Clinicopathological Correlation of BI-RADS FAC 4 Breast Lesions: A Retrospective Study from a Tertiary Cancer Centre in South India.

Abstract

Breast Imaging Reporting and Data System (BI-RADS) is commonly used to assess breast lesions, with category 4 suggesting a suspicious lesion with malignancy risk ranging from 2%-95%. This study aimed to evaluate the predictive accuracy of BI-RADS FAC (Final Assessment Criteria) 4 lesions and its subcategories. This is a retrospective analysis of 230 women with BI-RADS FAC 4 lesions detected on mammography and /or ultrasound at a South Indian tertiary centre over a 3-year period. Demographic, clinical, radiological features were correlated with histopathological data. Positive Predictive Value (PPV) of BI-RADS 4 lesions and its subcategories were calculated. Of 230 women, with BI-RADS-FAC 4 lesions in the study population, 26.9% were malignant. PPVs of BI-RADS FAC 4A lesions was 18.7%, 4B lesions was 27.6% and 4C lesions was 50.0%. Patients with a prior history of breast cancer had a malignancy rate of 34.9% for BI-RADS 4 lesions. In comparison, patients without a prior history of breast cancer had a malignancy rate of 21.5%. This difference was statistically significant (p = 0.001). BI-RADS FAC 4A PPV exceeded typical lexicon values of 2 to 10% risk of malignancy. There was no significant correlation between age, menopausal status, palpability and, BI-RADS FAC 4 sub-category. The risk of malignancy in BI-RADS FAC 4 lesions in our Indian population is high especially if there is a history of breast cancer. There should be a high index of suspicion for malignancy with appropriate surgical intervention in all patients with BI-RADS FAC 4 lesions.