ORIGINAL ARTICLE PURPOSE We aimed to evaluate ultrasonography (US) findings for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions using BI-RADS US lexicon and determine the positive and negative predictive values (PPV and NPV) of US with respect to biopsy results. METHODSSonograms of 186 BI-RADS 4 nonpalpable breast lesions with a known diagnosis were reviewed retrospectively. The morphologic features of all lesions were described using BI-RADS lexicon and the lesions were subcategorized into 4A, 4B, and 4C on the basis of the physician's level of suspicion. Lesion descriptors and biopsy results were correlated. Pathologic results were compared with US features. PPVs of BI-RADS subcategories 4A, 4B, and 4C were calculated. RESULTSOf 186 lesions, 38.7% were malignant and 61.2% were benign. PPVs according to subcategories 4A, 4B, and 4C were 19.5%, 41.5%, and 74.3%, respectively. Microlobulated, indistinct, and angular margins, posterior acoustic features, and echo pattern were nonspecific signs for nonpalpable BI-RADS 4 lesions. Typical signs of malignancy were irregular shape (PPV, 66%), spiculated margin (PPV, 80%) and nonparallel orientation (PPV, 58.9%). Typical signs of benign lesions were oval shape (NPV, 77.1%), circumscribed margin (NPV, 67.5%), parallel orientation (NPV, 70%), and abrupt interface (NPV, 67.6%). CONCLUSION BI-RADS criteria are not sufficient for discriminating between malignant and benign lesions, and biopsy is required. Subcategories 4A, 4B, and 4C are useful in predicting the likelihood of malignancy. However, objective and clear subclassification rules are needed.A dvancements in ultrasonography (US) equipment has significantly increased the value of US in breast imaging (1). Especially in women under the age of 50, detection of mammographically occult masses by US has increased up to 27% (1, 2). With the increasing use of US in routine breast imaging, in 2003 the American College of Radiology developed the first version of Breast Imaging Reporting and Data System (BI-RADS) US lexicon in order to standardize breast lesion characterization with US, as with mammography (3). In 2013, the second version of BI-RADS US lexicon was published in the fifth edition of BI-RADS atlas (4). The first version of BI-RADS US lexicon included shape, orientation, margins, lesion boundary, echo pattern, posterior acoustic features, and surrounding tissue alterations as descriptors (1-3, 5-8). The changes were minimal in the second version of BI-RADS US lexicon, with no changes in shape, orientation, margin, and feature descriptors; however, lesion boundary was removed. There were some differences in the nomenclature such as "posterior features" instead of "posterior acoustic features," and "associated features" instead of "surrounding tissue alterations." In the second version, "elasticity assessment" was added among the associated features and heterogeneous term was added to its echo pattern. Macrocalcification was removed from calcifications terminology, but intraductal was added (4)...

BackgroundBI-RADS was first developed in 1993 for mammography and in 2003 it was redesigned for ultrasonography (US). If the observer agreement is high, the method used in the classification of lesion would be reproducible.ObjectivesThe aim of this study is to evaluate the inter- and intraobserver agreement of sonographic BI-RADS lexicon in the categorization and feature characterization of nonpalpable breast lesions.Patients and MethodsWe included 223 patients with 245 nonpalpable breast lesions who underwent ultrasound-guided wire needle localization. Two radiologists retrospectively described each lesion using sonographic BI-RADS descriptors and final assessment. The observers were blinded to mammographic images, medical history and pathologic results. Inter- and intraobserver agreement was assessed using Kappa (κ) agreement coefficient.ResultsThe interobserver agreement for sonographic descriptors changed between fair and substantial. The highest agreement was detected for mass orientation (κ=0.66). The lowest agreement was found in the margin (κ=0.33). The interobserver agreement for BI-RADS final category was found as fair (κ=0.35). The intraobserver agreement for sonographic descriptors changed between substantial and almost perfect. The intraobserver agreement of BI-RADS result category was found as substantial for observer 1 (κ=0.64) and excellent for observer 2 (κ=0.83).ConclusionOur results demonstrated that each observer was self-consistent in interpreting US BI-RADS classification, while interobserver agreement was relatively poor. Although it has been ten years since the description of sonographic BI-RADS lexicon, further training and periodic performance evaluations would probably help to achieve better agreement among radiologists.

Congenital bladder diverticula are strongly associated with vesicoureteral reflux (VUR), and are mostly present in childhood. The most common symptom is urinary tract infection at the time of admission. The diverticulum is usually solitary and its location is near the ureteral orifice, which is probably the main cause of VUR. We report a woman who presented with a vaginal mass located on the right inferior part of the external urethral meatus. The patient had a history of recurrent urinary tract infection and right nephrectomy due to VUR nephropathy. We examined her with cystography, computerized tomography, and cystoscopy. The cystoscopic examination was very diagnostic in our patient. The patient underwent diverticulectomy, and after 6 months of followup, her complaints had completely disappeared.

This study was planned to see the results of follow-up of ovarian cysts in newborn patients at a university hospital.Methods: Newborns with ovarian cysts that were diagnosed by US between 2010 and 2018 were retrospectively evaluated. US follow-up was performed in 2 to 3 month periods. Initial largest diameter of the ovarian cyst, number of cysts, bilateral or unilateral localization, if the cyst is complex or simple, alpha fetoprotein and β-HCG levels, if operated the type of the operation and pathology results were retrieved.Results: Nineteen patients were included. Seven patients had ovarian cysts ≥20 mm and 5 were complex cysts. Two of 5 complex cysts were operated for abdominal mass and ovarian torsion was diagnosed. Other 3 complex cysts are having a conservative treatment due to lack of any clinical symptoms. All regressed in size. All simple cysts had non-operative management and regressed in size during follow-up. AFP levels were high in all. Control AFP levels decreased in all patients.Conclusion: Conservative management seems appropriate for patients both with complex or simple cysts, because nearly all cysts were regressed and both ovaries persisted during follow-up. Surgical decision was the clinical presence of a mass in complex cysts. This is a small series and follow-up is short to make a final decision for management. A consensus is needed among the surgeons about the treatment options after discussing the complications related to conservative and surgical approaches of complex ovarian cysts.

Objective: To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of sonographic Breast-Imaging Reporting and Data System (BI-RADS) final assessment categories for nonpalpable breast lesions. Materials and Methods:Between January 2008 and 2011, a total of 245 nonpalpable breast lesions (223 patients) that had undergone excisional biopsy after ultrasound-guided wire needle localization in our clinic were evaluated retrospectively. Eight patients excluded from the study because we could not find the pathology results for them. Two hundred and thirty-seven lesions in 215 patients were included in the study. Lesion evaluation was done with a high resolution Logiq 7 USG device (General Electrics) by using a 10-14 MHz linear probe before ultrasound-guided wire needle localization. Static image records were evaluated by two expert radiologists on breast imaging without the knowledge of clinical information, mammographic images and pathologic results of the patients. The radiologists determined the most appropriate BI-RADS category for each lesion. The diagnostic performance of BI-RADS category was compared with the final pathology of the patient by using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results: Of the 237 lesions, 49 (20.6%) were malignant, 43 (18.1%) were high-risk atypical lesions and 145 (61.1%) were benign. Sensitivity and NPV were 100% for both radiologists, while specificity was 20.7% and 30.3%; PPV was 24.7% and 27.2%, respectively. When evaluation was done for BI-RADS subcategories; PPV for BI-RADS 4 was 15.6% and 22.8% (5.6% and 9.3% for 4; 17.6% and 24.3% for 4b; 40.6% and 66.7% for 4c); for BI-RADS 5 PPV was 66.7% and 84.6%. Conclusion