Rjoop Wesam, Rjoop Anwar, Almohtaseb Alia, Bataineh Lama, Nser Joubi Zeina, Gharaibeh Maha, Al-Qwabah Abdalrahman, Alasheh Yousef, Matalka Ismail
Primrose Breast Care Center, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
BMC Womens Health. 2025 Feb 3;25(1):47. doi: 10.1186/s12905-025-03569-7.
Timely diagnosis is a crucial factor in decreasing the death rate of patients with breast cancer. BI-RADS categories IVc and V indicate a strong suspicion of cancer. The categorisation of each group is determined by the characteristics of the lesion. Certain benign breast lesions might have radiological features indicative of malignancy; thus, biopsy is mandatory. This study aimed to identify the histopathological diagnosis of benign breast masses classified into BIRADS IVc and V subgroups, investigate the radiological characteristics of these masses, and identify ultrasound features that could lead to false positive results (benign lesions that mimic malignancy on imaging).
This was a retrospective cross-sectional study at a single facility. Breast lesions reported as BIRADS IVc and V that underwent needle core/stereotactic vacuum-assisted biopsy were reviewed. Patients with benign pathologic diagnoses were analysed, delineating pathological diagnoses. Radiological descriptors were compared to those of a matched control of 50 malignant cases with BIRADS IVc.
A total of 828 breast lesions classified as BIRADS IVc or V were detected during the period spanning from 2015 to 2022. Forty-four lesions (44/828, 5.3%) were benign at initial biopsy, while 784 lesions (784/828, 94.7%) were malignant. After histopathological testing and repeat biopsy, 26/828 (3.14%) patients had discordant benign diagnosis. Half of the repeated biopsies (10/20, 50%) showed malignant pathology. Compared to that in the control group, the presence of an oval shape of the mass was significantly more common in patients with benign pathology (p = 0.035). Conversely, the presence of posterior shadowing was significantly less common (p = 0.050) in benign lesions. No significant differences were observed for the other radiological characteristics. The most common histopathological diagnosis was fibrocystic change.
This study highlights key findings regarding the sonographic imaging descriptors and histopathological diagnoses of benign breast lesions categorised as BIRADS IVc/V. The study recommends a correlation between clinical and radiological findings and encourages multidisciplinary decision-making among radiologists, pathologists, and clinicians to determine if a repeat biopsy is warranted. There is a need for continuous research to improve the diagnosis and treatment of breast lesions and reduce false-positive rates by incorporating other methodologies such as sonoelastography and incorporating deep learning and artificial intelligence in the decision-making to eliminate unnecessary procedures.
及时诊断是降低乳腺癌患者死亡率的关键因素。BI-RADS分类中的IVc和V类提示高度怀疑为癌症。每组的分类由病变特征决定。某些良性乳腺病变可能具有提示恶性的放射学特征；因此，活检是必要的。本研究旨在确定分类为BIRADS IVc和V亚组的良性乳腺肿块的组织病理学诊断，研究这些肿块的放射学特征，并确定可能导致假阳性结果（在影像学上类似恶性的良性病变）的超声特征。
这是一项在单一机构进行的回顾性横断面研究。对报告为BIRADS IVc和V且接受了针芯/立体定向真空辅助活检的乳腺病变进行了回顾。对病理诊断为良性的患者进行分析，明确病理诊断。将放射学描述符与50例BIRADS IVc恶性病例的匹配对照组进行比较。
在2015年至2022年期间共检测到828例分类为BIRADS IVc或V的乳腺病变。44例病变（44/828，5.3%）在初次活检时为良性，而784例病变（784/828，94.7%）为恶性。经过组织病理学检测和重复活检后，26/828（3.14%）的患者良性诊断不一致。重复活检中有一半（10/20，50%）显示为恶性病理。与对照组相比，肿块呈椭圆形在良性病理患者中明显更常见（p = 0.035）。相反，后方声影在良性病变中明显较少见（p = 0.050）。其他放射学特征未观察到显著差异。最常见的组织病理学诊断是纤维囊性变。
本研究突出了关于分类为BIRADS IVc/V的良性乳腺病变的超声影像学描述符和组织病理学诊断的关键发现。该研究建议临床和放射学结果之间建立关联，并鼓励放射科医生、病理科医生和临床医生进行多学科决策，以确定是否有必要进行重复活检。需要持续研究以通过纳入其他方法（如超声弹性成像）并在决策中纳入深度学习和人工智能来改善乳腺病变的诊断和治疗并降低假阳性率，从而消除不必要的程序。
