Aya Michaels MD, Presenter: Nothing to Disclose

Catherine Streeto Giess MD, Abstract Co-Author: Nothing to Disclose

Chris Sungwon Chung MD, Abstract Co-Author: Nothing to Disclose

Elisabeth P. Frost MD, Abstract Co-Author: Nothing to Disclose

Robyn L. Birdwell MD, Abstract Co-Author: Nothing to Disclose

To evaluate clinical or imaging differences between screen-detected benign and malignant upgraded lesions initially assessed as BIRADS 3 at diagnostic evaluation

IRB approved retrospective review of the mammography database from 1/1/04-12/31/08 identified 1188 (1.07%) of 110,776 screening examinations assessed as BIRADS 3 following diagnostic evaluation at our academic center (staffed by breast specialists) or our outpatient center (staffed by general radiologists), 1017 with at least 24 months follow up or biopsy. Sixty (5.9%) BIRADS 3 lesions were upgraded to BIRADS 4 or 5 during imaging surveillance (the study population). Prospective reports, patient demographics, and clinical outcomes were abstracted from the longitudinal medical record.

Mean patient age was 54.1 years (range 35-85). Lesions consisted of 7 masses, 12 focal asymmetries (FAD), and 41 calcifications. Fifteen (25%) of 60 lesions upgraded from initial BIRADS 3 assessment were malignant (1.47% of total; 15/1017 BIRADS 3 examinations). Breast imaging specialists interpreted 21 of 60 upgraded lesions, with 3 (14.3%) malignancies, compared to general radiologists who interpreted 39 of 60 upgrades, with 12 (30.8%) malignancies (p=0.160). Twelve (26.7%) of 45 benign upgraded lesions were masses or FADs, and 7 (46.7%) of 15 upgraded malignant lesions were masses or FADS (p=0.149). Six of 7 malignant upgraded masses/FADs had negative US at time of initial BIRADS 3 assignment. At initial assessment, prospective reports described features appropriate for BIRADS 3 classification in only 30/60 (50%). Mammographic development or change was reported in 18/60 (30%), increased prominence in 20/60 (33.3%) and stability in 1/60 (1.7%); change was not reported in 17/60 (28.3%), and 4/60 (6.7%) had no prior studies.  

Most mammographic lesions upgraded from probably benign to suspicious had shown change or increased conspicuity at the time of initial BIRADS 3 assessment. Non breast imaging specialists had a higher malignancy rate among upgraded lesions compared to specialists. Masses and focal asymmetries represented a higher proportion of malignant than benign upgrades, and usually had no US correlate. 

Malignant masses and focal asymmetries mis-characterized as probably benign usually had no US correlate. Careful utilization of BIRADS terminology will improve appropriate characterization.

Michaels, A, Giess, C, Chung, C, Frost, E, Birdwell, R, Imaging and Histopathologic Features of BIRADS 3 Lesions Upgraded During Imaging Surveillance.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008792.html