Paul Martin Murphy MD, PhD, Presenter: Nothing to Disclose

Katherine Elizabeth Abihider BS, Abstract Co-Author: Nothing to Disclose

Ajay A. Rao MD, Abstract Co-Author: Nothing to Disclose

Jade De Guzman MD, Abstract Co-Author: Nothing to Disclose

Haydee Ojeda-Fournier MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study is to determine whether all palpable breast masses should be biopsied in patients under the age of 30 after considering imaging features from the 5th edition of BI-RADS.

A retrospective review was performed on all ultrasound-guided breast biopsies performed in patients under the age of 30 presenting for a palpable finding from 2010 to 2014. Male patients, biopsies occurring in the axilla and cases suggestive of abscess were excluded. Age, BI-RADS features, risk factors and pathology were recorded.

221 cases were identified. The mean age was 23.4 years. Imaging features: 5 round, 186 oval, 30 irregular; 145 circumscribed, 8 angular, 48 microlobulated, 19 indistinct, 1 spiculated; 212 parallel, 9 not parallel; 172 hypoechoic, 2 isoechoic, 28 heterogenous, 1 hyperechoic and 18 complex cystic and solid; 117 no posterior acoustic features; 4 posterior shadowing, 87 posterior enhancement, 13 combined pattern. 1 intraductal mass was included. 5 of the 221 cases (2.3%) were diagnosed with malignancy. 3 of the 221 cases were diagnosed with a high risk lesion, two not upgraded to malignancy after surgery and one lost to follow up. 5 malignancies, 2 BI-RADS 5 (ages 27 and 29), both irregular masses, one with calcifications. Other 3 malignancies: 2 low grade DCIS occurring within fibroadenomas that were oval, parallel and microlobulated; grade 1 invasive mucinous carcinoma (patient known BRCA2 positive) oval parallel circumscribed hypoechoic mass with no posterior features. The remaining benign masses included 177 fibroadenomas.

Our series demonstrates that only 2% of palpable masses in patients under 30 were malignant. 100% of patients that were BI-RADS 5 had a malignant lesion. 1.4% of patients with BI-RADS 4 lesions were malignant.

Short interval follow up as opposed to biopsy should be considered in patients who are not high risk and presenting with masses that have benign features and do not meet BI-RADS 5 criteria. Radiologists interpreting breast imaging cases should use the BI-RADS lexicon.

Murphy, P, Abihider, K, Rao, A, De Guzman, J, Ojeda-Fournier, H, Malignancy Detected in Women Under Age 30 Presenting With Palpable Findings: To Biopsy the Young or Not.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045495.html