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DOI:10.2214/AJR.07.2861
AJR 2008; 191:653-658
© American Roentgen Ray Society

Original Research

Application of Sonographic BI-RADS to Synchronous Breast Nodules Detected in Patients with Breast Cancer

Suk Jung Kim1,2, Eun Young Ko1, Jung Hee Shin1, Seok Seon Kang1, Sung Hee Mun1,3, Boo-Kyung Han1 and Eun Yoon Cho4

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-ku, Seoul 135-710, Korea.
2 Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
3 Department of Radiology, Catholic University of Daegu, College of Medicine, Daegu, Korea.
4 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

OBJECTIVE. The purpose of this study was to evaluate the applicability of the current BI-RADS for sonography to the assessment of synchronous breast nodules other than the primary malignant tumor in patients with breast cancer.

MATERIALS AND METHODS. One hundred eighty-nine synchronous nodules in 147 breast cancer patients were surgically excised after localization, and 412 synchronous nodules in 191 patients were observed or biopsied or excised without localization. Among a total of 601 synchronous nodules, 372 nodules were ipsilateral and 229 were contralateral to a primary malignant tumor. Two radiologists retrospectively reviewed sonograms of these nodules and determined the sonographic BI-RADS category without clinical information or pathologic results. For each nodule, the preoperative BI-RADS category and pathologic or follow-up results were compared.

RESULTS. Four hundred eighty-two nodules were classified category 3; 112 nodules, category 4; and seven nodules, category 5. Fifty-five (11.4%) of the category 3 nodules and 57 (47.9%) of the category 4 and 5 nodules were confirmed malignant. Thirty-six (21.2%) of 170 category 3 synchronous nodules in the same quadrant as the primary tumor were confirmed malignant, as were 12 (9.8%) of 122 nodules in a different quadrant and eight (4.2%) of 190 nodules in the contralateral breast.

CONCLUSION. For assessment of synchronous nodules in breast cancer patients, application of conventional screening sonographic BI-RADS categories may not account for possible increased risk of malignancy in synchronous nodules, especially those in the same quadrant of the breast as the index malignant tumor.

Keywords: BI-RADS • breast cancer • sonography • synchronous


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