BI-RADS 3 lesions in North Indian population: Their outcome and how to proceed for follow-up

Abstract

Background: Breast Imaging Reporting and Data System (BI-RADS) classification for breast lesions was proposed for uniformity in categorizing breast lesions. While BI-RADS 1, 2 and 4–6 categories are straightforward, BI-RADS 3 is an intermediate category lesion with significantly different meanings and findings for mammography, ultrasound, and magnetic resonance imaging and is diagnostically challenging. Our study aims to determine the frequency and the malignancy rate of BI-RADS category 3 lesions detected on ultrasound breast and digital X-ray mammography by doing follow-ups at 6, 12, and 24 months of imaging. Materials and Methods: This ambispective study was conducted in the Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, from October 2020 to October 2022, which included 55 patients referred for digital X-ray and breast ultrasound. All BI-RADS category 3 in the initial sonomammography and digital X-ray mammography were included in the study and were followed up for final diagnosis and outcome either by pathological analysis or follow-up using sonomammography and digital X-ray mammography for a maximum of 24 months. Results: Fifty-five patients were categorized into the benign or malignant category from the results of tissue diagnosis or via follow-up. Fifty-four patients (98.18%) showed benign lesions, and one (1.82%) got malignant lesions. In the majority, 31 (56.36%) patients, the mean follow-up time was 6 months, followed by 12 months 10 (18.18%). Follow-up was 24 months in only 1 out of 55 patients (1.82%). The mean value of time to follow-up (months) of study subjects was 6 ± 4.6 with a median (25th–75th percentile) of 6. Conclusion: Short-term interval follow-up in BI-RADS category: three patients are enough to detect early breast malignancy, and this will avoid unnecessary tissue diagnosis (invasive procedure) in benign lesions. In our study, the malignancy yield in the follow-up of BI-RADS 3 was 1.82% (<2%).