Abstract
Introduction: Ultrasound (US) and mammography (MM) are often combined with clinical examination in the diagnosis of breast diseases. The Breast Imaging Reporting and Data System (BI-RADS) is employed to describe findings and assess the risk of malignancy. BI-RADS category 4 encompasses a wide predictive range for malignancy (2% - 95%). The American College of Radiology (ACR) recommends subdividing BIRADS 4 into categories 4A, 4B, and 4C to better inform clinicians and patients about the level of suspicion.
Subjects and Methods: A cross-sectional descriptive study involved 90 patients with breast lesions classified as BI-RADS 4 (4A, 4B, 4C) on US and/or MM. The study was conducted at Hue University of Medicine and Pharmacy Hospital from April 2023 to July 2024. Results: Malignant breast tumors accounted for 56.7%, with invasive ductal carcinoma of no special type being the most common (72.5%). Meanwhile, 43.3% were benign breast tumors, with predominantly fibroadenoma (36.0%). Significant US features for predicting breast cancer risk included: irregular shape with angular margins, spiculated margins, posterior acoustic shadowing, and echogenic halo. BI-RADS 4A commonly showed gently lobulated margins (41.7%). BI-RADS 4B and 4C frequently had irregular shapes with angular margins. On MM: suspicious microcalcifications, density increase, irregularly shaped masses, obscured margins, and spiculated masses. BI-RADS 4A most commonly showed high density (18.8%). BI-RADS 4B commonly showed masses with obscured margins (60.0%). Irregularly shaped masses were most frequently seen in BI-RADS 4C (94.4%). Combining US and MM increases the detection rate of breast cancer from 2.0–66.7% to 5.9–94.1%, while achieving the theoretical positive predictive value in each BI-RADS subgroup: 4A (10.0%), 4B (36.8%), and 4C (80.0%).
Conclusion: Suspicious malignant features on US and MM have high value in predicting and stratifying the risk for breast cancer. Improved breast cancer detection rates with the combination of US and MM in diagnosing BI-RADS 4 breast lesions.
| Published | 2025-12-25 | |
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| Issue | Vol. 15 No. 7 (2025) | |
| Section | Original Articles | |
| DOI | 10.34071/jmp.2025.7.17 | |
| Keywords | bệnh lý tuyến vú, ung thư vú, BI-RADS 4, siêu âm, nhũ ảnh breast diseases, breast cancer, BI-RADS 4, ultrasound, mammography |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2025 Hue Journal of Medicine and Pharmacy
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