Quaternary prevention in women’s health: the importance of stratification of BI-RADS 4 breast lesions
DOI:
https://doi.org/10.29289/2594539420250038Keywords:
mammography, early cancer detection, breast neoplasm, quaternary preventionAbstract
Introduction: Breast cancer is the most common malignant neoplasm among women in Brazil and worldwide, excluding non-melanoma skin tumors. The definitive diagnosis is based on the histopathological analysis of samples obtained through biopsies, performed after the identification of suspicious radiological findings on breast imaging studies. In this context, the Breast Imaging Reporting & Data System (BI-RADS) plays a central role in stratifying the risk of malignancy, particularly in the BI-RADS 4 category, which encompasses lesions with a broad spectrum of diagnostic probability and significant heterogeneity regarding histopathological outcomes. Objective: To evaluate the diagnostic performance of BI-RADS category 4 stratification through the correlation between radiological findings and histopathological results of breast biopsies. Methods: This is a descriptive, cross-sectional study based on the analysis of secondary data from a tertiary hospital in Southern Brazil for the year 2023. The variables analyzed were age, sex, BI-RADS category, sample type, lesion side, radiological finding, disease type, presence of histological microcalcifications, Nottingham histological grade, expression of tumor biomarkers, cell proliferation index, and immunophenotypic subtype. Results: Of the imaging findings analyzed, 14.9% were classified as BI-RADS 4 without subdivision. The diagnostic test performed without stratification had an accuracy of 29.87% (95% confidence interval [CI] 18.18%–43.86%), while the accuracy of the group with stratification of imaging findings was significantly higher, reaching 47.68% (95%CI 38.71%–56.76%). Conclusions: Stratification of the BI-RADS 4 category allowed for a more precise correlation between radiological suspicion and histopathological findings, resulting in greater diagnostic accuracy in biopsy indications. This process aligns with the concept of quaternary prevention, contributing to more assertive clinical management and a reduction in unnecessary interventions.
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Copyright (c) 2026 Camila Caminha Kondlatsch, Guilherme Felipe Staudt, Regina Arruda Leal
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