INTRODUCTION AND OBJECTIVES: To determine the association between mammographic alterations classified as BI-RADS® 5 category (lesions highly suggestive of malignancy) and the corresponding histopathological diagnoses of samples obtained by stereotactic core biopsy; to establish the positive predictive value of this mammographic category for the diagnosis of cancer. METHODS: By means of retrospective cross sectional analytical study comparing diagnostic methods, we investigated seventy stereotactic core biopsies of nonpalpable breast lesions classified as BI-RADS® 5 from 70 patients seen at private Anatomic Pathology and Radiology services in Recife (Pernambuco state, Brazil) from 2001 to 2006. RESULTS: Female patients (97.1%) were predominantly affected. The left breast (60%) and upper outer quadrant (62.9%) were more commonly involved. Irregular spiculated nodules corresponded to 70% of the cases, and microcalcifications to 44.3%. The mean number of core fragments was 6 ± 2. The histopathological diagnoses were: carcinoma (59 cases; 84.3%), benign lesions (seven cases; 10%) and atypical ductal hyperplasia or lesion suspected of malignancy (four cases; 5.7%). Invasive carcinoma was significantly associated with irregular spiculated nodules (p = 0.005). Pure comedo DCIS was more frequently associated with microcalcifications on histology. The positive predictive values were: 84.3% for BI-RADS® 5 category as a whole, 100% for irregular spiculated nodules with microcalcifications, 87.8% for irregular spiculated nodules with or without calcifications, 84.2% for irregular spiculated nodules without microcalcifications and 75% for microcalcifications without nodes. CONCLUSION: Breast lesions classified as BI-RADS® 5 have a high positive predictive value for carcinoma, particularly irregular spiculated nodules with microcalcifications.
Breast cancer; Mammography; Core biopsy; Predictive value
