Probably Benign Solid Breast Lesions on Ultrasound: Need for Biopsy Reassessed

Abstract

Objective: To determine the negative predictive value of ultrasound for breast masses with probably benign<br />morphology, and to assess whether follow-up may be an acceptable alternative to biopsy. Methods: After Institutional<br />Review Board approval, all solid breast masses categorized as probably benign (American College of Radiology Breast<br />Imaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and having<br />either tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillance<br />were included. Result: A total of 157 lesions in 40 patients constituted the study population. The mean patient age was<br />31.3 years (range, 20-56 years). Seventeen of these 157 lesions underwent tissue diagnosis with no invasive breast cancer.<br />Out of the remaining 140 lesions, 115 were stable on imaging for 24 months or more. The rest 25 were deemed benign<br />because of decrease in size on follow up (n=1), non-recommendation of further imaging by the second radiologist on<br />follow up ultrasound (n= 13) or presence of benign tissue diagnosis in the largest lesion (n=11). Conclusion: Ultrasound<br />has 100% negative predictive value for breast lesions with probably benign morphology, whether palpable or not.<br />Follow up is an appropriate option to immediate biopsy of such lesions keeping in mind that noncompliance with<br />surveillance may be a potential problem.