Pathological and radiological assessment of benign breast lesions with BIRADS IVc/V subtypes - should we repeat the biopsy?

Sep 23, 2026

Timely diagnosis is critical for reducing breast-cancer mortality. BI-RADS categories IVc and V reflect strong suspicion of malignancy, yet some benign lesions can mimic cancer radiologically, making repeat or confirmatory sampling a concern. This retrospective cross-sectional study reviewed needle core/stereotactic vacuum-assisted biopsies of lesions reported as BI-RADS IVc or V and analyzed benign cases, comparing radiological descriptors with a matched malignant control.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

Background

Rjoop etal. BMC Women's Health (2025) 25:47 BMC Women's Health [https://doi.org/10.1186/s12905-025-03569-7](https://doi.org/10.1186/s12905-025-03569-7) RESEARCH Open Access Pathological and radiological assessment of benign breast lesions with BIRADS IVc/V subtypes. should we repeat the biopsy? Wesam Rjoop 1, Anwar Rjoop2*, Alia Almohtaseb2, Lama Bataineh2, Zeina Nser Joubi3, Maha Gharaibeh3, Abdalrahman Al-Qwabah3, Yousef Alasheh4 and Ismail Matalka5 Abstract Background Timely diagnosis is a crucial factor in decreasing the death rate of patients with breast cancer. BI-RADS categories IVc and V indicate a strong suspicion of cancer. The categorisation of each group is determined by the characteristics of the lesion. Certain benign breast lesions might have radiological features indicative of malignancy; thus, biopsy is mandatory. This study aimed to identify the histopathological diagnosis of benign breast masses classified into BIRADS IVc and V subgroups, investigate the radiological characteristics of these masses, and identify ultrasound features that could lead to false positive results (benign lesions that mimic malignancy on imaging) . Methods This was a retrospective cross-sectional study at a single facility. Breast lesions reported as BIRADS IVc and V that underwent needle core/stereotactic vacuum-assisted biopsy were reviewed. Patients with benign pathologic diagnoses were analysed, delineating pathological diagnoses. Radiological descriptors were compared to those of a matched control of 50 malignant cases with BIRADS IVc. Results A total of 828 breast lesions classified as BIRADS IVc or V were detected during the period spanning from 2015 to 2022. Forty-four lesions (44/828, 5 . 3%) were benign at initial biopsy, while 784 lesions (784/828, 94 . 7%) were malignant. After histopathological testing and repeat biopsy, 26/828 (3 . 14%) patients had discordant benign diagnosis. Half of the repeated biopsies (10/20, 50%) showed malignant pathology. Compared to that in the control group, the presence of an oval shape of the mass was significantly more common in patients with benign pathology (p = 0 . 035) . Conversely, the presence of posterior shadowing was significantly less common (p = 0 . 050) in benign lesions. No significant differences were observed for the other radiological characteristics. The most common histopathological diagnosis was fibrocystic change. Conclusion This study highlights key findings regarding the sonographic imaging descriptors and histopathological diagnoses of benign breast lesions categorised as BIRADS IVc/V. The study recommends a correlation between clinical and radiological findings and encourages multidisciplinary decision-making among radiologists, pathologists, and clinicians to determine if a repeat biopsy is warranted. There is a need for continuous research to improve the diagnosis and treatment of breast lesions and reduce false-positive rates by incorporating other methodologies such *Correspondence: Anwar Rjoop [anwarrjoop@gmail.com](anwarrjoop@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory reg

FAQs

Why are BI-RADS IVc and V categories important in breast lesion assessment?

BI-RADS IVc and V indicate a strong suspicion of cancer based on lesion characteristics on imaging. Their high malignancy probability means biopsy is typically mandatory to clarify diagnosis.

What did the study find about benign lesions initially diagnosed from BI-RADS IVc/V biopsies?

Among 828 lesions classified as BI-RADS IVc or V, 44 were benign at initial biopsy. After histopathological testing and repeat biopsy, 26/828 had discordant benign diagnoses, and half of the repeated biopsies in that subset showed malignant pathology.

Which ultrasound descriptors differed between benign and malignant cases in the comparison?

An oval mass shape was significantly more common in benign pathology, while posterior shadowing was significantly less common in benign lesions. Other radiological characteristics showed no significant differences.

Sep 23, 2026

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