Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS<sup>®</sup>) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy

Badan, Gustavo Machado; Roveda Júnior, Décio; Ferreira, Carlos Alberto Pecci; Ferreira, Felipe Augusto Trocoli; Fleury, Eduardo de Faria Castro; Campos, Mário Sérgio Dantas do Amaral; Seleti, Rodrigo de Oliveira; Cruz Júnior, Hélio da

doi:10.1590/S0100-39842013000400006

Gustavo Machado Badan

Specialist in Breast Imaging, Second Radiologist Assistant, Breast Radiology Group of Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Décio Roveda Júnior

PhD, Professor of Radiology, Director of the Department of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Carlos Alberto Pecci Ferreira

Physician Assistant, Coordinator, Breast Imaging Service, Department of Medical Practice, Faculdade de Medicina da Santa Casa de São Paulo, São Paulo, SP, Brazil.

Felipe Augusto Trocoli Ferreira

MDs, Specialists in Radiology, Second Radiologist Assistants, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Eduardo de Faria Castro Fleury

PhD, Professor of Radiology, Second Radiologist Assistant, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Mário Sérgio Dantas do Amaral Campos

MDs, Specialists in Radiology, Second Radiologist Assistants, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Rodrigo de Oliveira Seleti

MD, Specialist in Radiology, Fellow Master degree in Breast Imaging, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Hélio da Cruz Júnior

Fellow Master degree in Breast Imaging, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Mailing Address: Dr. Gustavo Machado Badan. Rua Loureiro da Cruz, 121, ap. 121, Aclimação. São Paulo, SP, Brazil, 01529-020. E-mail: gustavobadan@hotmail.com.

Figures (2)
Tables (5)

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Figure 1.
Non palpable nodules located in the axillary extension of the left breast in a 63-year-old woman. Ultrasonography demonstrates an ovoid, hypoechoic, circumscribed nodule measuring 9 × 6 × 8 mm, with homogeneous echotexture, parallel orientation, without posterior acoustic shadowing. Category BI-RADS 3. FNAB demonstrated the presence of cells positive for malignancy. Surgery revealed a mucinous carcinoma measuring 7 mm with negative sentinel lymph node.

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Figure 2.
Non palpable nodule in the retroareolar region of the left breast in a 66-year-old woman previously submitted to surgery for a benign nodule in the same breast. A: Mammography demonstrates the presence of an irregular, isodense nodule with spiculated margins. Category BI-RADS 5. B: Ultrasonography demonstrates irregular, hypoechoic nodule with angulated margins, measuring 6 mm, with heterogeneous echotexture, non parallel orientation, and posterior acoustic shadowing. Category BI-RADS 5. Core biopsy revealed adenosis and fibrocystic alterations. Considering the absence of anatomo-radiological correlation, the patient underwent surgery that revealed the same anato-mopathological finding.

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Table 1
Histopathological result of percutaneous biopsies of lesions classified as BI-RADS categories 3, 4 and 5.

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Table 2
Distribution of cases of percutaneous stereotactic biopsies, in agreement with the radiological BI-RADS classification and histopathological diagnosis of benignity or malignancy.

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Table 3
Distribution of cases of percutaneous ultrasonography-guided biopsies, in agreement with the radiological BI-RADS classification and histopathological diagnosis of benignity or malignancy.

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Table 4
BI-RADS categorization of sonographic findings and attribution of PPVs of the morphological characteristics of lesions.

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Table 5
BI-RADS categorization of mammographic findings and attribution of PPVs of the morphological characteristics of lesions.

Histopathological result	Histological type	Number of cases	Percentage
Findings negative for malignancy	Fibroadenoma	165	28.45%
	Fibrocystic alteration	137	23.62%
	Ductal hyperplasia without atypias	60	10.34%
	Steatonecrosis	17	2.93%
	Mastitis	16	2.76%
	Adenosis	9	1.55%
	Apocrine cyst	7	1.20%
	Fibrosclerosis	6	1.04%
	Papilloma	6	1.04%
	Sclerosing adenosis	2	0.35%
	Intramammary lymph node	2	0.35%
	Tubular adenoma	1	0.17%
Precursor lesions/lesions with increased breast cancer risk	Ductal hyperplasia with atypias	13	2.24%
	Complex sclerosing lesion	4	0.69%
	Complex fibroadenoma	3	0.52%
	Columnar cell lesions with atypias	1	0.17%
	Lobular hyperplasia with atypias	1	0.17%
Positive for malignancy	Invasive ductal carcinoma	87	15.0%
	Invasive lobular carcinoma	14	2.41%
	In situ ductal carcinoma	10	1.72%
	Mucinous carcinoma	5	0.86%
	Invasive apocrine carcinoma	5	0.86%
	Lesion of malignant nature	5	0.86%
	Invasive papilliferous carcinoma	3	0.52%
	Invasive cribriform carcinoma	1	0.17%

BI-RADS	Histopathological diagnosis
	Benign		Malignant		Total
	N	%	N	%	N	%
3	5	100.00	0	00.00	5	4.90
4	80	85.10	14	14.90	94	92.16
5	0	0.00	3	100.00	3	2.94
Total	85	77.97	17	22.03	102	100.00

BI-RADS	Histopathological diagnosis
	Benign		Malignant		Total
	N	%	N	%	N	%
3	269	99.26	2	0.74	271	56.70
4	91	66.92	45	33.08	136	28.45
5	5	7.05	66	92.95	71	14.85
Total	365	76.36	113	23.64	478	100.00

BI-RADS category	Ultrasonographic findings	Total	Positive for malignancy	PPV
3	Ovoid nodule with circumscribed margins	248	2	0.80%
3	Thick-walled cyst or clustered cysts	23	0	0%
4	Solid nodule with noncircumscribed margins	118	43	36.44%
4	Complex cyst	18	2	11.11%
5	Irregular nodule with spiculated margins	71	66	92.95%

BI-RADS category	Mammographic findings	Total	Positive for malignancy	PPV
3	Clustered punctiform microcalcifications	4	0	0%
3	Focal asymmetry without associated findings	1	0	0%
4	Clustered pleomorphic microcalcifications	79	10	12.65%
	Architectural distortion	13	4	30.77%
	Focal asymmetry with punctiform calcifications	2	0	0%
5	Fine pleomorphic and segmental branching microcalcifications	3	3	100%

[1] Mailing Address: Dr. Gustavo Machado Badan. Rua Loureiro da Cruz, 121, ap. 121, Aclimação. São Paulo, SP, Brazil, 01529-020. E-mail: gustavobadan@hotmail.com.

Brasil

Brasil

Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS^®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy^* * Study developed at Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.

Objective

Materials and Methods

Results

Conclusion

Brasil

Brasil

Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy* * Study developed at Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.

Objective

Materials and Methods

Results

Conclusion

Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS^®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy^* * Study developed at Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.