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Non-mass lesions detected by breast US: stratification of cancer risk for clinical management

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Abstract

Objective

To develop a classification system using imaging features to interpret breast non-mass lesions (NMLs) detected on US and to stratify their cancer risk.

Methods

This retrospective study included 715 patients with 715 breast NMLs detected on breast US from 2012 to 2016. Each patient underwent mammography at the time of diagnosis. Radiologists assessed US and mammographic features and final BI-RADS categories. Multivariable logistic regression was used to find imaging features associated with malignancy in a development dataset (n = 460). A system to classify BI-RADS categories (3 to 5) was developed based on the odds ratios (ORs) of imaging features significantly associated with malignancy and validated in a distinct validation dataset (n = 255).

Results

Among 715 NMLs, 385 (53.8%) were benign and 330 (46.2%) were malignant. In the development dataset, the following B-mode US features were associated with malignancy (all p < 0.001): segmental distribution (OR = 3.03; 95% confidence interval [CI], 1.50–6.15), associated calcifications (OR = 4.26; 95% CI, 1.62–11.18), abnormal ductal change (OR = 4.91; 95% CI, 2.07–11.68), and posterior shadowing (OR = 20.20; 95% CI, 6.46–63.23). The following mammographic features were also associated with malignancy (all p < 0.001): calcifications (OR = 7.98; 95% CI, 3.06–20.81) and focal asymmetry (OR = 4.75; 95% CI, 1.90–11.88). In the validation dataset, our classification system using US and mammography showed a higher area under the curve (0.951–0.956) compared to when it was not applied (0.908–0911) to predict malignancy with BI-RADS categories (p < 0.05).

Conclusion

Our classification system which incorporates US and mammographic features of breast NMLs can help interpret and manage all NMLs detected on breast US by stratifying cancer risk according to BI-RADS categories.

Key Points

• When diagnosing breast NMLs detected on US, suspicious US features are segmental distribution, associated abnormal ductal change, calcifications, and posterior shadowing within or around the NML on B-mode US, while a probably benign US feature is the presence of multiple small cysts.

• Corresponding suspicious mammographic features of breast NMLs detected on US are associated calcifications and focal asymmetry.

• Our classification system which incorporates US features with and without mammography can potentially be used to interpret and manage any NMLs detected on breast US in clinical practice.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

BI-RADS:

Breast Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

NML:

Non-mass lesion

OR:

Odds ratio

US:

Ultrasonography

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Ko Woon Park, Surin Park, Boo-kyung Han, Eun Young Ko, Eun Sook Ko, Jung Hee Shin, Mi-ri Kwon & Ji Soo Choi

  2. Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea

    Insuk Shon & Min-Ji Kim

Authors
  1. Ko Woon Park
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  2. Surin Park
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  3. Insuk Shon
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Corresponding author

Correspondence to Ji Soo Choi.

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Guarantor

The scientific guarantor of this publication is Ji Soo Choi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper. Statistical analysis of this study was conducted with the advice of our institutional statisticians (Insuk Shon, PhD; Min-Ji Kim, MS) in our institution. They are the authors of this study.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Park, K.W., Park, S., Shon, I. et al. Non-mass lesions detected by breast US: stratification of cancer risk for clinical management. Eur Radiol 31, 1693–1706 (2021). https://doi.org/10.1007/s00330-020-07168-y

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  • DOI: https://doi.org/10.1007/s00330-020-07168-y

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