Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy?

Ha Yeon Kim; Yun-Woo Chang

doi:10.3348/jksr.2013.69.1.71

Journal List > J Korean Soc Radiol > v.69(1) > 1087349

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Chang: Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy?

Breast Radiology

Journal of the Korean Society of Radiology 2013; 69(1): 71-77.

Published online: 12 July 2013

DOI: https://doi.org/10.3348/jksr.2013.69.1.71

Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy?

Ha Yeon Kim, MD, Yun-Woo Chang, MD

Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, Korea.

Corresponding author: Yun-Woo Chang, MD. Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. Tel. 82-2-709-9396, Fax. 82-2-709-9066, ywchang@schmc.ac.kr

Received 20 February 2013 Accepted 30 April 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate whether sonographic findings can predict malignancy in complex echoic breast masses using the Breast Imaging Reporting and Data System (BI-RADS) lexicon and to demonstrate the need for biopsy recommendations for all complex breast masses.

Materials and Methods

135 pathologically proven complex echoic masses detected on sonography were identified. We retrospectively reviewed the sonographic findings according to the BI-RADS lexicon which include shape, margin, orientation, lesion boundary, posterior acoustic features, and vascularity. The sonographic findings were correlated with the pathology and mammographic findings. Differentiation between the sonographic appearance of benign and malignant complex cystic lesions was evaluated using the chi-square test or the Mann-Whitney U test.

Results

59.3% (80/135) were benign lesions and 40.7% (55/135) were malignant lesions. Malignant lesions were correlated with irregular (p < 0.001), nonparallel (p = 0.023), noncircumscribed (p < 0.001), echogenic halo (p < 0.001), increased vascularity (p = 0.001) and large size (p = 0.002) compared to benign lesions. However, 12.7% (7/55) of benign looking complex cystic masses were proved to be malignant. All seven lesions had malignant microcalcifications or abnormality on mammography.

Conclusion

Using the sonographic BI-RADS lexicon can be useful for differentiating between malignant and benign complex cystic breast masses. Notably, 12.7% of the complex cystic lesions showing a benign appearance on sonography were pathologically proven malignant. Therefore, radiologist should recommend biopsy for complex cystic lesions.

Keywords: Ultrasonography, Complex Cystic Mass, Breast Cancer

Figures and Tables

Fig. 1

A 42-year-old women with palpable mass.

A. Sonography shows about 5.4 cm sized, round, non parallel, noncircumscribed, complex echoic mass with posterior acoustic enhancement.

B. Color Doppler image shows increased vascularity of the mass. Pathology revealed infiltrative ductal carcinoma.

Fig. 2

A 52-year-old women with palpable mass.

A. Sonography shows about 2 cm sized, oval, parallel, circumscribed complex echoic mass with posterior acoustic enhancement.

B. Color Doppler image shows no increased vascularity of the mass. Pathology revealed papillary carcinoma.

Fig. 3

A 43-year-old women with palpable mass.

A. Sonography shows oval, parallel, circumscribed, complex echoic mass with posterior acoustic enhancement.

B. Mammography revealed partial obscured hyperdense mass in left upper inner quadrant. Pathology revealed infiltrative ductal carcinoma.

Table 1

Analysis of Ultrasonography and Pathology

Note.-^*Parenthesis (%).

CNB = core needle biopsy, DCIS = ductal carcinoma in situ, E&B = excisional biopsy, IDC c/s DCIS = infiltrative ductal cancer with/without ductal carcinoma in situ

Table 2

Sonographic Features of 136 Complex Echo Mass of the Breast

Note.-chi-square test; p < 0.05 is considered as statistically significant.

NS = not significant

Table 3

Analysis of Masses That Ultrasonographic Features of Oval/Round, Circumscribed, Thin Lesion Boundary and Absent of Vascularity

Note.-^*Parenthesis (%).

DCIS = ductal carcinoma in situ, FA = fibroadenoma, FCD = fibrocystic disease, IDC = infiltrative ductal carcinoma

Table 4

Mammographic Evaluation for Complex Echoic Masses

Note.-Mammography was available in 88.1% of patients (119/135).

Table 5

Mammographic Evaluation for Benign Looking Complex Echogenic Mass

Note.-Six patient was not performed mammography because of younger age (teenage or the twenties).

References

1. American College of Radiology. ACR BI-RADS_ ultrasound. ACR breast imaging reporting and data system, breast imaging atlas. Reston, VA: American College of Radiology;2003.

2. Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 2010; 48:931–987.

3. Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 2003; 227:183–191.

4. Chang YW, Kwon KH, Goo DE, Choi DL, Lee HK, Yang SB. Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 2007; 26:47–53.

5. Yoo JL, Woo OH, Kim YK, Cho KR, Yong HS, Seo BK, et al. Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 2010; 30:1689–1702.

6. Doshi DJ, March DE, Crisi GM, Coughlin BF. Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics. 2007; 27:Suppl 1. S53–S64.

7. American College of Radiology. ACR practice guidelines for the performance of diagnostic mammography. ACR guidelines and technical standards. Reston, VA: American College of Radiology;2006.

8. Doshi DJ, March DE, Coughlin BF, Crisi GM. Accuracy of ultrasound: guided percutaneous biopsy of complex cystic breast masses [abstr]. Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, IL: Radiological Society of North America;2006. p. 655.

TOOLS

Similar articles