Ultrasound criteria and histo-pathology correlationt of the solid breast lesions with BIRADS systems

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1 Ultrasound criteria and histo-pathology correlationt of the solid breast lesions with BIRADS systems Poster No.: C-1154 Congress: ECR 2012 Type: Scientific Paper Authors: J. Slobodníková; Tren#ín/SK Keywords: Breast, Oncology, Computer applications, Ultrasound, Mammography, Ultrasound-Power Doppler, Biopsy, Comparative studies, Neoplasia, Dysplasias, Biological effects DOI: /ecr2012/C-1154 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Purpose The aim of the retrospective study was to determine the correlation between the ultrasound criteria of the solid breast lesions and histological diagnosis for evaluation of solid breast lesions by BI-RAD system. Methods and Materials We performed between December 2005 and January ,563 mammographic examinations and 59,204 ultrasound examinations. The 1,836 new cases of the solid breast lesions were included into this retrospective study. The women were years old and were examined with equipment Mammomat 3000 Nova, ultrasound machine Simens SG 50 and Focus by B-K. The lesions were evaluated according to 9 ultrasound criterion (Table 1) and were marked 1 or 0 (1 for malignancy, 0 for benign). Our hypothesis was: the lesions marked 0-2 are benign (BI-RADS 2), 3-4 are susp. benign (BI-RADS 3), 5-7 susp. malignant (BI-RADS 4), 8-9 are malignant (BI-RADS 5, Table 2). All lesions were histologicaly verified, fine needle aspiration biopsy and core cut biopsy were performed under ultrasound control, method free hand., needle 22, 20 G and core cut 14 and 16 G, by Magnum. The most of the suspitional lessions were surgically verified and definitive evaluated with histopathology. CRITERIA FOR EVALUATION EVALUATION SCORE EVALUATION SCORE Criteria / MG- USG lesion 0 1 mammography examination benign susp. malignant shape of the lesions regular irregular border smooth rough internal echo homogeneous heterogeneous posterior echo not attenuated attenuated lateral shadows exist not exist D/W ratio more that 1 under 1 change of architecture no yes lymphadenopathy no Table 1.: Criteria for evaluation yes Page 2 of 12

3 LESIONS MARKED LEVEL OF SUSPECTION BI-RADS 0-2 benign susp. benign susp. malignancy 4 a, 4 b 8-9 malignancy Table 2 : Evaluation - our hypothesis and BI-RADS 4 c, 5 Images for this section: Page 3 of 12

4 Fig. 1: A benign fibroadenoma. Linear US - probe 18 MHz. Fig. 2: A benign fibroadenoma with stromal changes - typical for the phyllodes tumor, benign variant Page 4 of 12

5 Results There were 726 lesions marked 0-2 (BI-RADS 2) with benign histology, 204 lesions were marked 3-4 (BI-RADS 3) with benign histology and with proliferative activity or risk. Next 290 potentionaly malignant lesions were marked 5-7 (BI-RADS 4) and last 624 histology malignant lesions were marked 8-9 (BI-RADS 5). All patients were after surgical and chemotherapeutic treatment. HISTO-PATHOLOGY NUMBER % benign ,28% malignant ,72% TOTAL Table 3: Histology and cytology 100,00% EVALUATION NUMBER BENIGN MALIGNANT BI-RADS c, 5 TOTAL Table 4: US criteria and histologic correlation, BI-RADS - Images for this section: Page 5 of 12

6 Fig. 3: 23 year old women. Solid breast lession, US criteria marked total 2. Level of suspection - benign. BI-RADS 2. Histology : Benign fibroadenoma Page 6 of 12

7 Fig. 4: 17 year old women, solid breast mass, pathology intratumorous vessels in CFM. Lesion marked 4. Susp.benign. BI-RADS 3. Histology: Phyllodes tumor, benign variant Page 7 of 12

8 Fig. 5: 47 year old asymptomatic women. Solid breast mass. US criteria 6. level of suspection : susp. malignant. BI-RADs 4b. Histology : Mucinous carcinoma. Page 8 of 12

9 Fig. 6: 3D image. 67 year old asymptomatic women. Irregulary round solid breast mass. US criteria - marked 7. Level of suspection - susp. malignant. BI-RADs 4b. Histology : Lobular carcinoma in situ Page 9 of 12

10 Fig. 7: 73 year old patient with palpable mass, the first examination. Irregular inhomogenous hypoechogenic mass with pathology vascularisation in CFM. Lesion marked by US criteria : 9. Level of suspection : malignant. BI-RADS 5. Histology : Invasive ductal carcinoma, G3. Page 10 of 12

11 Conclusion The number evaluation of the lesions shows sensitivity 95,5% and the specificity 85 %, PPV 93,42 %. The evaluation by the BI-RAD system is useful for practise sonomammography. References 1. Kopans D.B.: Histologic, pathologic and imaging correaltion. In.: Kopans D.B. editor: Breast imaginig, 3rd ed. Philadelphia. Lippincrott Williams Wilkins: 2006, P Guray M., Sahin A.A.: Benign breast diseases, classification, diagnosis and management, Oncologist 2006: 11: Tabar I., Dean P.B.: Stellate/speculated lesions, in: Tabar I., Dean P.B. editors, Teaching atlas of mammography, 3er ed., Stuttgart: Thieme, 2001, p Tse G.M., Tan P.H., Pang Al., Cheung H.S.: calcification in breast lesions : pathologist# perspective, J Clin pathol.,, 2008, 61: Ganesan S., Karthik G., Joshi M., Damodaran V.: Ultrasound spectrum in intraductal papillary neoplasms of the breast. BR J Radiol 2006 : 79 : Liberman I., Holland A.E., Marjan D., Murray M.P., Bartella L., Morris E.A et al: Underestimation of atypical ductal hyperplasia at MRI guided 9 gauge vacuum assisted breast biopsy. AJR, Am J Roentgenol 2007, 188 : Kuhl C.K., Schrading S., Bieling H.B., Wardelmann E., Leutner CC., Koenig R. et al.:mri for diagnosis of pure ductal carcinoma in situ in prospective obsarvational study. Lancet 2007, 370: Doneag W.I., Spratt J.S. editors. cancer of the breast, 4th ed.,philadelphia, WB Saunders, Parker S.H., Burtbank E, Jackman R.J., Cardenosa G., Cink T.M. et al.: Percutaneous large core breast biopsy: a multi- institutional study. Radiology, 1994, 193: Heywang-. Korbrunner S.H., Sinnatamy R., Lebeau A., Lebrecht P.D., Schreer I.: Intredisciplinary consensus on the use and techniqueof MR.guided vacuum asisted breast biopsy ( VAB ) : results of a European concensus meeting,. Eur, J Radiol. 2009, Tabar I., Dean P.B., Pentek Z.: Galactography : the diagnostic procedureof choise for nipple discharge, radiology, 1983: 149_: Dixon a.m.: Breast ultrasound, how, why and when, Churchill Livingstone, Elsevier, 2008, 283, ISBN 13: Page 11 of 12

12 13. Szopinski K.T.,Pajk, A.M., Wysocki M et al.: 2003, Tissue harmonic imaging. Utility in breast sonography. Journal of Ultrasound in Medicine 22(5) : Strano S., Gombos E.C., Friedland O. et al.: 2004, Colour Doppler Imaginig of fibroadenomas of the breast with histopathologic correlation. Journal of Clinical Ultrasound, 32 ( 7 ) : Personal Information Page 12 of 12