Should the BI-RADS 3 ultrasound category be revised?

By Kate Madden Yee, AuntMinnie.com staff writer

October 19, 2018 -- Should the current BI-RADS 3 ultrasound category -- covering breast lesions that are "probably benign" -- be revised? It appears so, according to research published online October 17 in Ultrasound in Medicine and Biology.

Although studies have shown that lesions in the ultrasound BI-RADS 3 category pose a malignancy risk of less than 2% -- and therefore can be safely followed in the short term with further imaging -- not everyone agrees that this is the best way to track them, wrote a team led by Dr. Chiara Pistolese from the University of Rome Tor Vergata. In fact, some practices recommend that women with BI-RADS 3 lesions undergo core-needle or surgical biopsy, just to be sure.

"Breast ultrasound, in daily practice, is an indispensable and irreplaceable method in breast nodule detection and characterization," the group wrote. "The introduction of the BI-RADS system helped radiologists to describe the sonographic characteristics and to assign lesions to a category associated with the most appropriate clinical treatment. Despite the help offered by this classification system, the BI-RADS 3 category includes probably benign lesions whose management has been widely debated in the literature."

Pistolese and colleagues sought to evaluate the validity of the BI-RADS 3 category in ultrasound by using cytologic and histologic results as the reference standard. The researchers included 122 patients with 122 nodular lesions found on breast ultrasound and classified as BI-RADS 3, all of which were biopsied percutaneously (Ultrasound Med Biol, October 17, 2018).

In 86 cases (70.5%), the biopsies showed benign results; 29 cases (23.7%) had uncertain results and seven (5.7%) had malignant results. Some of these malignant lesions had cysts or small anechoic components that have typically been associated with benign lesions, according to Pistolese's team.

The presence of these typically benign characteristics in malignant lesions -- as well as the higher than expected malignancy rate -- surprised the researchers and led them to believe that the BI-RADS 3 category for ultrasound may need to be revised.

"The management of probably benign nodular lesions should not only be guided by BI-RADS classification; it is also necessary to include clinical ... data and apply a multidisciplinary approach to select cases that require histologic verification instead of the usual follow-up," the group wrote.

"Despite the small cohort, our data seem to indicate the need to revise the current BI-RADS 3 category," the authors concluded. "It could be useful to evaluate as suspicious the presence of nonhomogeneous echoes within the corpuscular cyst and solid nodular lesions with cystic components."

Ultrasound helps identify dementia risk factor

By AuntMinnie.com staff writers

October 17, 2018 -- Ultrasound can help researchers identify a dementia risk factor among older adults that could be treated, therefore putting off the onset of the disease, according to a study published online October 16 in the Journal of Alzheimer's Díease.

A team led by Rachel Mackey, PhD, of the University of Pittsburgh found that the arterial stiffness of the heart can predict who will go on to develop dementia. And since arterial stiffness can be reduced with antihyperintensive medication, it could be possible to delay dementia's onset.

"As the large arteries get stiffer, their ability to cushion the pumping of blood from the heart is diminished, and that transmits increased pulsing force to the brain, which contributes to silent brain damage that increases dementia risk," Mackey noted in a statement released by the university.

The researchers used pulse wave velocity ultrasound to measure the heart's arterial stiffness in 356 adults without dementia when the study started in 1998. This ultrasound technique measures the speed of the blood pressure pulse as it travels through the arteries. Study participants also underwent MRI to identify any signs of brain disease.

Mackey and colleagues found that subjects with high pulse wave velocity readings were 60% more likely to develop dementia during the following 15 years compared with those with lower values.

"What's exciting to think about is that the strong association of arterial stiffness to dementia in old age suggests that even at age 70 or 80, we might still be able to delay or prevent the onset of dementia," Mackey stated.