Probably Benign Solid Breast Lesions on Ultrasound: Need for Biopsy Reassessed

Document Type: Research Articles

Authors

Department of Radiology, Aga Khan University, Karachi, Pakistan.

Abstract

Objective: To determine the negative predictive value of ultrasound for breast masses with probably benign
morphology, and to assess whether follow-up may be an acceptable alternative to biopsy. Methods: After Institutional
Review Board approval, all solid breast masses categorized as probably benign (American College of Radiology Breast
Imaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and having
either tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillance
were included. Result: A total of 157 lesions in 40 patients constituted the study population. The mean patient age was
31.3 years (range, 20-56 years). Seventeen of these 157 lesions underwent tissue diagnosis with no invasive breast cancer.
Out of the remaining 140 lesions, 115 were stable on imaging for 24 months or more. The rest 25 were deemed benign
because of decrease in size on follow up (n=1), non-recommendation of further imaging by the second radiologist on
follow up ultrasound (n= 13) or presence of benign tissue diagnosis in the largest lesion (n=11). Conclusion: Ultrasound
has 100% negative predictive value for breast lesions with probably benign morphology, whether palpable or not.
Follow up is an appropriate option to immediate biopsy of such lesions keeping in mind that noncompliance with
surveillance may be a potential problem.

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