Features of breast cancer initially assessed as probably benign on ultrasound: A retrospective study

We evaluated the features of breast cancers initially assessed as probably benign at ultrasound (US). Of the 7098 patients who underwent breast cancer surgery at our institution between 2014 and 2016, 179 lesions in 178 patients who had both a prior US with Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment and a recent US with a diagnosis of breast cancer were enrolled. Prior and recent US findings and category were retrospectively reassessed in line with the BI-RADS Atlas and analyzed. Of the 179 BI-RADS 3 lesions, 105 (59%) were retrospectively reassessed to category 4 and 74 (41%) retained category 3. Noncircumscribed margin, irregular shape, posterior enhancement, and nonparallel orientation were more frequently observed in the reassessment category 4 group than in the reassessment category 3 group (94% vs 43%, 81% vs 19%, 16% vs 4%, 14% vs 0%, respectively). The recent US revealed that 150 of the 179 lesions (84%) had > 20% size increase, and 121 (68%) showed morphologic changes. Margin was the most frequently observed morphologic feature to change (41%, 73/179). Care should be taken to look for subtle but suspicious US features and changes in mass, especially of margin, for early diagnosis of breast cancer.