New research suggests BI-RADS 3 ultrasound category needs revision
New research published online Oct. 17 in the journal Ultrasound in Medicine and Biology has indicated the need for the current BI-RADS 3 category for breast ultrasound to be revised.
Although research has shown that lesions in the ultrasound BI-RADS 3 category have a malignancy risk of less than two percent and can followed with short term imaging surveillance, there lacks a consensus regarding this practice, wrote lead author Chiara Adriana Pistolese, from the department of diagnostic imaging at Tor Vergata University Rome in Italy, and colleagues.
“The introduction of the BI-RADS system helped radiologists to describe the sonographic characteristics and to assign lesions to a category associated with the most appropriate clinical treatment,” Pistolese et al. wrote. “Despite the help offered by this classification system, the BI-RADS 3 category includes probably benign lesions whose management has been widely debated in the literature.”
Involved in the study were 122 women with 122 ultrasound nodular lesions classified as BI-RADS 3 who underwent fine-need aspiration cytology and biopsy for benign lesions.
Of the 122 cases, the researchers identified malignancies in 5.7 percent—which is contrary to previous research determining the risk of malignancy of BI-RADS 3 to be greater than two percent, according to the researchers. A total of 86 cases (70.5 percent) had biopsy results that were benign, 29 cases (23.7 percent) that were borderline and seven cases (0.57 percent) that were malignant.
“The management of probably benign nodular lesions should not only be guided by BI-RADS classification; it is also necessary to include clinical and anamnestic data and apply a multidisciplinary approach to select cases that require histologic verification instead of the usual follow-up,” the researchers wrote.
In the future, they suggest the BI-RADS 3 category be used to evaluate the presence of non-homogeneous echoes within the corpuscular cyst and solid nodular lesions with cystic components—especially in larger lesions—estimated by setting a dimensional cut off.
Additionally, the researchers noted a patient's age, hormone therapy, family history and personal history of breast cancer should be evaluated in select cases that require histologic verification instead of usual short-term follow-up.
"Despite the small cohort, our data seem to indicate the need to revise the current BI-RADS 3 category," the researchers concluded. "It could be useful to evaluate as suspicious the presence of nonhomogeneous echoes within the corpuscular cyst and solid nodular lesions with cystic components."
A recent graduate from Dominican University (IL) with a bachelor’s in journalism, Melissa joined TriMed’s Chicago team in 2017 covering all aspects of health imaging. She’s a fan of singing and playing guitar, elephants, a good cup of tea, and her golden retriever Cooper.