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Published online before print July 22, 2008, 10.1148/radiol.2483071786
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(Radiology 2008;248:773-781.)
© RSNA, 2008

Breast Imaging

BI-RADS 3, 4, and 5 Lesions: Value of US in Management—Follow-up and Outcome1

Sughra Raza, MD, Sona A. Chikarmane, AB, Sarah S. Neilsen, DO, Lisa M. Zorn, MD, and Robyn L. Birdwell, MD

1 From the Department of Radiology, Brigham & Women's Hospital, 75 Francis St, Boston, MA 02115 (S.R., S.A.C., L.M.Z., R.L.B.); and Department of Radiology, Marshfield Clinic, Wausau, Wis (S.S.N.). From the 2006 RSNA Annual Meeting. Received October 10, 2007; revision requested November 27; final revision received January 9, 2008; accepted March 20; final version accepted April 10. Address correspondence to S.R. (e-mail: sraza1{at}partners.org).

Purpose: To evaluate the use, final outcome, and positive biopsy rate of American College of Radiology ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4, and 5 recommended for breast masses.

Materials and Methods: At US, consecutive masses, palpable and nonpalpable, categorized as BI-RADS 3, 4, and 5 between January 1, 2003, and December 31, 2004, were retrospectively reviewed with institutional review board approval. Medical records provided imaging and histologic information.

Results: After patients lost to follow-up were excluded, the study population was 767 patients with 926 masses (476 palpable, 450 nonpalpable). In BI-RADS 3 masses (n = 356), imaging follow-up of 252 masses documented stability for 6–24 months. Aspiration of 24 masses revealed cysts. Biopsy in 80 masses revealed three malignancies, all of which were diagnosed within 6 months of the index examination, were smaller than 1 cm, and were node negative (negative predictive value = 99.2%). In BI-RADS 4 masses (n = 524), aspiration results indicated 35 cysts; biopsy in 455 revealed 85 malignancies (positive predictive value [PPV] = 16.2%). Imaging follow-up only in 34 revealed no cancers 2 and more years later. Among BI-RADS 5 masses (n = 46), 43 were malignant and three benign (PPV = 93.4%).

Conclusion: Inconsistent use of BI-RADS category 3 occurred in 14.0% of cases when biopsy was recommended. Although biopsy was performed in almost equal numbers of palpable and nonpalpable masses, only 11% of palpable BI-RADS 3 and 4 masses were malignant, as compared with 22% of nonpalpable masses. Strict adherence to lexicon characteristics of probably benign lesions should improve specificity.

© RSNA, 2008