title: Synchronous BI-RADS Category 3 Lesions on Preoperative Ultrasonography in Patients with Breast Cancer: Is Short-Term Follow-Up Appropriate?
abstract: OBJECTIVE
  Breast ultrasonography (US) has been widely used in the preoperative examination of patients with breast cancer. Breast Imaging Reporting and Data System (BI-RADS) category 3 (C3) lesions (probably benign) are regarded as having a low probability of malignancy (≤2%). The purposes of this study were to verify the malignancy rates for synchronous BI-RADS C3 lesions in patients with breast cancer and consider appropriate management strategies for these lesions.
  
  
  METHODS
  Between January 2010 and January 2013, a total of 161 patients underwent surgery in our institute for breast cancer and synchronous BI-RADS C3 lesions. In the US reports, we found records of 219 synchronous BI-RADS C3 nodules in 161 patients. They were excised during surgery for breast cancer management. Stepwise logistic regression analysis was used to identify predictors of malignancy for synchronous BI-RADS C3 lesions.
  
  
  RESULTS
  The rate of malignancy among the 219 BI-RADS C3 lesions was 9.6%. In simple logistic regression analysis, the size of the primary tumor (p<0.001), pathologic T (pT) stage (p=0.002), and progesterone receptor (PR) status of the primary tumor (p=0.029) were significant predictive factors. In multiple logistic regression analysis, the pT stage and PR status of the primary tumor remained significant predictors (p=0.004 and p=0.003, respectively), and human epidermal growth factor receptor 2 (HER2) was identified as another significant factor (p=0.006).
  
  
  CONCLUSIONS
  In patients with breast cancer who are scheduled for surgery, needle biopsy or excision should be considered for synchronous BI-RADS C3 lesions identified on preoperative US when the primary tumor has the following risk factors: large size, high PR expression, and HER2 positivity.
authors.affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Seokwon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Younglae
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Youngtae
authors.initials: Y
authors.lastname: Bae
keywords: Breast diseases; Breast neoplasms; Multiple primary neoplasms; Predictive value of tests; Ultrasonography