## 4 Discussion
This result is in line with the current literature in the general population [18; 19]. These findings enhance the fact that some radiological features help in deciding further management after a B3 needle core biopsy diagnosis in mutation carrier patients. Parenchymal distortion was present in 28% of lesions, and was more often associated with ADHs and RSs. Among them, 66.7% were upgraded to cancer (three ADHs and one RS), and more specifically, three were BRCA1 mutation carriers and one ATM. BRCA1 mutation carrier patients were most often correlated with cancer evolution by histology. The ultrasound detected 13/21 lesions. The most common finding of the BRCA1, BRCA2 and ATM groups included hypoechoic masses with an irregular shape, parallel orientation and non-circumscribed margins. These results are in line with the study of [PERSON] et al., who described 95 of 99 (96.0%) BRCA1 and 102 of 103 (99.0%) BRCA2 lesions detected at sonography as characterized by hypoechoic lesions with an irregular shape, non-circumscribed margins and a parallel orientation in both groups. In their series, the authors described a higher frequency of posterior acoustic enhancements in the BRCA1 group, a finding not encountered in our sample, as the majority of B3 lesions identified by US were LNs and RSs, with one case of FEA and two cases of ADH only, which did not demonstrate a posterior acoustic shadowing. According to MRI, there was no significant difference between the three groups in the proportion of mass versus non-mass lesions, mass shapes and non-mass features. In the BRCA1 group, mass lesions tended to exhibit more circumscribed margins compared to the BRCA2 and ATM groups, but without evidence of a significant difference. Additionally, in the study by [PERSON] et al., BRCA1 mutation carriers tended to show more regular lesions in comparison to the BRCA2 group [20]. In our study, the upgrade was more often associated with a mass-like lesions, with a significant correlation with the risk of malignancy; in particular, the upgrade was characterized by ADH and LN lesions. This result is in line with some previous studies in the general population, which found a significant correlation between malignancy and mass-like lesions with a lower risk in the case of non-mass-like lesions [17; 19]. In all cases appearing as mass lesions, ADHs showed almost regular margins and a positive DWI. When analyzing the MRI morphologic and functional features among the different B3 lesions groups and when comparing with the final post-operative histological examination, DWI and kinetic curves significantly correlated with the risk of carcinoma, suggesting that in the presence of a mass-like lesion with regular margins and mild enhancement, the functional information given by DWI and contrast enhancement can help in guiding the decision process. Our study has several limitations. Firstly, the small sample size resulted in only a few conclusions concerning significance. Second, the retrospective study design did not allow evaluation of the variables affecting the management of every single patient. Third, the lack of some B3 findings, such as papillary lesions, prevented a comprehensive evaluation of all B3 lesions and, in the end, the patients did not perform VAE prior to surgery because of the lack of equipment at the time of the examinations.