Mammography: BI-RADS 4

Management and Determining the Cause

Chief Complaint: Breast Mass

a. History: No Co-morbidties

b. Ultrasound: Solid Mass

c. Mammography:BI-RADS 4 (suspicious, 2–95% risk)

Pivotal Assessment	Finding
Core Needle Biopsy	Benign Lesions Fibroadenoma	High-risk/Pre-malignant Lesions	Malignant Lesions

Pivotal Assessment

Finding

Core Needle Biopsy

Benign Lesions

Fibroadenoma

High-risk/Pre-malignant Lesions

Malignant Lesions

In a geriatric patient, a core needle biopsy of a solid breast mass can yield various diagnoses, which can be categorized into benign, high-risk/pre-malignant, and malignant conditions:

1. Benign Lesions:

Fibroadenoma (less common in older women)
Fibrocystic changes (e.g., apocrine metaplasia, sclerosing adenosis)
Intraductal papilloma
Fat necrosis
Mammary duct ectasia
Pseudoangiomatous stromal hyperplasia (PASH)
Lactating adenoma (unlikely in elderly)
Granulomatous mastitis (rare)

2. High-Risk / Pre-Malignant Lesions:

Atypical ductal hyperplasia (ADH)
Atypical lobular hyperplasia (ALH)
Lobular carcinoma in situ (LCIS)
Flat epithelial atypia
Radial scar / Complex sclerosing lesion

3. Malignant Lesions:

Invasive ductal carcinoma (IDC) (most common)
Invasive lobular carcinoma (ILC)
Ductal carcinoma in situ (DCIS)
Mucinous (colloid) carcinoma (more common in older women)
Tubular carcinoma
Medullary carcinoma (rare in elderly)
Metaplastic carcinoma
Inflammatory breast cancer (if associated with erythema/edema)
Sarcomas (phyllodes tumor, angiosarcoma)
Lymphoma (rare but possible in elderly)

In a geriatric patient, malignant diagnoses, particularly invasive ductal carcinoma (IDC), are the most common. Mucinous carcinoma and tubular carcinoma also have higher prevalence in elderly women.

Would you like a deeper dive into any particular diagnosis?

Next Pivotal Assessment	Finding
Core Needle Biopsy (CNB Standard for diagnosing solid breast masses.

Next Pivotal Assessment

Finding

Core Needle Biopsy (CNB

Standard for diagnosing solid breast masses.