Imaging, Patient, and Diagnostic Radiologist Factors Associated With Malignancy for Mammographic Asymmetries Undergoing Biopsy.

Abstract

Objective: To identify imaging, patient, and radiologist factors associated with malignant pathology for mammographic asymmetries referred for image-guided biopsy.

Methods: This is an IRB-approved study of consecutive image-guided core-needle biopsy reports from an academic center and affiliated imaging centers January 1, 2015 to June 30, 2022 with lesion type reported by biopsy radiologist as "asymmetry" on biopsy requisition form retrieved from the pathology database. Imaging features (asymmetry type, associated mammographic features, US correlate, lesion size) and patient demographics (age at biopsy, breast density, family or personal history of breast cancer) were extracted from imaging reports and electronic health record. Cases were excluded if the diagnostic or biopsy radiologist reported the lesion other than "asymmetry" or if imaging review identified the finding as predominantly mass or architectural distortion. Multiple logistic regression was performed to calculate the odds ratio (OR) of malignant outcome.

Results: Image-guided core-needle biopsy was requested of 326 asymmetries; 79 were excluded, yielding 247 asymmetries (9 asymmetry, 218 developing asymmetry, 20 focal asymmetry). Overall, 40/247 (16.2%) were malignant and 207/247 (83.8%) were benign. Presence of associated distortion (OR 14.78; 95% CI, 4.87-44.83; P <.001) or calcifications (OR 9.86; 95% CI, 2.74-35.53; P <.001), personal history of breast cancer (OR 2.65; 95% CI, 1.04-6.77; P = .041), and increasing patient age at biopsy (OR 1.08; 95% CI, 1.04-1.12; P <.001) were associated with likelihood of malignancy.

Conclusion: Malignancy of mammographic asymmetries is more likely in the presence of associated distortion or calcifications, personal history of breast cancer, and increasing patient age. These results may be useful in diagnostic management of mammographic asymmetries.