Concordance of Ultrasound and Fine Needle Aspiration Cytology Findings in BIRADS IV Breast Lesions

Background Breast mass is a common presenting complaint in women attending any breast clinic. Approximately 10 % of the lumps are often diagnosed as malignant. Accurate diagnosis in specialized breast centers depends on the Triple Assessment Technique which combines the findings of clinical examination, radiological analysis and fine needle aspiration cytology. Aims The objective of the study was to evaluate the role of the ultrasound in the diagnosis of suspicious breast lesions classified according to BIRADS (Breast Imaging Reporting and Data System) as BIRADS IV, and correlate the findings with the results of fine needle aspiration cytology (FNAC). Methods A retrospective study included 50 patients who complained of apparent breast lumps and attending the Training Center for Early Detection of Breast Tumors in the Oncology Teaching Hospital, Medical City Complex, Baghdad during the period from January 2017 to March 2018. Their age ranged from 24 to 77 years. Patients were subjected to ultrasound test after clinical examination and the findings of those cases diagnosed as BIRADS IV were correlated with the corresponding cytopathology results. Results By reviewing breast ultrasound findings, masses were seen in 74 %, of these 30 % were poorly demarcated while 44 % were well defined. Complex cysts were observed in five cases (10 %) while axillary lymphadenopathy with lost or asymmetrical cortical thickening was noted in four cases (8 %). FNAC revealed highly suspicious changes in 33 cases (66 %), of these changes in favor of carcinoma was seen in 26 %, while severe and moderate atypical cellular changes were observed in 40 % and mild atypia in 18 %. By correlating the ultrasound findings of BIRAS IV with FNAC results, breast carcinoma (11 cases, 22 %) and moderate to severe atypia (20 cases, 40 %) totally represented 62 % of all detected lesions seen by ultrasound in this study. Conclusion Ultrasonography remains a reliable diagnostic modality for breast lesions and a recommended tool for evaluation the underlying cause standing behind the suspicious breast mass. Its value was illustrated in localizing the mass lesion, assessing its size, consistency, the margin of the lesion and in defining suspicious axillary or supraclavicular lymph nodes.