Simple rules for ultrasonographic subcategorization of BI-RADS®-US 4 breast masses

Jales, Rodrigo Menezes; Sarian, Luís Otávio; Torresan, Renato Zocchio; Marussi, Emílio Francisco; Álvares, Beatriz Regina; Derchain, Sophie

doi:10.1016/j.ejrad.2013.02.032

Cited by 27 publications

(16 citation statements)

References 13 publications

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“…When malignancy is not obvious, most doctors err on the side of caution and choose a lower rather than a higher category, which explains why PPVs for subcategories 4a and 4b are a little higher. Because there are no clear divisions in category 4, some radiologists have established simple rules for subclassification in their research (Jales et al 2013), trying to improve the consistency of subcategories 4a-4c, to change the condition of no specific rules. They obtained PPVs of 17%, 45% and 85%, respectively, for these subcategories, somewhat close to the theoretical values.…”

Section: Discussionmentioning

confidence: 99%

“…If the hypothesis of our study that subcategories 4a and 4b do not reflect well the likelihood of malignancy is in general use, with moderate inter-observer agreement for subcategories 4a-4c, the popularization of subclassification needs to be discreet. Although the research on simple rules for subcategorization provides a good orientation for the subsequent exploration (Jales et al 2013), its availability requires more clinical practice and in-depth research to confirm. On the other hand, subclassification does not essentially change management: core biopsy or surgical excision is necessary for lesions in category 4 or 5 as the clinical routine.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions

Wang

Lan

et al. 2016

Ultrasound in Medicine & Biology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions

Wang

Lan

et al. 2016

Ultrasound in Medicine & Biology

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“…As a third factor, the criteria defining the BI-RADS 4A masses are not well-defined. We used our internal criteria with reference to the study of Jales et al (14) and it might not be compatible with other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Although in our routine practice the recommendation for BI-RADS 3 masses is short interval follow-up, for some of those masses biopsy was recommended by the radiologist or referring clinician due to presence of some relative risk factors such as palpability, large size of the mass, advanced age, or positive family history for breast cancer or patient preference. Breast masses with BI-RADS 3 sonographic features except for nonparallel orientation or irregular shape or microlobulated margin or exuberant vascularity were classified as BI-RADS 4A (14).…”

Section: Analysis Of Mammography and Us Findingsmentioning

confidence: 99%

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

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T he Breast Imaging Reporting and Data Systems (BI-RADS) lexicon (1) of AmericanCollege of Radiology (ACR) provides an efficient and standardized assessment and management of breast lesions. It also stratifies breast cancer risk for a given lesion by classifying them into categories 1 through 5 according to the degree of suspicion.According to this system, solid masses with a circumscribed margin, oval shape (including those with two or three gentle lobulations) and parallel orientation on ultrasonography (US) exam are classified as BI-RADS 3. These types of masses are commonly seen at diagnostic and screening examinations. In this category malignancy is highly unlikely (less than 2%) and a short interval follow-up is recommended (1). However, up to one-third of such masses undergo biopsy mainly because of radiologist, referring clinician, or patient concern about the substantial risk of malignancy (2-4). Many BI-RADS 3 masses are traditionally referred for biopsy if they are palpable, large in size, patient is of advanced age or has a positive family history for breast cancer.The BI-RADS 4 assessment is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. This category is largely indeterminate and highly variable in outcome. Breast lesions in this category carry 2% to 95% risk for malignancy (1). Thus, almost all recommendations for breast biopsies come from assessments made using this category. According to BI-RADS classification; category 4 is subgrouped as 4A, 4B, and 4C to better inform the clinicians, pathologists, and patients of the degree of concern. However, the criteria for distinguishing among these subcategories have not been well delineated. BI-RADS 4A designates lesions with a low suspicion for malignancy. In this group, a benign pathologic diagnosis is expected and considered concordant (1). Studies of several institutions by the use of their internal criteria revealed positive predictive value (PPV) of 7%-9% for 4A lesions, and more than 50% of the suspicious lesions fall into this category. On the other hand, BI-RADS 4B and 4C 287From the Department of Radiology (S.K.  sibel_ozy@ yahoo.com) Karadeniz Technical University, School of Medicine, Trabzon, Turkey. BREAST IMAGING ORIGINAL ARTICLE PURPOSE We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates. METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging charact...

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“…In a 2013 study performed by Jales et al, 339 patients were evaluated by three experienced radiologists [12], who assessed the patients’ ultrasound data using BI-RADS criteria, and then compared the BI-RADS results with the pathology results. The rate of malignancy in BI-RADS Groups 4A, 4B and 4C was 20%, 38% and 79%, respectively, according to the first radiologist.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinicopathological findings among patients whose mammography results were classified as category 4 subgroups of the BI-RADS

Leblebici

Bozkurt

Eren

et al. 2014

North Clin Istanbul

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OBJECTIVE:Our aim is to compare mammographic, demographic and clinicopathological characteristics of patients whose mammographies were classified as subgroups of BI-RADS 4 category (Breast Imaging – Reporting and Data System).METHODS:In total, 103 patients with mammography (Senographe 600t Senix HF; General Electric, Moulineaux, France) results classified as BI-RADS 4 were included in the study. Demographic data (age, menopause, and family history) were recorded. All data were compared among BI-RADS 4 subgroups.RESULTS:In all, 68.9% (71/103), 7.8% (8/103) and 23.3% (24/103) the patients were in groups BI-RADS 4A, 4B and 4C, respectively. The incidence of malignancy was higher in Groups 4B and 4C than in Group 4A (p<0.05), but similar in Groups 4B and 4C (p>0.05). Mean age was lower in Group 4B than in Groups 4A and 4C (p<0.05). A positive family history was more common in Group 4A than in Group 4B (p=0.025). The frequency of menopausal patients was greater in Groups 4A and 4C than in Group 4B (p=0.021, and 0.003, respectively).METHODS:The rate of malignancy was higher in Groups 4B, and 4C than in Group 4A. A positive family history was more common in Group 4A than in Group 4C. Groups 4A, and 4C patients tended to be older and were more likely to be menopausal than Group 4B patients.

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Simple rules for ultrasonographic subcategorization of BI-RADS®-US 4 breast masses

Cited by 27 publications

References 13 publications

Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions

Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Comparison of clinicopathological findings among patients whose mammography results were classified as category 4 subgroups of the BI-RADS

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