Marthay Karthikeyan, Yahya Maya Mazuwin, Tengku Din Tengku Ahmad Damitri Al-Astani, Wan Zain Wan Zainira, Haron Juhara, Wong Michael Pak-Kai, Ramely Rosenelifaizur, Wan Mokhter Wan Muhammad Mokhzani, Hashim Isa Merican Siti Rahmah, Mohd Hashim Mohd Nizam
Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS.
Breast Cancer Research and Awareness Unit (BestARi), Hospital Universiti Sains Malaysia, Kota Bharu, MYS.
Cureus. 2022 Mar 1;14(3):e22757. doi: 10.7759/cureus.22757. eCollection 2022 Mar.
The Breast Imaging Reporting and Data System (BI-RADS) lexicon used in reporting breast imaging has several categories with specific positive predictive values for breast cancer. Among those, BI-RADS 4 is associated with a wider range of risk for breast cancer, which makes the decision for biopsy difficult. The study aim was to determine the malignancy rate and clinical outcomes of BI-RADS 4 lesions in Hospital Universiti Sains Malaysia (HUSM) for a period of five years.
This was a retrospective study of patients diagnosed by mammographic or ultrasonographic findings with BI-RADS 4 breast lesions in HUSM, Kelantan from July 2015 to June 2020. Data were collected from the medical records and an electronic database. Patients with BI-RADS 4 lesions who underwent biopsy and had a known tissue diagnosis were included in this study. The data was used to calculate the malignancy rate and associated positive predictive factors for breast cancer associated with BI-RADS 4 lesions.
From the mammography and ultrasonography performed at HUSM from July 2015 to June 2020, a total of 256 lesions were categorized as BI-RADS 4. However, only 198 BI-RADS 4 lesions underwent biopsy and were included in the study. Of these 198 lesions, 26.8% were malignant on histopathological examination of the biopsy samples. Simple logistic regression analysis showed that age, diabetes mellitus, hypertension, number of parity, and certain mammogram findings were significantly associated with breast cancer. Invasive breast cancer was the most common type. Fibrocystic disease was the most common benign pathology, followed by fibroadenoma.
The malignancy rate of BI-RADS 4 lesions in HUSM was similar to previously reported rates. A thorough evaluation of positive predictive factors and careful selection of patients for biopsy in BI-RADS 4 lesions will minimize unwanted biopsies and associated patient anxiety, in addition to reducing the health care burden.
用于报告乳腺影像的乳腺影像报告和数据系统（BI-RADS）词典对乳腺癌有几个具有特定阳性预测值的类别。其中，BI-RADS 4类与范围更广的乳腺癌风险相关，这使得活检决策变得困难。本研究的目的是确定马来西亚理科大学医院（HUSM）5年间BI-RADS 4类病变的恶性率和临床结果。
这是一项对2015年7月至2020年6月在吉兰丹州HUSM经乳腺X线摄影或超声检查发现为BI-RADS 4类乳腺病变的患者进行的回顾性研究。数据从病历和电子数据库中收集。本研究纳入了接受活检且有已知组织诊断的BI-RADS 4类病变患者。这些数据用于计算与BI-RADS 4类病变相关的乳腺癌恶性率和相关阳性预测因素。
在2015年7月至2020年6月于HUSM进行的乳腺X线摄影和超声检查中，共有256个病变被分类为BI-RADS 4类。然而，只有198个BI-RADS 4类病变接受了活检并纳入本研究。在这198个病变中，活检样本的组织病理学检查显示26.8%为恶性。简单逻辑回归分析表明，年龄、糖尿病、高血压、产次和某些乳腺X线摄影表现与乳腺癌显著相关。浸润性乳腺癌是最常见的类型。纤维囊性疾病是最常见的良性病理类型，其次是纤维腺瘤。
HUSM中BI-RADS 4类病变的恶性率与先前报道的率相似。对BI-RADS 4类病变的阳性预测因素进行全面评估并仔细选择活检患者，除了减轻医疗负担外，还将最大限度地减少不必要的活检和相关患者焦虑。
