title: Breast ultrasound diagnostic performance and outcomes for mass lesions using Breast Imaging Reporting and Data System category 0 mammogram.
abstract: OBJECTIVE
  To evaluate the outcomes and diagnostic performance of ultrasonography after a Breast Imaging Reporting and Data System (Bi-RADS) category 0 mammogram.
  
  
  METHODS
  This retrospective study reviewed 4,384 consecutive patients who underwent a screening mammography from January 2005 to July 2006; 391 of the 4,384 exams were classified as Bi-RADS category 0. After exclusions, 241 patients received subsequent sonogram. Ultrasonography was considered diagnostic when the Bi-RADS category was changed to 2, 4, or 5, and it was considered indeterminate (Bi-RADS 3) when the results indicated that the patients should return for a mammographic follow-up. The outcomes of these patients were assessed to evaluate the diagnostic performance of ultrasonography.
  
  
  RESULTS
  The mean age of the patients was 53.3 years (ranging from 35 to 81). Of the 241 patients, ultrasonography was considered diagnostic in 146 (60.6%) patients and indeterminate in 95 (39.4%) patients. In the diagnostic group, 111 out of 146 patients (70.2%) had a sonogram result of Bi-RADS category 2 after a 2-year follow-up without evidence of malignancy. Furthermore, 35 out of 146 patients (29.8%) had a suspicious sonogram with a result of Bi-RADS category 4. After a tissue sampling procedure, 10 patients were confirmed to have breast cancer, and 25 had benign histopathological features without any evidence of malignancy after a 2-year follow-up. The sensitivity of ultrasonography was 100%, specificity was 89.1%, and overall accuracy was 89.6%.
  
  
  CONCLUSIONS
  Based on the degree of resolution and its diagnostic performance, ultrasonography was determined to be an excellent method for the subsequent evaluation of Bi-RADS 0 mammograms.
authors.affiliation: Diagnostic Imaging Division, Internal Medicine Department, School of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil.
authors.forename: Paulo Almazy
authors.initials: PA
authors.lastname: Zanello
authors.forename: Andre Felipe Cica
authors.initials: AF
authors.lastname: Robim
authors.forename: Tatiane Mendes Gonçalves de
authors.initials: TM
authors.lastname: Oliveira
authors.forename: Jorge
authors.initials: J
authors.lastname: Elias Junior
authors.forename: Jurandyr Moreira de
authors.initials: JM
authors.lastname: Andrade
authors.forename: Carlos Ribeiro
authors.initials: CR
authors.lastname: Monteiro
authors.forename: Joaquim Moraes
authors.initials: JM
authors.lastname: Sarmento Filho
authors.forename: Helio Humberto Angotti
authors.initials: HH
authors.lastname: Carrara
authors.forename: Valdair Francisco
authors.initials: VF
authors.lastname: Muglia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002277:Carcinoma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*