Assessment of breast lesions using BI-RADS US lexicon in mammographically dense breasts (ACR categories 3 and 4) with histopathological correlation

To assess the role of ultrasonography in detection, and categorization of breast lesions in patients with mammographically dense breasts with the use of the BI-RADS US lexicon. This study included 60 female patients (age range from 20 to 80 years, mean 38.3 ± 11.9) complaining of mastalgia, breast lump or nipple discharge with mammographically dense breast tissue. Breast ultrasound was performed to all patients with a 12-MHz linear-array transducer. Sonographic findings of the breast lesions were described and categorized according to the BI-RADS US assessment categories. Biopsy procedures were performed for the sonographically detected breast lesions with histopathological examination of the biopsied tissue. The main complaint was palpable breast mass encountered in 25 patients, 12 of mastalgia, 4 of nipple discharge, 12 patients were on screening and 7 on follow up. 36 patients were categorized as ACR 3 and 24 ACR 4 regarding the density of their breasts in mammography. Mammography revealed no abnormalities in 31 patients and abnormal in 29 patients, the commonest mammographic finding was breast mass, detected in 19 patients. Ultrasound detected breast lesions in 56 (93.3%) out of 60 patients. BI-RADS US category 2 was the most common category representing 36.7%. Ultrasonography had a diagnostic reliability for differentiating between benign and malignant breast lesions (p = 0.869) in mammographically dense breasts while mammography was diagnostically unreliable (p = 0.045). Ultrasound is a mandatory adjunct to mammography in detection and characterization of breast lesions in mammographically dense breasts.