Rationale and Objectives
The objective of this study was to evaluate the utility of the fifth edition of the
Breast Imaging-Reporting and Data System (BI-RADS) in clinical breast radiology by
using prospective multicenter real-time analyses of ultrasound (US) images.
Materials and Methods
We prospectively studied 2049 female patients (age range, 19-86 years; mean age 46.88
years) with BI-RADS category 4 breast masses in 32 tertiary hospitals. All the patients
underwent B-mode, color Doppler US, and US elastography examination. US features of
the mass and associated features were described and categorized according to the fifth
edition of the BI-RADS US lexicon. The pathological results were used as the reference
standard. The positive predictive values (PPVs) of subcategories 4a-4c were calculated.
Results
A total of 2094 masses were obtained, including 1124 benign masses (54.9%) and 925
malignant masses (45.1%). For BI-RADS US features of mass shape, orientation, margin,
posterior features, calcifications, architectural distortion, edema, skin changes,
vascularity, and elasticity assessment were significantly different for benign and
malignant masses (p< 0.05). Typical signs of malignancy were irregular shape (PPV, 57.2%), spiculated
margin (PPV, 83.7%), nonparallel orientation (PPV, 63.9%), and combined pattern of
posterior features (PPV, 60.6%). For the changed or newly added US features, the PPVs
for intraductal calcifications were 80%, 56.4% for internal vascularity, and 80% for
a hard pattern on elastography. The associated features such as architectural distortion
(PPV, 89.3%), edema (PPV, 69.2%), and skin changes (PPV, 76.2%) displayed high predictive
value for malignancy. The rate of malignant was 7.4% (72/975) in category 4a, 61.4%
(283/461) in category 4b, and 93.0% (570/613) in category 4c. The PPV for category
4b was higher than the likelihood ranges specified in BI-RADS and the PPVs for categories
4a and 4c were within the acceptable performance ranges specified in the fifth edition
of BI-RADS in our study.
Conclusion
Not only the US features of the breast mass, but also associated features, including
vascularity and elasticity assessment, have become an indispensable part of the fifth
edition of BI-RADS US lexicon to distinguish benign and malignant breast lesions.
The subdivision of category 4 lesions into categories 4a, 4b, and 4c for US findings
is helpful for further assessment of the likelihood of malignancy of breast lesions.
Key Words
Abbreviations:
BI-RADS (Breast Imaging-Reporting and Data System), ACR (American College of Radiology), US (ultrasound), MRI (magnetic resonance imaging), PPV (positive predictive value), ROC (receiver operating characteristic), AUC (the area under the curve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 04, 2020
Accepted:
June 24,
2020
Received in revised form:
June 17,
2020
Received:
May 13,
2020
Identification
Copyright
© 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
