As people pay more attention to their health and the widespread use of breast ultrasound, the detection rate of breast nodules is increasing, which may cause psychological stress and panic to many women. In fact, the majority of breast nodules are benign, especially breast fibroadenoma is the most common, other diseases include breast adenopathy, breast cysts, intraductal papilloma, ductal dilatation and breast tuberculosis, and individual nodules can also be breast cancer. So how can we tell if my breast nodule is benign? It is important to understand what the BI-RADS means and what further tests are available in the breast specialist to determine the nature of the nodule.
The BI-RADS (Breast imaging reporting and data system) is the “Breast Imaging Reporting and Data System” recommended by the American College of Radiology, which is a more standardized report. The significance of each grade is as follows.
Grade 0: Cannot be judged and should be evaluated in conjunction with other examinations. This means that the information obtained from the examination may not be complete.
Grade I: No abnormality is seen.
Grade II: benign changes are considered and regular follow-up is recommended (e.g., once a year). Grade III: Benign disease is possible, but a shorter follow-up period (e.g., once every 3-6 months) is required. The percentage of malignancy at this level is less than 2%.
Grade IV: There are abnormalities that cannot completely exclude the possibility of malignant lesions and require biopsy for clarification.
Grade IVa: low likelihood of predisposition to malignancy.
Grade IVb: moderate likelihood of malignancy.
Grade IVc: high probability of malignancy.
Grade V: High suspicion of malignant lesion (almost identified as malignant disease), requiring surgical excision or puncture biopsy.
Grade VI: Malignant lesion has been confirmed by pathology.
Routine breast examinations are.
Ultrasound, which has a long history and rich experience, especially for breast cysts with a diagnostic rate of more than 90%, is radiation-free and can be repeatedly performed, and for Chinese women with small and dense glands, the shape of the lump, elasticity index and blood flow signal can be initially identified as benign or malignant, and is generally used for female physical examinations, and is the first choice for initial screening of lump benignity and malignancy, and also for patients with breast pain and nipple overflow. It is also used in patients with breast pain and nipple discharge. It is difficult to determine the nature of small nodules, and ultrasound is more dependent on the level of the examining physician.
Mammography. Generally used for physical examinations of women over 40 years of age with slightly higher fat content in the breast gland, to identify benign and malignant breast masses, calcifications and localized entanglement.
Breast magnetic resonance examination. MRI has good contrast and can be observed in three dimensions. It can show the edge of breast lesion, location, signal intensity, invasion or non-invasion, as well as the time signal curve after enhancement to determine the benignity and malignancy, which is the best method to diagnose breast cancer.
Puncture biopsy. It is the final method to determine the benignity and malignancy of breast nodules, and is the “judge” to determine the nature of nodules. For breast specialists, in addition to the above-mentioned auxiliary examinations, they trust their own sense of touch to determine the malignancy of breast nodules. Generally speaking, an experienced specialist will be able to determine whether surgery or biopsy is needed by hand inspection of a palpable breast nodule. Therefore, it is the author’s opinion that
For breast nodules in which the patient has palpated or can palpate a lump, a specialist must be consulted to determine whether surgery or biopsy is needed.
For ultrasound-detected breast nodules without a palpable mass, if the patient is younger than 40 years old and has a BI-RADS classification of ≤3, a review after 3 months is recommended, which can be extended to once every 6 months if the nodule does not increase in size.
For ultrasound-detected breast nodules without a palpable mass, if the age is less than 40 years and the BI-RADS grade is ≥4, mammography or MRI is recommended, and if necessary, puncture biopsy or surgery.
For ultrasound-detected breast nodules without a palpable mass, if the age is older than 40 years and the BI-RADS grade is ≤3, mammography is recommended. If the mammography is normal, close follow-up is performed for 2 to 3 months, and if the nodule does not increase in size, the follow-up can be extended to once every 6 months.
For ultrasound-detected breast nodules without a palpable mass, if the age is >40 years and the BI-RADS grade is ≥4, mammography or MRI and, if necessary, puncture biopsy are recommended. In particular, early surgery is recommended for solitary nodules.