Thesis (M.Sc.) - Cairo University - National Cancer Institute - Department of Oncology (Surgical)

Objectives: To determine the pathological outcome (benign versus malignant) of surgical excision BI-RADS III and IV unbiopsied breast lesions. Materials and Methods: All data from hospital records between the 1st of January 2016 and the 31st of December 2017 at the National Cancer Institute, Cairo University, was examined retrospectively for patients with BI-RADS III or IV masses who have undergone surgical excision without conclusive tissue biopsy. These patients were stratified into three groups: benign, pre-malignant or malignant. The data was collected manually. Items collected include age, reported and excised size, BI-RADS classification, diagnosis and classification after pathology and the type of surgery. Results: A total of 93 cases were included, of which 39 were BI-RADS III and 54 were BI-RADS IV. Only one BI-RADS III case was malignant. Only one underwent mastectomy. The rest underwent different forms of breast conservative surgery. All cases deviated from the published recommendation for close follow-up. For BI-RADS IV cases the percentage malignancy was similar to published estimates. Six cases underwent mastectomy, five with axillary clearance, four of which were node-negative. Only 20 cases had undergone an attempt (failed or inconclusive) at prior biopsy. There was discrepancy between some reports that included a BI-RADS IV subtype, and others that did not. Conclusion: These cases represent a deviation from published recommendations. Wider use of biopsy, sentinel lymph node sampling, and vacuum-assisted techniques could reduce surgical load. Institutional standardization on subtyping can improve consistency

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