Effectiveness of mammography and breast ultrasound in detecting lesions suspicious of breast cancer (BI-RADS 4 AND 5)

Alfaro Eraso, Leidy; Alemán García, Daniela; Fernández Mercado, Robinson; Llinás, Federico; Diaz-Yunez, Israel; De Nubila, Eduardo; Franco Novella, Hernando

Effectiveness of mammography and breast ultrasound in detecting lesions suspicious of breast cancer (BI-RADS 4 AND 5)

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Fecha

2024

Autores

Alfaro Eraso, Leidy

Alemán García, Daniela

Fernández Mercado, Robinson

Llinás, Federico

Diaz-Yunez, Israel

De Nubila, Eduardo

Franco Novella, Hernando

Editor

Universidad del Egeo
Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud

Resumen

To evaluate the effectiveness of mammography and breast ultrasound in the detection of lesions suspicious of breast cancer (BI-RADS 4 and 5). This cross-sectional study examined 315 cases involving mammographic and ultrasound reports categorised as BI-RADS 4 or 5. These cases underwent image-guided biopsies between 2018 and 2023. Cases involving radiotherapy or chemotherapy were excluded. Data were collected from medical histories and pathology reports from biopsies. The following variables were recorded: age; BI-RADS classification; type of study; and histological type. Descriptive statistics were used and chi-square tests were performed. Statistical significance was considered at p < 0.05. Of the BI-RADS 4 cases, 28.78% were classified by ultrasound and 90% by digital mammography. Seventy-one point twenty-two percent of BI-RADS 5 were detected by ultrasound and 10% by digital mammography. Ultrasound detected 80.98% (n = 166) of malignant cases. Digital mammography identified 23.64% (n = 26) of malignant cases. In subcategory 4A, 13 out of 70 cases (18.5%) were confirmed as cancerous, with a 95% confidence interval (CI) of 10.2% to 29.6%. For BIRADS 4B: In subcategory 4B, 14 out of 70 cases (20.0%) were found to be cancerous, with a 95% confidence interval (CI) ranging from 11.3% to 31.2%. In subcategory 4C, 15 out of 18 cases (83.3%) were confirmed as cancerous, with a 95% confidence interval (CI) ranging from 58.5% to 96.4%. Finally, for the BIRADS 5 category: Of the 157 cases classified as BIRADS 5, 95.5% (150 cases) were found to be cancerous, with a 95% CI ranging from 91% to 98%. Overall, 73.42% (n = 116) of BI-RADS 4 cases were benign, while 95.54% (n = 150) of BI-RADS 5 cases were malignant. The cancer detection rate by ultrasound for BIRADS 4 was 41%, compared to 16.1% for mammography. Ultrasound detected 95.8% of the total number of patients with BIRADS-5, and mammography detected 90.9%. Conclusion: BI-RADS category 5 offers high diagnostic predictability, whereas BI-RADS category 4 still yields a high number of false positives, primarily within subcategories 4a and 4b. Combining ultrasound and digital mammography improves the overall diagnostic capacity.