BIRADS 3 Breast Lesions: Can Follow-up Replace Biopsy

Objective: To compare the two years follow-up versus biopsy in probably benign breastlesions (BIRADS3 category) with assessment of the malignancy potential in both conditions. Patients and Methods: This is a comparative descriptive record survey where records of all BIRADS 3 patients (number=575) who were admitted to the Women and Fetal Imaging (WAFI) center in Cairo-Egypt during the period from January 2007 to December 2010 were traced, however, only 464 were finally included and divided into: Group A (number = 395), those who were subjected to follow up protocol and Group B (number = 69), who underwent biopsy. Results: 85.1%of the cases underwent the two years follow up by mammography and ultrasonography through periodic imaging surveillance (group A), while 14.9% underwent biopsy and were allocated as (group B). Among the follow up cases 98.48%weretrue negative (benign cases) and six cases (1.52%) were upgraded in their follow up visits and were confirmed malignant by histopathology. In group (B) 97.1% were true negative while 2 cases (2.9%) were confirmed malignant (false negative).No significant difference between both groups as regards false negative results (p=0.339). When we investigated all false negative cases (cases proved malignant) in both groups, positive family history was the only variable that counts and favoring the malignant suspicion in all cases but other parameters like irregular lesions, subtle asymmetry, calcified masses, focal distortion and parenchymal disruption may direct the radiologists and physicians, to proceed to biopsy. Conclusion: In BIRADS 3 breast lesions interpreted by experienced radiologists and surgeons especially in absence of the parameters favoring malignancy, short term follow up can confidently replace biopsy.