Application of Sonographic BI-RADS to Synchronous Breast Nodules Detected in Patients with Breast Cancer

• Published in: American journal of roentgenology (1976) Vol. 191; no. 3; pp. 653 - 658
• Main Authors: Kim, Suk Jung, Ko, Eun Young, Shin, Jung Hee, Kang, Seok Seon, Mun, Sung Hee, Han, Boo-Kyung, Cho, Eun Yoon
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01-09-2008; American Roentgen Ray Society
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Breast Neoplasms - classification; Breast Neoplasms - diagnostic imaging; Female; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Mammary gland diseases; Medical sciences; Middle Aged; Radiography; Reproducibility of Results; Sensitivity and Specificity; Tumors; Ultrasonography, Mammary - methods; Ultrasonography, Mammary - standards; United States; Human; Mammary gland diseases; Nuclear medicine; Breast disease; Radiology; Breast; Breast cancer; Malignant tumor; Mammary gland; Nodule; Cancer
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.07.2861

The purpose of this study was to evaluate the applicability of the current BI-RADS for sonography to the assessment of synchronous breast nodules other than the primary malignant tumor in patients with breast cancer.
One hundred eighty-nine synchronous nodules in 147 breast cancer patients were surgically excised after localization, and 412 synchronous nodules in 191 patients were observed or biopsied or excised without localization. Among a total of 601 synchronous nodules, 372 nodules were ipsilateral and 229 were contralateral to a primary malignant tumor. Two radiologists retrospectively reviewed sonograms of these nodules and determined the sonographic BI-RADS category without clinical information or pathologic results. For each nodule, the preoperative BI-RADS category and pathologic or follow-up results were compared.
Four hundred eighty-two nodules were classified category 3; 112 nodules, category 4; and seven nodules, category 5. Fifty-five (11.4%) of the category 3 nodules and 57 (47.9%) of the category 4 and 5 nodules were confirmed malignant. Thirty-six (21.2%) of 170 category 3 synchronous nodules in the same quadrant as the primary tumor were confirmed malignant, as were 12 (9.8%) of 122 nodules in a different quadrant and eight (4.2%) of 190 nodules in the contralateral breast.
For assessment of synchronous nodules in breast cancer patients, application of conventional screening sonographic BI-RADS categories may not account for possible increased risk of malignancy in synchronous nodules, especially those in the same quadrant of the breast as the index malignant tumor.