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Predictive value of BI-RADS classification for breast imaging in women under age 50

Breast Cancer Research and Treatment volume 130, pages 819–823 (2011)Cite this article

Abstract

In this study, we assessed the positive-predictive value (PPV) of mammography and/or ultrasonography in women age 50 based on recommendations for biopsies and final pathology results. We performed a retrospective analysis of all mammography and ultrasonography reports issued from 9/2005 to 1/2007 resulting in biopsy among women aged 18–50 at a large county hospital. Data included demographics, imaging modality, breast density, type of finding, BI-RADS, and final pathology. Results were compared to women aged >50 at the same institution. Four hundred and seventy-five biopsies in 395 patients were reviewed. The PPV of BI-RADS 3 (n = 11) was 9.1%, BI-RADS 4 (n = 440) 5.9%, and BI-RADS 5 (n = 24) 66.7%. Forty three (9%) were malignant, of which 31 (6.5%) were invasive carcinomas and 12 (2.5%) were noninvasive. None of the biopsies on patients aged <30 were malignant. Recommended biopsies based on mammography alone were malignant in 20.2% (20/99) compared to 3.4% (7/205) for ultrasonography alone, and 8.9% (15/168) for both mammography and ultrasonography. Suspicious calcifications were malignant in 25% compared to 6.8% for masses/nodules and 3.6% for cysts. Lesions larger than 2 cm are more likely to be malignant (11.8%) than lesions between 1 and 2 cm (3.6%) or below 1 cm (4.3%). The PPV of the current screening modalities diminishes markedly in women under the age of 50 and even more below the age of 40. Calcifications and masses larger than 2 cm should be biopsied, but the current BI-RADS criteria may benefit from revision for other findings in young patients.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Author information

Affiliations

  1. Miller School of Medicine, University of Miami, Miami, FL, USA

    Gannon Kennedy, Matthew Markert & Eli Avisar

  2. Taylor Breast Health Center, Jackson Health System, Miami, FL, USA

    Joseph Richard Alexander & Eli Avisar

  3. Breast Site Disease Group, Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Eli Avisar

  4. Clinical Research Building (C232), 1120, NW 14th Street, 4th Floor, Miami, FL, 33136, USA

    Eli Avisar

Authors
  1. Gannon Kennedy
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  2. Matthew Markert
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  3. Joseph Richard Alexander
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  4. Eli Avisar
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Correspondence to Eli Avisar.

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Kennedy, G., Markert, M., Alexander, J.R. et al. Predictive value of BI-RADS classification for breast imaging in women under age 50. Breast Cancer Res Treat 130, 819–823 (2011). https://doi.org/10.1007/s10549-011-1669-x

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  • DOI: https://doi.org/10.1007/s10549-011-1669-x

Keywords

  • BIRADS
  • PPV
  • Radiology
  • Mammogram
  • Mammography
  • Biopsy
  • PPV
  • Positive-predictive value