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Br J Radiol. 2018 Feb 6:20170816. doi: 10.1259/bjr.20170816. [Epub ahead of print]

Retroareolar masses and intraductal abnormalities detected on screening ultrasound: can biopsy be avoided?

Guo Y1,2, Raghu M1,2, Durand M1,2, Hooley R1,2.

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1 Department of Radiology and Biomedical Imaging, Yale New Haven Hospital , New Haven, CT , USA.
2 Yale University School of Medicine , New Haven, CT , USA.


To investigate the malignancy rate of retroareolar masses and intraductal abnormalities discovered in asymptomatic females during screening whole breast ultrasound (US-S) and determine if biopsy can be avoided.


This is a HIPAA compliant retrospective study. Our radiology electronic medical records were searched for the phrases "retroareolar mass" or "intraductal mass" combined with "screening whole breast ultrasound" performed between 10/1/2009 and 5/30/2015. Inclusion criteria included retroareolar masses in asymptomatic females with normal mammography, mammographically dense breast tissue and imaging or biopsy follow-up.


1136 charts were reviewed. 87 BI-RADS 3 and 4 retroareolar findings were included in final analysis. The average lesion size was 9.5 mm (range 4-28 mm). 47/87 lesions were classified as BI-RADS 3 and 40/87 BI-RADS 4. Of the 47 BI-RADS 3 lesions, 36 were stable on follow-up; 6 benign lesions were biopsied at patients' request; and 5 biopsied due to suspicious interval change on follow-up imaging, including 4 benign lesions and a 5 mm Grade 2 ductal carcinoma in situ . 3/40 BI-RADS 4 lesions were not biopsied and stable at follow-up; 37/40 lesions underwent benign biopsy. The malignancy rate of BI-RADS 3 and 4 lesions was 2.1% [CI (0.4-11.1)] and 0% [CI (0.0-8.8)], respectively. The overall combined malignancy rate was 1/87 [1.1%, CI (0.2-6.2)].


The malignancy rate for BI-RADS 3 and 4 retroareolar masses and intraductal abnormalities detected on US-S is low (<2%). Advances in knowledge: Careful imaging surveillance in lieu of biopsy of these lesions may be appropriate in asymptomatic females with negative mammography.


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