J Surg Ultrasound.  2020 Nov;7(2):55-61. 10.46268/jsu.2020.7.2.55.

Predictive Value of BI-RADS Category 4A and 4B Lesions Detected on Breast Ultrasonography: Single Center Experience

• Kim EY
• Bae HS
• Lee SR
• Yun Js
• Park YL
• Park CH

• KMID: 2511905
• DOI: http://doi.org/10.46268/jsu.2020.7.2.55

Abstract

Purpose
The malignancy rates within the Breast Imaging Reporting and Data System (BI-RADS) category 4a and 4b lesions were examined, and the correlations with the histopathology results were analyzed. In addition, the positive predictive value (PPV) and clinical utility of BIRADS category 4a and 4b lesions for predicting a malignancy were assessed.
Methods
From January 2017 to December 2019, patients with BI-RADS category 4a and 4b lesions on breast ultrasonography (US) who underwent a subsequent core needle biopsy in the authors’ institution were evaluated. The clinical, pathological, and sonographic features were assessed to identify the malignancy rate and pathologic factors predictive of malignancy. The sensitivity, specificity, PPV, and negative predictive value (NPV) were calculated. A Binary logistic regression test was used to estimate the odds ratio (OR) and 95% confidence interval (CI).
Results
The study population included 314 lesions in 275 patients (mean age, 45.3 years; range, 21–78 years). The overall malignancy rate was 9.8% (31 of 314). The malignancy rates among the BI-RADS category 4a and 4b lesions were 9.3% (28 out of 300) and 21.4% (3 out of 14), respectively. Compared to the well-defined margins, ill-defined margins were associated with an increased risk of breast cancer with a corresponding OR (95% CI) of 1.880 (1.304-2.554). The sensitivity, specificity, PPV, and NPV of the C4a and C4b lesions were as follows: 90.3%, 3.9%, 9.4%, and 78.6%, respectively, for C4a lesions and, 9.7%, 96.1%, 21.4%, and 90.6%, respectively, for C4b lesions. Only the equivocal elasticity on ultrasonography was associated with an increased risk of breast cancer with an OR (95% CI) of 2.357 (1.004-5.532).
Conclusion
BI-RADS categories 4a and 4b are useful for predicting malignancy. Nevertheless, further studies will be needed to identify more predictive factors for breast cancer.

Keyword

Breast imaging reporting data system; Breast neoplasm; Ultrasonography

Figure

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  Fig. 1 An asymptomatic 40-year-old woman presented for breast USG. (A) USG revealed a 5-mm oval mass with ill-defined margins on her right upper outer quadrant. (B) Elastography showed equivocal elasticity. (C) The lesion demonstrated increased vascularity on color Doppler USG. The mass was categorized as BI-RADS category 4a. Pathology showed multifocal microinvasive carcinoma. The size of invasive component was 300 µm and the in situ component was 40 mm.

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  Fig. 2 A 53-year-old woman pre-sented for routine check-up. (A) USG showed an approximately 10-mm hypoechoic mass with ill-defined margins on her right upper outer breast. (B) Elastography revealed positive elasticity results. The mass was assessed as BI-RADS category 4b and histopathology confirmed micro-invasive carcinoma. The size of inva-sive component was 480 μm and the in situ component was 75 mm.

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