Farras Roca Josep A.,
Tardivon Anne,
Thibault Fabienne,
Rouzier Roman,
Klijanienko Jerzy
Publication year - 2021
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.22402
Subject(s) - medicine , benignity , ultrasound , radiology , bi rads , lesion , mammography , overdiagnosis , breast imaging , fine needle aspiration , pathological , breast ultrasound , nuclear medicine , pathology , biopsy , breast cancer , malignancy , cancer
Background The purpose of this study was to determine the pathological and ultrasound (US) features of benign nonpalpable breast lesions (NPBLs) classified as Breast Imaging Reporting and Data System (BI‐RADS) category 4C or 5. Methods Between 2003 and 2007, 849 consecutive NPBLs detected at US and classified as BI‐RADS category 4C (505) or 5 (344) initially underwent US‐guided fine needle aspiration (FNA) at our institution. Benign diagnoses were established according to surgical excision findings or during a minimal 6‐month imaging follow‐up (mean, 3.7 years [SD, 2.6 years]). US BI‐RADS features were reviewed and compared retrospectively using a chi‐square test for the following pathological categories: epithelial and fibrous proliferation (EFP), cystic and papillary lesion (C&P), inflammatory lesion (IL), benign tumor (BT), intramammary lymph node (ILN), intraepithelial proliferative lesion (IPL), and nonspecific morphological alteration (NMA). The performance of FNA in the diagnosis of benignity was assessed. Results Of 849 NPBLs, 110 (12.9%) NPBLs were benign: 88 (17.4%) were BI‐RADS category 4C, and 22 (6.4%) were BI‐RADS category 5. Forty‐four (40%) were EFPs, 21 (19%) were C&Ps, 13 (12%) were NMAs, 11 (10%) were ILs, 11 (10%) were BTs, 8 (7%) were IPLs, and 2 (2%) were ILNs. Lesion shape, US pattern distribution, and posterior features showed statistically significant differences between these categories ( P < .05): 33 (75%) EFPs exhibited posterior shadowing, 18 (86%) C&Ps were homogenous, 9 (82%) ILs were heterogeneous, 11 (100%) BTs were homogeneous, 9 (82%) BTs were oval, and 6 (75%) IPLs were irregularly shaped. Of the 110 benign NPBLs, FNA diagnosis was falsely positive in 7 (6%), suspicious in 10 (9%), and benign in 90 (82%), and 3 (3%) were inadequate for diagnosis. Conclusion A diverse array of benign NPBLs can be classified as BI‐RADS category 4C or 5 on US, each showing specific imaging presentations.