Journal of Korean Society of Ultrasound in Medicine 2009;28(4): 275-279.
Outcomes of US BI-RADS 4A, 4B, and 4C Lesions.
Jae Wang Shin, Eun Young Ko, Boo Kyung Han, Jung Hee Shin, Seok Seon Kang, Soo Yeon Hahn
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
  Published online: December 1, 2009.
PURPOSE: The aim of our study was to evaluate the outcomes of sonographic (US) BIRADS category 4 lesions according to subcategories 4A, 4B, and 4C and palpability. MATERIALS AND METHODS: We retrospectively reviewed the pathology results of 512 US BI-RADS category 4 lesions in 460 patients after ultrasound-guided percutaneous biopsy (n = 435) and surgical biopsy (n = 77). We analyzed the results according to subcategories 4A, 4B, 4C, and palpability, and compared outcomes of five breast radiologists. RESULTS: In BI-RADS 4A lesions (n = 302), biopsy results indicated 48 malignancies (15.9%). In BI-RADS 4B lesions (n = 113), biopsy revealed 69 malignancies (61.1%). Among BI-RADS 4C lesions (n = 97), 87 lesions were malignancies (89.7 %). Palpability had no correlation with the rate of malignancy in BI-RADS category 4 lesions, and the rate of malignancy for category 4A ranged widely from 8.1% - 26.4%. CONCLUSIONS: The outcomes of US BI-RADS category 4 lesions according to subcategories varied widely between radiologists, especially for 4A lesions. The US finding itself warrants a BI-RADS 4 subcategory. In category 4 lesions, the malignant rate was the same between palpable and nonpalpable lesions.
Keywords: Breast; BI-RADS, Inter-observer variability, Ultrasound (US)
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