South African Medical Journal

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Evaluation and correlation of mammographically suspicious lesions with histopathology at Addington Hospital, Durban

BD Cupido, F Vawda, A Sabri, CT Sikwila


Background. Stereotactic core-needle biopsies (SCNBs) are a reliable alternative to surgical biopsy for microcalcifications. The positive
predictive value (PPV) of SCNB has been shown to be reproducible in several studies using the Breast Imaging Reporting and Data System
(BIRADS) classification, which is the current gold standard in mammographic reporting. At this stage, no study has been done in KwaZulu-
Natal to assess local outcomes against BIRADS. The current standard of care utilises vacuum-assisted breast biopsy, but is not available
in a resource-constrained environment such as ours. The need, therefore, is for constant evaluation of existing practice to ensure that it is
optimised for the challenges and limitations facing local radiologists.
Objective. To assess the PPV of SCNB in Addington Hospital, and to compare it with that of BIRADS.
Material and methods. Mammographically detected lesions were assigned to 3 categories: benign, indeterminate and suspicious. A
retrospective review of 67 SCNBs was performed for lesions falling within the suspicious category, and the PPV and rates of ductal
carcinoma in situ (DCIS) were determined.
Results. Our study demonstrated a PPV of 20.9%. This correlated well with international studies for BIRADS 4 and 5 lesions. DCIS
accounted for 21.4% of detected malignancies, which is in keeping with current literature.
Conclusion. Despite resource limitations, local outcomes were comparable with those of BIRADS. Given our fairly general categorisation
of lesions, however, it should be emphasised that BIRADS allows better organisation, consistency and clarity in breast imaging reporting,
as well as accurate data comparison between centres facing limitations similar to our own.
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