Correlation Between BI-RADS 4 Subcategories and Histopathological Outcomes in Mexican Women With Breast Lesions: A Retrospective Study of Lesion Laterality and Cancer Incidence
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: BI-RADS category 4 is subdivided into 4A, 4B, and 4C to convey increasing levels of suspicion for malignancy, yet reported predictive performance varies across settings. We evaluated how BI-RADS 4 subcategories relate to histopathological outcomes in Mexican women and explored whether age, lesion laterality, and imaging findings provide additional context for malignancy risk. MATERIALS and METHODS: This retrospective cross-sectional study included 173 women with BI-RADS 4 lesions evaluated by mammography and/or ultrasound, with subsequent histopathological confirmation. Cases were identified at the Hospital General de México between January 2023 and May 2024. Associations between BI-RADS subcategory and malignancy, as well as age, lesion laterality, and selected imaging features, were examined using chi-square tests and one-way ANOVA. RESULTS: Among 173 patients, 41.6% had BI-RADS 4A lesions, 35.8% had 4B lesions, and 22.5% had 4C lesions. Malignancy rates increased across subcategories: 7.5% (4A), 40.0% (4B), and 85.0% (4C) (p < 0.001). Mean age rose with BI-RADS level (42.1, 47.8, and 55.3 years for 4A, 4B, and 4C, respectively), although this trend did not reach statistical significance (p = 0.063). Nodules were the most frequent imaging finding (83.2%), and fibroadenoma was the most common benign diagnosis. Left-sided lesions were more frequently malignant (p = 0.034). DISCUSSION: In this cohort, BI-RADS 4 subcategorization separated malignancy risk in a clinically meaningful way. Lesion laterality showed an association with malignancy and may merit further evaluation as an adjunct variable in imaging audits. CONCLUSION: BI-RADS 4 subclassification corresponded to progressively higher malignancy rates, supporting its use for risk communication and biopsy prioritization. Incorporating histopathological outcomes with basic demographic and anatomic variables, such as laterality, may further strengthen local risk assessment strategies.
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7128960745