Pathological correlation of BIRADS 3 and 4 breast lesions

Abstract

Background: BIRADS has become the standard in characterizing the radiological findings of the breast lesions. Compared with other categories, BIRADS 3 and 4 are more difficult to manage. The aim was to present our clinical experience in the evaluation of breast lesions classified as BIRADS 3 and 4. Methods: Female patients who underwent surgical intervention for BIRADS 3 or 4 lesions were included in the study. The primary endpoint was the comparison of preoperative BIRADS scores (BIRADS 3 and 4) and postoperative histopathological results. Results: Data of 373 patients with a mean age of 52.3 years was analyzed. Preoperatively, 249 patients had BIRADS 3 lesions, while 124 patients had BIRADS 4 lesions. The mean age of patients with BIRADS 3 lesions was lower than that of patients in BIRADS 4 group. Thirty-six (14.5%) patients in the BIRADS 3 group and 40 (32.3%) patients in the BIRADS 4 group were above 50 years. Malignancy was detected in 3 (1.2%) and 31 (25%) patients in the BIRADS 3 and BIRADS 4 groups, respectively. BIRADS classification was found to be 91.2% sensitive and 72.6% specific, with an accuracy rate of 74.2%. Positive and negative predictive values were 25% and 98.8% respectively. Conclusions: A high malignancy rate of 25% in the BIRADS 4 patients indicated that preoperative histopathological assessment is mandatory. Although 3% malignancy rate in the BIRADS 3 group was low, it was valuable to show the importance of careful physical examination and detailed family history questioning. The malignancy risk in BIRADS 4 lesions was significantly higher in women above 50 years than in younger women, demonstrating that advanced age is an important risk factor for BC.