Disparities Associated With Patient Adherence to BI-RADS 3 Assessment Follow-up Recommendations for Mammography and Ultrasound

ObjectiveTo assess the relationship between sociodemographic factors and adherence rates in patients with a BI-RADS 3 assessment.MethodsThis retrospective cohort study reviewed data from all patients with a BI-RADS 3 assessment on mammography and ultrasound examinations at a single, multisite academic institution, which serves a diverse urban-suburban population, from January 1, 2015, to December 13, 2017. Appropriate follow-up was defined as returning for the first follow-up examination 3 to 9 months after the index examination. Associations between BI-RADS 3 adherence rates and patient sociodemographic characteristics were evaluated using logistic regression.ResultsThere were 4,038 patients in our study period; 2,437 patients (60%) had appropriate follow-up, 765 (19%) patients had delayed follow-up, and 836 patients (21%) were lost to follow-up. The overall malignancy rate was 1.4% (46 of 3,202). Older age, retired employment status, and Medicare insurance status were associated with increased adherence to BI-RADS 3 follow-up recommendations. Black race, single relationship status, Medicaid and self-pay insurance status, and living in a top 15% disadvantaged zip code were associated with decreased adherence. On multivariate analysis, older age remained associated with increased adherence and Medicaid insurance status with decreased adherence. Time between index examination and cancer diagnosis was shorter in patients who had timely follow-up (202 days [interquartile range 183-358] versus 392 days [interquartile range 365-563], P ≤ .001), although there was not a significant difference in stage at diagnosis (P = .46).DiscussionMultiple sociodemographic factors are associated with low adherence to BI-RADS 3 follow-up recommendations suggesting that more frequent and targeted interventions are needed to close disparity gaps.     

Breast MRI BI-RADS 3: Impact of Patient-Level Factors on Compliance With Short-Term Follow-Up

PurposeA BI-RADS 3 assessment on breast MRI is given when a finding is estimated to have less than 2% chance of breast cancer. Patients in this category are typically recommended to return for a 6-month follow-up MRI. Compliance with this recommendation is low, and we aim to understand which factors are associated with compliance.Materials and MethodsAll patients with an MRI examination given a BI-RADS category 3 between February 1, 2011, and June 30, 2016, were retrospectively reviewed. Patient demographics and breast-related medical history were extracted from the electronic medical record. Patients presenting for follow-up MRI between 3 and 10 months were considered compliant. Univariate and multivariate analysis was performed to identify which patient-level factors were associated with compliance with follow-up MRI.ResultsOverall, 190 women with a BI-RADS 3 assessment on MRI were included in the study. Of these women, 106 were compliant with the recommended follow-up MRI (57.3%), 34 had delayed follow-up (18.4%), and 45 were noncompliant (24.3%). Reason for examination, personal history of breast cancer, and family history of breast cancer were significantly associated with compliance.ConclusionsWe found that 75.7% of patients had a follow-up MRI after a BI-RADS 3 assessment, but only 57.3% were timely in their follow-up. Our data suggest that there may be subsets of patients who would benefit from additional support and resources to help increase overall compliance and timely compliance.     

Stereotactic Breast Biopsy With Benign Results Does Not Negatively Affect Future Screening Adherence

PurposeTo evaluate whether false-positive stereotactic vacuum-assisted breast biopsy (SVAB) affects subsequent mammographic screening adherence.Materials and MethodsThis Institutional Review Board–approved, HIPAA-compliant retrospective review of women with SVAB was performed between 2012 and 2014. Patient age, clinical history, biopsy pathology, and first postbiopsy screening mammogram were reviewed. Statistical analyses were performed using Fisher’s exact, Mann-Whitney, and χ² tests.ResultsThere were 913 SVABs performed in 2012 to 2014 for imaging detected lesions; of these, malignant or high-risk lesions or biopsies resulting in a recommendation of surgical excision were excluded, leaving 395 SVABs yielding benign pathology in 395 women. Findings were matched with a control population consisting of 45,126 women who had a BI-RADS 1 or 2 screening mammogram and did not undergo breast biopsy. In all, 191 of 395 (48.4%) women with a biopsy with benign results and 22,668 of 45,126 (50.2%) women without biopsy returned for annual follow-up >9 months and ≤18 months after the index examination (P = .479). In addition, 57 of 395 (14.4%) women with a biopsy with benign results and 3,336 of 45,126 (7.4%) women without biopsy returned for annual follow-up >18 months after the index examination (P < .001). Older women, women with personal history of breast cancer, and women with postbiopsy complication after benign SVAB were more likely to return for screening (P = .026, P = .028, and P = .026, respectively).ConclusionThe findings in our study suggest that SVABs with benign results do not negatively impact screening mammography adherence. The previously described “harms” of false-positive mammography and biopsy may be exaggerated.     

Patient Perceptions of Breast Cancer Risk in Imaging-Detected Low-Risk Scenarios and Thresholds for Desired Intervention: A Multi-Institution Survey

PurposeTo determine women’s perceptions of breast cancer risk and thresholds for desiring biopsy when considering BI-RADS 3 and 4A scenarios and recommendations, respectively.Materials and MethodsWomen presenting for screening mammography from five geographically diverse medical centers were surveyed. Demographic information and baseline anxiety were queried. Participants were presented with scenarios of short-term imaging follow-up recommendations (ie, BI-RADS 3) and biopsy recommendations (ie, BI-RADS 4A) for low-risk mammographic abnormalities and asked to estimate their breast cancer risk for each scenario. Participants reported the threshold (ie, likelihood of cancer) where they would feel comfortable undergoing short-term imaging follow-up and biopsy and their anticipated regret for choosing short-term follow-up versus biopsy.ResultsAnalysis of 2,747 surveys showed that participants estimated breast cancer risk of 32.8% for a BI-RADS 3 and 41.1% for a BI-RADS 4A scenarios are significantly greater rates than clinically established rates (<2% [P < .001] and 2%-10% [P < .001], respectively). Over one-half (55.4%) of participants reported they would never want imaging follow-up if there was any chance of cancer; two-thirds (66.2%) reported they would desire biopsy if there was any chance of cancer. Participants reported greater anticipated regret (P < .001) and less relief and confidence (P < .001) with the decision to undergo follow-up imaging versus biopsy.ConclusionWomen overestimate breast cancer risk associated with both BI-RADS 3 and 4A scenarios and desire very low biopsy thresholds. Greater anticipated regret and less relief and confidence was reported with the choice to undergo short-term imaging follow-up compared with biopsy.     

Disparities Associated With Patient Adherence of Post-Breast-Conserving Surgery Surveillance Imaging Protocols

ObjectiveCurrently, national and international breast imaging practices utilize variable postsurgical surveillance protocols without uniform recommendations. Because of the innate differences between screening versus diagnostic mammography from scheduling flexibility to out-of-pocket costs, this creates the opportunity for lapses in patient adherence, which has the potential to impact clinical outcomes. The purpose of this study is to evaluate the relationship between sociodemographic factors and postsurgical surveillance imaging protocols on patient adherence rates.MethodsThis retrospective study reviewed 3 years of surveillance imaging for all patients having breast-conserving surgery at our institution from January 2011 to December 2016. Follow-up adherence was defined as returning for all of the first 3 years of annual follow-up after breast-conserving surgery (institutional surveillance protocol). Associations between adherence to surveillance imaging and patient sociodemographic characteristics were evaluated using univariate and multivariate logistic regression.ResultsThe study included 1,082 patients after breast surgery, 715 of whom adhered completely to the first 3 years of annual follow-up (66.1%). Black women were 1.36 times less likely to follow up annually compared with White women (95% confidence interval 1.02-1.80). Similarly, patients with Medicare were 1.84 times less likely to follow up annually compared with patients with private insurance (95% confidence interval 1.34-2.51). Women with benign breast disease after breast-conserving surgery were significantly less likely to adhere to annual surveillance than women with breast cancer.ConclusionSociodemographic disparities exist as barriers for annual mammography surveillance in patients after breast-conserving surgery.     

BI-RADS 3 on dense breast screening ultrasound after digital mammography versus digital breast tomosynthesis

ObjectiveCompare the BI-RADS 3 rate and follow-up of dense breast ultrasound (US) screening following digital mammography (DM) versus digital breast tomosynthesis (DBT).MethodsIRB-approved, HIPAA compliant retrospective search was performed of databases at two tertiary breast centers and an office practice for BI-RADS 3 screening US examinations performed 10/1/14–9/30/16. Prior DM versus DBT, downgrade and upgrade rate, and timing and pathology results were recorded. Differences were compared using the two-sample proportions test.Results3183 screening US examinations were performed, 1434/3183 (45.1%) after DM and 1668/3183 (52%) after DBT (2.5% (81/3183) no prior mammogram available). 13.9% (199/1434) had BI-RADS 3 results after DM and 10.6% (177/1668) after DBT (p < 0.01). Median imaging follow-up after DM was 12 months (IQR 6, 24) versus 18 after DBT (IQR 11, 25), p = 0.02. 19.5% (73/375) of patients were lost to follow-up (19.2% (38/198) after DM (68.4% (26/38) no follow-up after initial exam) versus 19.8% (35/177) after DBT (54.3% (19/35) no follow-up after initial exam). 1.3% (5/375) of patients elected biopsy (1.5% (3/198) after DM and 1.1% (2/177) after DBT). 75.2% (282/375) of patients were downgraded (75.3% (149/198) after DM and 75.1% (133/177) after DBT). 2.5% (5/198) were upgraded after DM and 0.6% (1/177) after DBT. Median time to upgrade was 6 months after both DM and DBT. 0.3% (1/375) of patients with BI-RADS 3 results had cancer on follow-up.ConclusionPatients with prior DBT had a lower risk of encountering BI-RADS 3 findings on screening ultrasound. BI-RADS 3 findings on screening ultrasound had an extremely low rate of being cancer.     

Impact of Second-Opinion Interpretation of Breast Imaging Studies in Patients Not Currently Diagnosed With Breast Cancer

PurposeTo study the impact of second-opinion interpretation of breast imaging studies submitted from outside facilities to a tertiary cancer center.Materials and MethodsA retrospective database review was conducted of second-opinion interpretations rendered at our institution from January 1, 2010, to June 30, 2014, on studies from patients who did not have a concurrent breast cancer diagnosis. A total of 2,253 patients were included.ResultsIn 800 of 2,253 patients (35.5%), the BI-RADS categories assigned at our institution and at outside facilities were discordant. Of 973 patients assigned BI-RADS category 4 or 5 at outside facilities, 278 (28.6%) were assigned BI-RADS category 1 to 3 (no biopsy necessary) at our institution. Of 923 patients assigned BI-RADS category 1 to 3 at outside facilities, 191 (20.7%) were assigned BI-RADS category 4 or 5 at our institution, and 189 of these had biopsies, which revealed 23 cancers, 15 high-risk lesions, and 151 benign lesions. One high-risk lesion at core biopsy was upgraded to invasive ductal carcinoma and ductal carcinoma in situ (DCIS) on excision, resulting in 24 cancers. Of these, 18 reflected true additional breast cancers detected as a result of second-opinion interpretation: 12 invasive carcinomas and 6 cases of DCIS. These results translate into a 9.4% (18/191) positive predictive value for the number of cancers diagnosed among all biopsies recommended and a 9.5% (18/189) positive predictive value for the number of cancers diagnosed among all biopsies recommended and actually performed.ConclusionsThese findings demonstrate the positive clinical impact of second-opinion interpretation at a tertiary cancer center of outside-facility breast imaging studies in patients without a breast cancer diagnosis.     

First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability?

ObjectivesTo evaluate the outcome of repeated short-term follow-up with ultrasound in no high-risk young patients with a BI-RADS3 lesion at first examination.MethodsIn this IRB-approved study 492 women, aged 18–34 years (mean ± standard deviation, 28 ± 4.5 years) with first breast ultrasound examination in 2012–2014 were retrospectively evaluated. Inclusion criteria were: at least one BI-RADS3 lesion and (a) biopsy/surgical excision or (b) follow-up of at least 18 months (including a 6-month follow-up). BI-RADS category assigned during follow-up and pathologic findings in cases undergoing biopsy/surgical excision were collected. At the 6- and 18-month follow-up the recommended biopsy rates (RBR) and the corresponding positive predictive value (PPV) were calculated.ResultsIn 97 patients, 151 BI-RADS3 lesions were identified. Biopsy/surgical excision was initially performed in 25/151 (16.5%) lesions. After 6-month, category was downgraded to BI-RADS1/2 in 23/126 (15.3%) and upgraded to BI-RADS4 in 9/126 lesions (7.1%). Pathological diagnosis of these lesions was fibroadenoma in 5 and benign phyllodes tumor in 4 cases (RBR 7%, PPV_bio 44.4%). After 18-month one lesion was classified BI-RADS4 and pathological diagnosis was fibroadenoma (RBR 1.1%, PPV_bio 0%).ConclusionsOur preliminary data show that follow-up imaging performed after 18 months from a first BI-RADS3 diagnosis does not affect clinical treatment and 6-month follow-up may be sufficient to assess the stability of probably benign lesions.     

Utilization and Cancer Yield of Probably Benign Assessment Category in the National Mammography Database: 2009 to 2018

PurposeData on utilization rate and cancer yield of BI-RADS® category 3 in routine clinical practice in diagnostic mammography are sparse. The aim of this study was to determine utilization rate and cancer yield of BI-RADS 3 in diagnostic mammography in the ACR National Mammography Database (NMD).MethodsRetrospective analysis of NMD mammograms from January 1, 2009, to June 30, 2018, was performed. BI-RADS 3 utilization rate in diagnostic setting was calculated and stratified by patient, facility, and examination-level variables. Patient-level cancer yield was calculated among women with BI-RADS 3 assessment and adequate follow-up (imaging follow-up ≥24 months or biopsy). Logistic regression was performed to assess the odds of utilization of BI-RADS 3, with respect to facility, examination, and patient variables, and the odds of malignancy among patients with probably benign findings. Chi-square and t tests were used to determine significance (P < .05).ResultsData from 19,443,866 mammograms from 500 NMD facilities across 31 states were analyzed, of which 3,039,952 were diagnostic mammograms. Utilization rate of BI-RADS 3 was 15.5% (470,155 of 3,039,952) in the diagnostic setting. There was a statistically significant difference in BI-RADS 3 utilization rate across all collected variables (P < .001). Patient-level cancer yield at 2-year follow-up was 0.91% (2,009 of 220,672; 95% confidence interval [CI], 0.87%-0.95%) in the diagnostic setting. Patient and examination variables associated with significantly higher likelihood of malignancy included calcifications (odds ratio, 4.27; 95% CI, 2.43-7.51), patient age > 70 years (odds ratio, 3.77; 95% CI, 2.49-5.7), and presence of prior comparisons (odds ratio, 1.23; 95% CI, 1.07-1.42).ConclusionsIn the NMD, BI-RADS 3 assessment was common in diagnostic mammography (15.5%), with an overall cancer yield of 0.91%, less than the benchmark of 2%. Utilization trends in diagnostic mammography warrant further research for optimization of use.     

Revisiting the mammographic follow-up of BI-RADS category 3 lesions

OBJECTIVE: Using data collected for one series during 1987-1989 and data collected for another series during 1996, we sought to compare the frequency of and positive predictive value for carcinoma of the breast in nonpalpable, probably benign lesions that had been detected on and followed up with mammography. MATERIALS AND METHODS: During 1996, mammography was performed in 18,435 women of whom 544 (3.0%) had lesions assigned to Breast Imaging Reporting and Data System (BI-RADS) category 3 for nonpalpable, probably benign lesions. The lesions in the women were assessed as BI-RADS category 3 after the patients had undergone a diagnostic study that included additional imaging, sonography, and a focused physical examination. Patients with BI-RADS category 3 lesions were recommended for mammographic surveillance. A minimum of 2 years of follow-up data was available for 511 patients, our study population. We compared the findings for our study population with those of the previous study. RESULTS: Ninety-seven percent of the follow-up mammograms showed stability or regression of the BI-RADS category 3 lesions. Fourteen patients (3%) had nonpalpable interval progression revealed on mammography and underwent biopsy. The breast cancer detection rate in category 3 lesions among the study population was 0.4% (2/511), which was 14% of the patients who had undergone biopsies because of interval progression of the lesions. The pathologic stage of the cancers in these two patients was T1b N0. CONCLUSION: Compared with the findings from the 1987-1989 study, the frequency of BI-RADS category 3 lesions has remained stable; patient compliance for follow-up has increased; and the positive predictive value of category 3 lesions for cancer has decreased from 1.7% to 0.4% (p = 0.04).     

Outcomes of screening mammography in women less than 40 prior to fertility treatment: a retrospective pilot study

ObjectiveThere are currently no evidence-based guidelines regarding breast cancer screening in women under 40 prior to initiating assisted reproductive technology (ART). The prevalence of abnormal findings on screening mammography in this population is unknown. The purpose of this study was to describe screening mammography outcomes in women less than 40 years old, referred for the indication of pre-ART.Materials, methods, proceduresThis is a retrospective review of women less than 40 years old presenting for screening mammography prior to ART between January 2010 and March 2017. Clinical history, breast cancer risk factors, imaging and pathology results were gathered from the electronic medical record.ResultsThe study included 80 women. Mean patient age was 37 years (range 34–39 years). Sixty-seven (84%) had negative or benign screening (BI-RADS 1 or 2) and 13 (16%) were recalled for diagnostic imaging (BI-RADS 0). Four of 13 (31%) recalled women were given BI-RADS 1 or 2 at diagnostic work-up, 4 (31%) were given a BI-RADS 3, and 5 (38%) were recommended for biopsy (BI-RADS 4). At patient request, 2 of 4 (50%) BI-RADS 3 cases underwent biopsy, for 7 total biopsies. Six (86%) biopsies yielded benign results and 1 (14%) yielded DCIS. Overall cancer yield was 1.3%.ConclusionIn women under 40 who plan to undergo ART, screening mammography may identify breast malignancies. This may be of particular importance given many breast cancers are hormone sensitive, and thus fertility treatments may affect tumor growth. Future, larger studies are needed.     

Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue.

PURPOSE: To evaluate the clinical utility of bilateral whole-breast ultrasonography (US) as an adjunct examination to mammography in asymptomatic women with dense (Breast Imaging Reporting and Data System [BI-RADS] density category 3 or 4) breast tissue. MATERIALS AND METHODS: Between July 1998 and April 2000, 1,862 patients with negative findings at clinical examinations, negative mammographic results, and breast tissue with BI-RADS category 3 or 4 density were evaluated with bilateral whole-breast US for occult cystic and solid masses, areas of architectural distortion, and acoustic shadowing. Suggestive findings were compared with tissue diagnoses from US-guided core biopsy specimens. US was initially performed by a US or a mammography technologist. The average time to perform the examination was approximately 10 minutes. Abnormal findings were corroborated by a fellowship-trained breast-imaging radiologist. RESULTS: In the 1,862 women examined with bilateral whole-breast US, 57 biopsies were recommended in 56 patients; follow-up data were available in 51 of the 56 patients. Six breast cancers were detected (cancer detection rate, 0.3%). CONCLUSION: Bilateral whole-breast US, when performed in patients with dense (BI-RADS category 3 or 4 density) breast tissue, is useful in detecting breast cancer not discovered with mammography or clinical breast examination. The 0.3% cancer detection rate compares favorably with that of screening mammography and with that in previously published studies involving bilateral whole-breast US.     

Recall rate of screening ultrasound with automated breast volumetric scanning (ABVS) in women with dense breasts: a first quarter experience

PurposeThe aim of this study was to determine the recall rate of screening ultrasound with automated breast volumetric scanning (ABVS) in women with dense breasts (BI-RADS density classification 3 or 4 on mammogram).Materials and MethodsIn this retrospective cohort study, at the end of the “first quarter” (August–October 2013) of use, our practice database was searched for all ABVS examinations performed and specifically, the positive examinations (defined as abnormal/BI-RADS 0) for which patients were recalled for additional imaging evaluation with handheld ultrasound (HHUS); the latter group was reviewed with respect to final BI-RADS and pathology if relevant.ResultsDuring the 3-month study time period, 558 ABVS studies were performed: 453 (81%) were initially BI-RADS 1 or 2 and 105 (19%) were BI-RADS 0-incomplete and recalled, corresponding with an overall recall rate of 19%; specifically, the recall rate trended down from 24.7% in August to 12.6% in October. To date, 98 of the 105 recalled women have returned for HHUS, with the resultant final BI-RADS as follows: 25/98=25% BI-RADS 1, 46/98=47% BI-RADS 2, 13/98=13% BI-RADS 3, 14/98=15% BI-RADS 4, and 0/98=0% BI-RADS 5. All biopsies performed to date of the ABVS-detected BI-RADS 4 lesions have yielded benign results, with the most common pathology being fibroadenoma.ConclusionThe recall rate of screening ABVS in women with dense breasts at our institution was under 20% overall during its first quarter of use, and trended down from nearly 25% in the first month to under 13% in the third. The clinical implication is that ABVS does have a learning curve, but that is a potentially feasible way to meet the increasing demands for screening ultrasound in women with dense breasts.     

The Impact of Patient-Initiated Subspecialty Review on Patient Care

PurposeTo determine the effect of subspecialty review of breast imaging on patients without a diagnosis of breast cancer who self-referred for a second opinion.MethodsInstitutional review board–approved retrospective review was performed of 415 breast imaging studies submitted to our cancer center for second-opinion review by 245 patients in 2014, excluding cases without follow-up or change in original BI-RADS 0 assessment. One hundred forty-seven patients with 176 lesions were included. Original and second-opinion interpretations and recommendations were compared with histopathology or follow-up imaging.ResultsNinety-six of 176 (55%) lesions were reported as suspicious in the original interpretation. Second-opinion review was discordant with the original interpretation in 82 of 176 (47%) lesions. Second-opinion review downgraded 24 of 96 (25%) lesions originally reported as suspicious to benign or probably benign, averting biopsy of these lesions. Second-opinion review upgraded 31 of 80 (39%) lesions originally reported as benign or probably benign to suspicious. A total of 87 lesions were biopsied yielding malignancy in 23 (26%) biopsies. Twenty-eight of 87 (32%) biopsies performed were recommended after second-opinion review, with 8 of 28 (29%) of these biopsies yielding cancer. Eight of 23 (35%) cancers detected represented malignancy not initially detected in the original interpretation.ConclusionSecond-opinion review is valuable in patients pursuing a breast imaging specialist’s opinion, even before they are diagnosed with breast cancer. Second-opinion review disagreed with the original interpretation for 47% of lesions, averted 25% of originally recommended biopsies, and detected cancer in 29% of additional biopsies recommended. Thirty-five percent of cancers diagnosed after second-opinion review were not initially detected in the original interpretation.     

Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients

Objective

To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients.

Methods

BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards.

Results

Of the 626 lesions, morphological features included a single focus in 26.5% (n?=?166), multiple foci in 47.1% (n?=?295), mass in 21.7% (n?=?136) and non-mass enhancement in 4.6% (n?=?29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29–66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA.

Conclusions

Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers.

Key Points

? BI-RADS category 3 lesions on preoperative MRI had 0.8% malignancy rate. ? All cancer diagnoses from BI-RADS 3 occurred after 24-month follow-up. ? Annual follow-up might be adequate for BI-RADS 3 detected on preoperative MRI.

     

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound

Purpose

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI).

Materials and methods

Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up.

Results

Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered.

Conclusions

Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.     

Cancer yield of probably benign breast MR examinations

PURPOSE: To evaluate the cancer yield, frequency of use, and follow-up compliance of breast MR examinations assessed as "probably benign." MATERIALS AND METHODS: We retrospectively reviewed our MR database of 809 consecutive examinations between January 2003 and June 2004. We identified all examinations that ultimately received an MR breast imaging reporting and data system (BI-RADS) 3 assessment and recommendation for a short-interval follow-up MR with or without an antecedent targeted ultrasound. The clinical indication for breast MR, date of the follow-up examination, follow-up assessment, and any pathology findings through June 2005 were collected from clinical records and radiology and pathology reports. Frequency of BI-RADS 3 use, follow-up compliance, and cancer yield were calculated. RESULTS: A total of 160 out of 809 (20%) examinations comprise the study population. A total of 100 out of 160 (63%) women returned for the recommended follow-up MR, in which three out of 100 (3%) were upgraded to BI-RADS 4 with biopsy recommended. One patient underwent biopsy and the result was benign. A total of seven out of 160 (4%) underwent mastectomy in lieu of MR for known cancer elsewhere in the breast. One out of seven mastectomy specimens contained malignancy that corresponded to the probably benign finding, resulting in a cancer yield of one out of 160 (0.6%). CONCLUSION: Our data suggest that follow-up MR is a valid alternative to biopsy for MR BI-RADS 3 lesions.     

钼靶X线、超声组合BI-RADS分类法指导农村妇女乳腺普查

目的:探讨应用钼钯X线(MAM)、超声(US)组合BI-RADS分类法确定农村妇女乳腺癌普查年龄的可行性。方法:954例本地区农村妇女,年龄35～60岁,平均(47.5±5.8)岁。所有妇女均接受US和MAM检查并行BI-RADS分类,US+MAM组合分类结果为每例受检者US与MAM分类结果中的最高级别,US+MAM分类Ⅲ类以上结果判定为高危人群并随访。将954例农村妇女及所检出的高危妇女划分为35～40岁、41～50岁、51～60岁3个年龄段,计算高危妇女在其相应年龄段所占比率,统计学分析其差异。结果:44例农村妇女被组合BI-RADS分类法评价为高危妇女,其随访结果与BI-RADS要求相符,35～40岁、41～50岁、51～60岁3个年龄段高危妇女所占比率分别为8.21%、5.32%、1.70%,其差异有统计学意义(P<0.05)。结论:应用US+MAM组合法BI-RADS分类可准确判定农村妇女乳腺癌的普查年龄。     

Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis

Purpose

To investigate prevalence, malignancy rates, imaging features, and follow-up intervals for probably benign (BI-RADS 3) lesions on breast magnetic resonance imaging (MRI).

Methods

A systematic database-review of articles published through 22/06/2016 was performed. Eligible studies reported BI-RADS 3 lesions on breast MRI. Two independent reviewers performed a literature review and data extraction. Data collection included study characteristics, number/type of BI-RADS 3 lesions, final diagnosis (histopathology and/or follow-up). Sources of bias (QUADAS-2) were assessed. Meta-analysis included data-pooling, heterogeneity testing, and meta-regression.

Results

Fifteen studies were included. Prevalence was reported in 11 studies (range: 1.2-24.3%). Malignancy rates ranged between 0.5-10.1% (pooled 61/2814, 1.6%, 95%-CI:0.9-2.3% (random-effects-model), I²=53%, P=0.007). In a subgroup of 11 studies (2183 lesions), highest malignancy rates were observed in non-mass lesions (pooled 25/714, 2.3%, 95%-CI:0.8-3.9%, I²=52%, P=0.021) followed by mass lesions (pooled 15/771, 1.5%, 95%-CI:0.7-2.4%, I²=0%, P=0.929), and foci (pooled 10/698, 1%, 95%-CI:0.3-1.7%, I²=0%, P=0.800). There was non-significant negative association between prevalence and malignancy rates (P=0.077). Malignant lesions were diagnosed at all follow-up time points.

Conclusion

While prevalence of MRI BI-RADS 3 lesions was strongly heterogeneous, pooled malignancy rates met BI-RADS benchmarks (<2%). Malignancy rates varied, exceeding 2% in non-mass lesions. Twenty-four-month surveillance is required to detect all malignant lesions.

Key points

? Probably benign (BI-RADS 3) lesions showed a pooled malignancy-rate of 1.6% (95%-CI:0.9-2.3%). ? Malignancy rates differ and are highest in non-mass lesions (2.3%, 95%-CI:0.8-3.9%). ? The prevalence of BI-RADS 3 lesions on breast MRI ranged from 1.2-24.3%. ? Malignant lesions were diagnosed at follow-up time points up to 24 months.