Evaluating the Efficacy of 6-Month Follow-Up for BI-RADS 3 Lesions Identified by Screening Ultrasound: A Retrospective Study Evaluating 6-month FU for BIRADS3

Jirapa Chansangrat (1), Nattawut Keeratibharat (2)
(1) School of Radiology, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000 Thailand, Thailand,
(2) School of Surgery, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000 Thailand, Thailand


Background: The Breast Imaging-Reporting and Data System (BI-RADS), developed to standardize mammographic findings, categorizes 'probably benign' lesions as BI-RADS 3, aiming to reduce unnecessary biopsies from false positives, with a cancer likelihood of less than 2%. In some countries, screening programs have been expanded to include ultrasound alongside mammography, particularly in populations with predominantly dense breast tissue, leading to an increased detection of BI-RADS 3 lesions through this additional modality. This study examines the effectiveness of 6-month follow-ups for these ultrasound-identified BI-RADS 3 lesions. The purpose is to evaluate cancer detection rates and diagnostic performance of ultrasound findings leading to decision for biopsy.

Materials and Methods: We retrospectively analyzed 7,577 women who underwent mammography and ultrasound screening from January 2016 to December 2021. Of these, 2,907 were classified as BI-RADS 3 based on ultrasound findings. The study focused on 1,163 patients with normal mammography and assessed BI-RADS 3 from ultrasound findings, who completed a 24-month follow-up. Data analysis included assessing demographic data, breast cancer risk, imaging features, and pathological findings.

Results: Among the 1,163 patients, the cancer detection of the entire cohort was 0.7%, with no cancers detected during the first six months. The cancer found at 6 months and 12-24 months were 0 and 0.17%, respectively (p<0.001). The median time to be reassesed from BI-RADS 3 to BI-RADS 4 was 18.4 months. Upon the change of BI-RADS, spiculation and angular margins were the most predictive ultrasound features for malignancy (AUROC=0.75 and 0.69, respectively). Lesion size growth alone was found insufficient as a biopsy criterion. A 28% growth cutoff distinguished between benign and malignant lesions better than 20% cutoff (AUROC=0.68 vs 0.64, p=0.038).

Conclusion: A 12-month follow-up interval may be more appropriate than the traditional 6-month interval for average-risk patients with BI-RADS 3 lesions detected by screening ultrasound. Combining suspicious imaging features with size increases enhances diagnostic accuracy, proposing a tailored follow-up approach based on individual risk profiles and imaging characteristics.

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Jirapa Chansangrat
jirapacha1986@gmail.com (Primary Contact)
Nattawut Keeratibharat
Chansangrat J, Keeratibharat N. Evaluating the Efficacy of 6-Month Follow-Up for BI-RADS 3 Lesions Identified by Screening Ultrasound: A Retrospective Study: Evaluating 6-month FU for BIRADS3. Arch Breast Cancer [Internet]. 2024 May 1 [cited 2024 Jun. 16];11(2):183-90. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/894

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