Raju Wadhwani
P D Hinduja National Hospital and Medical Research Centre, India
Title: Evaluation of clinico-radiological findings of non-palpable breast lesions with their histological diagnosis highlighting the importance of bi – rads in radiopathology correlation
Biography
Biography: Raju Wadhwani
Abstract
Objectives 1)​​ ​To​ ​assess​ ​the​ ​diagnostic​ ​value​ ​of​ ​Breast​ ​Imaging​ ​Reporting​ ​and​ ​Data​ ​system​ ​(BI-RADS)​ ​​ ​in​ ​screening​ ​and​ ​management​ ​of​ ​non​ ​-​ ​palpable​ ​breast​ ​lesions​ ​in​ ​the​ ​setting​ ​of​ ​a tertiary​ ​care​ ​hospital​ ​in​ ​Western​ ​India​ ​(​ ​Mumbai,​ ​Maharashtra)​ ​with​ ​histopathological correlation.
2)​ ​Evaluate​ ​the​ ​rates​ ​of​ ​radiologic​ ​and​ ​pathologic​ ​correlation​ ​in​ ​breast​ ​biopsies.
3) Subcategorization of BI- RADS Category 4 to 4a,4b and 4c and correlation with histopathology.
Material​ ​and​ ​methods:​​ ​The​ ​authors​ ​retrospectively​ ​reviewed​ ​the​ ​mammography​ ​and sonography​ ​findings​ ​of​ ​425​ ​women​ ​who​ ​had​ ​come​ ​for​ ​screening​ ​between​ ​May​ ​2010​ ​and​ ​May 2016.​ ​BIRADS​ ​categorisation​ ​of​ ​these​ ​lesions​ ​by​ ​combined​ ​mammography​ ​and​ ​ultrasound was​ ​followed​ ​by​ ​histopathological​ ​examination.
Results:​ ​​​ ​All​ ​425​ ​cases​ ​were​ ​classified​ ​into​ ​​ ​BI-RADS​ ​categories​ ​2,3,4​ ​and​ ​5.​ ​The​ ​distribution of​ ​lesions​ ​on​ ​BI-RADS​ ​category​ ​was​ ​BI-RADS​ ​2​ ​:7(1.6%),​ ​BI-RADS​ ​3:100(23.52%),​ ​BI-RADS 4a:154(36.23%),​ ​BI-RADS​ ​4b:39(9.17%),​ ​BI-RADS​ ​4c:71(16.7%),​ ​BI-RADS​ ​5:54(12.7%).
​Malignancy​ ​was​ ​detected​ ​in​ ​5​ ​(5%)​ ​​ ​BIRADS​ ​3​ ​lesions,​ ​in​ ​9​ ​(5.7%)​ ​BIRADS​ ​4a​ ​lesions,​ ​in​ ​21 (54%)​ ​BIRADS​ ​4b​ ​lesions,​ ​in​ ​64(92.7%)​ ​BIRADS​ ​4c​ ​lesions​ ​and​ ​in​ ​47​ ​(87%)​ ​BIRADS​ ​5 lesions.
Histology​ ​revealed​ ​279​ ​benign​ ​cases​ ​(65.64%),​ ​33(7.7%)​ ​DCIS​ ​and​ ​113​ ​invasive malignancies​ ​(26.5%).​ ​It​ ​was​ ​seen​ ​that​ ​the​ ​sensitivity,​ ​specificity,​ ​positive​ ​predictive value, negative​ ​predictive​ ​value​ ​and​ ​Diagnostic​ ​accuracy​ ​of​ ​BIRADS​ ​was​ ​89.73%, 90.32%,82.91%,94.38%​ ​and​ ​90.12%​ ​respectively.​ ​The​ ​disease​ ​prevalence,​ ​positive​ ​likelihood ratio,​ ​negative​ ​likelihood​ ​ratio​ ​and​ ​area​ ​under​ ​the​ ​curve​ ​was​ ​34.35%, 9.272, 0.114​ ​and​ ​0.9 respectively.
Conclusions:​ ​​In​ ​our​ ​study,​ ​BIRADS​ ​proved​ ​to​ ​be​ ​a​ ​very​ ​good​ ​diagnostic​ ​test​ ​in​ ​the​ ​screening and​ ​initial​ ​management​ ​of​ ​non​ ​-palpable​ ​breast​ ​lesions.​ ​​ Majority​ ​of​ ​the​ ​lesions​ ​detected​ ​were benign​ ​and​ ​the​ ​malignant​ ​cases​ ​showed​ ​better​ ​prognostic​ ​features​ ​like​ ​smaller​ ​size,​ ​more​ ​ER positivity,​ ​lower​ ​rates​ ​of​ ​lymphatic​ ​and​ ​metastatic​ ​spread. The subcategorization of BI – RADS 4 lesions into 4a, 4b and 4c further demonstrated ​that​ ​these​ ​subcategories​ ​remain​ ​as​ ​invaluable contribution​ ​for​ ​accurate​ ​assessment​ ​of​ ​lesions​ ​suspicious​ ​for​ ​malignancy. ​The​ ​present​ ​study​ ​has​ ​demonstrated that​ ​BI-RADS​ ​allows​ ​a​ ​safe​ ​prediction​ ​of​ ​high​ ​suspicion​ ​of​ ​malignancy​ ​in​ ​category​ ​4C​ ​&​ ​5 and​ ​low​ ​suspicion​ ​for​ ​category​ ​3​ ​and​ ​4A.​ ​​ ​ ​ ​​