title: Surveillance of probably benign (BI-RADS 3) lesions in mammography: what is the right follow-up protocol?
abstract: BI-RADS-3 is a category in mammography for probably benign lesions and for which periodic follow-up with repeat imaging is recommended. At our institution repeated mammograms are performed at 6, 12, 18, and 24 months. The purpose of this study was to assess the significance of 18-month mammogram for evaluation of BI-RADS-3 lesions. Following IRB approval, electronic medical records and picture archiving and communications system were used to review 121,862 consecutive mammograms between February, 2002-May, 2009. A total of 8,400 patients with BI-RADS-3 mammograms were identified. Of these, 7,632 patients were followed until completion of 24 month mammogram or biopsy following an upgrade in their BI-RADS status. Over the follow-up, 197 patients received an upgrade in their BI-RADS status of which 179 were biopsied. Histopathologic results were reviewed. The majority of the BI-RADS-3 lesions were upgraded at 6-month mammogram (n = 150, 76.1%) followed by 32 (16.2%), 11 (5.6%), and 4 (2.0%) at 12, 18, and 24 month mammograms respectively. Thirty-four of 179 upgraded and biopsied lesions were found to be malignant. From these 27 (79.4%), 3 (8.8%), 3 (8.8%), and 1 (2.9%) lesions were identified at 6, 12, 18, and 24 month mammograms respectively. At the 18-month mammogram 3/7,632 lesions (0.04%) were found to be malignant. The vast majority of malignant lesions (88.2%) were detected within the first 12-months of follow-up. Only three of 179 biopsies (1.7%) were malignant at 18-month follow-up. Based on those results a 6-, 12-, and 24-month follow-up protocol for BI-RADS-3 lesions is sufficient.
authors: Department of Radiology, Boston University Medical Center, Boston, Massachusetts.
authors: Karen A
authors: KA
authors: Buch
authors: Muhammad M
authors: MM
authors: Qureshi
authors: Bianca
authors: B
authors: Carpentier
authors: Deborah A
authors: DA
authors: Cunningham
authors: Michael
authors: M
authors: Stone
authors: Carl
authors: C
authors: Jaffe
authors: Marie
authors: M
authors: Quinn
authors: Carlos
authors: C
authors: Gonzalez
authors: Justine
authors: J
authors: LaVoye
authors: Neely
authors: N
authors: Hines
authors: Boris Nicolas
authors: BN
authors: Bloch
mesh_terms: D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D013997:Time Factors
keywords: BI-RADS; breast neoplasm; mammography