Diagnostic value of lesions reported as bi-rads 4 on radiological imaging of the breast and their relationship with systemic inflammatory parameters

Objective: To evaluate the association of systemic inflammatory parameters with breast cancer diagnosed after biopsy from lesions reported as BI-RADS 4 by mammography and breast USG. Patients and Methods: Patients and Methods: In our study, patients who were evaluated as BI-RADS 4 on mammography or breast US and had a biopsy diagnosis at Ankara Bilkent City Hospital between 29 March 2022 and 29 November 2022 were evaluated. In the study, the sample size was determined using G-power 3.1.9.4 version software. This test was used to calculate the number of subjects with a large effect size, 2% margin of error, and 98% power level. As a result, it was decided to include at least 440 patients in total. A total of 1310 patients underwent TRU-CUT biopsy. These patients do not contain breast tissue, have fat lobules, fat necrosis, etc. Patients with inappropriate results were excluded from the study. The ages of 650 patients included in the study were recorded by finding the mammography and breast USG report, tru-cut biopsy report, postoperative pathology report and surgery report, and WBC, neutrophil, lymphocyte, monocyte and platelet counts from the hemogram examination. Results: As a result of the tru-cut biopsy of 650 women whose mammography or breast USG was reported as BI-RADS 4, surgery was performed in 34.15% of the patients (222/650). Ductal or columnar cell hyperplasia with atypia was detected in 28% of the operated patients (62/222), DCIS or LCIS in 4.5% (10/222), and invasive breast carcinoma in 39% (87/222). When looked at according to BI-RADS category, the sensitivity for detecting precancerous or breast cancer was calculated as 21.3% in BI-RADS 4, 10% in 4a, 44% in 4b, and 78.3% in 4c. According to the BI-RADS reporting results, the biopsy result of invasive breast cancer in the 4c group was significantly higher than the other groups (p < 0.001) (Table 4). Among the systemic inflammatory parameters, PLR and SII were significantly higher in patients with invasive breast cancer (p = 0.001 and p = 0.012, respectively) (Table 6). Although LMR was lower in malignant patients than in benign patients, it was not statistically significant (p = 0.095). Conclusions: Among the systemic inflammatory parameters, PLR and SII were found to be significantly higher in patients with invasive breast cancer. Although it is still necessary to perform a biopsy for tissue diagnosis, systemic inflammatory parameters can be guiding before biopsy. Key words: BIRADS 4 lesions, biopsy, breast, breast cancer, pathologic diagnosis, inflammatory index