A New Practical Decision Rule to Better Differentiate BI-RADS© 3 or 4 Breast Masses on Breast Ultrasound.

A New Practical Decision Rule to Better Differentiate BI-RADS© 3 or 4 Breast Masses on Breast Ultrasound.

Pfob A; Barr RG; Duda V; Büsch C; Bruckner T; Spratte J; Nees J; Togawa R; Ho C; Fastner S; Riedel F; Schaefgen B; Hennigs A; Sohn C; Heil J; Golatta M

Journal Of Ultrasound In Medicine

2021

2021-05-04

Objectives: The BI-RADS© classification provides a standardized way to describe ultrasound findings in breast cancer diagnostics. However, there is little information regarding which BI-RADS© descriptors are most strongly associated with malignancy, to better distinguish BI-RADS© 3 (follow-up imaging) and 4 (diagnostic biopsy) breast masses.; Methods: Patients were recruited as part of an international, multicenter trial (NCT02638935). The trial enrolled 1294 women (6 excluded) categorized as BI-RADS© 3 or 4 upon routine B-mode ultrasound examination. Ultrasound images were evaluated by three expert physicians according to BI-RADS©. All patients underwent histopathological confirmation (reference standard). We performed univariate and multivariate analyses (chi-square test, logistic regression, and Krippendorff's alpha).; Results: Histopathologic evaluation showed malignancy in 368 of 1288 masses (28.6%). Upon performing multivariate analysis, the following descriptors were significantly associated with malignancy (P < .05): age ≥50 years (OR 8.99), non-circumscribed indistinct (OR 4.05) and microlobulated margin (OR 2.95), nonparallel orientation (OR 2.69), and calcification (OR 2.64). A clinical decision rule informed by these results demonstrated a 97% sensitivity and missed fewer cancers compared to three physician experts (range of sensitivity 79-95%) and a previous decision rule (sensitivity 59%). Specificity was 44% versus 22-83%, respectively. The inter-reader reliability of the BI-RADS© descriptors and of the final BI-RADS© score was fair-moderate.; Conclusions: A patient should undergo a diagnostic biopsy (BI-RADS© 4) instead of follow-up imaging (BI-RADS© 3) if the patient is 50 years or older or exhibits at least one of the following features: calcification, nonparallel orientation of mass, non-circumscribed margin, or posterior shadowing. (© 2021 The Authors. Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

BI-RADS; breast mass; decision rule; malignancy; reliability; ultrasound; BI-RADS; breast mass; decision rule; malignancy; reliability; ultrasound

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

journalArticle

1550-9613

NEOMED College of Medicine

Department of Radiology

May 2021 List