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Can Short-term Follow-up with Ultrasound be Offered as an Acceptable Alternative to Immediate Biopsy or Surgery for Patients with First Ultrasound Diagnosis of BI-RADS 4A Lesions?

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Abstract

Objectives

To evaluate the relevant factors associated with malignancy in Breast Imaging Reporting and Data System (BI-RADS) 4A and to determine whether it was possible to establish a safe follow-up guideline for lower-risk 4A lesions.

Methods

In this retrospective study, patients categorized as BI-RADS 4A on ultrasound who underwent ultrasound-guided biopsy or/and surgery between June 2014 and April 2020 was analyzed. Classification-tree method and cox regression analysis were used to explore the possible correlation factors of malignancy.

Results

Among 9965 patients enrolled, 1211 (mean age, 44.3 ± 13.5 years; range, 18–91 years) patients categorized as BI-RADS 4A were eligible. The result of cox regression analysis revealed the malignant rate was only associated with patient age (hazard ratio (HR) = 1.038, p < 0.001, 95% confidence interval (CI): 1.029–1.048) and the mediolateral diameter of the lesion (HR = 1.261, p < 0.001, 95% CI: 1.159–1.372). The malignant rate for patients (≤ 36 y) with BI-RADS 4A lesions (the mediolateral diameter ≤ 0.9 cm) was 0.0% (0/72). This subgroup included fibrocystic disease and adenosis in 39 patients (54.2%), fibroadenoma in 16 (22.2%), intraductal papilloma in 8 (11.1%), inflammatory lesions in 6 (8.3%), cyst in 2 (2.8%), and hamartoma in 1 (1.4%).

Conclusions

Patient age and lesion size are associated with the rate of malignancy in BI-RADS 4A. For patients with lower-risk BI-RADS 4A lesions (≤ 2% likelihood of malignancy), short-term follow-up with ultrasound may be offered as an acceptable alternative to immediate biopsy or surgery.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China

    Ping He, Wen Chen & Li-Gang Cui

  2. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China

    Hua Zhang

Authors
  1. Ping He
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  2. Wen Chen
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  3. Li-Gang Cui
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Corresponding author

Correspondence to Wen Chen.

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This retrospective study was approved by our institutional review board and the requirement to obtain informed consent was waived.

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He, P., Chen, W., Cui, LG. et al. Can Short-term Follow-up with Ultrasound be Offered as an Acceptable Alternative to Immediate Biopsy or Surgery for Patients with First Ultrasound Diagnosis of BI-RADS 4A Lesions?. World J Surg 47, 2161–2168 (2023). https://doi.org/10.1007/s00268-023-07037-x

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  • DOI: https://doi.org/10.1007/s00268-023-07037-x

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