title: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation.
abstract: OBJECTIVE
  We aimed to evaluate ultrasonography (US) findings for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions using BI-RADS US lexicon and determine the positive and negative predictive values (PPV and NPV) of US with respect to biopsy results.
  
  
  METHODS
  Sonograms of 186 BI-RADS 4 nonpalpable breast lesions with a known diagnosis were reviewed retrospectively. The morphologic features of all lesions were described using BI-RADS lexicon and the lesions were subcategorized into 4A, 4B, and 4C on the basis of the physician's level of suspicion. Lesion descriptors and biopsy results were correlated. Pathologic results were compared with US features. PPVs of BI-RADS subcategories 4A, 4B, and 4C were calculated.
  
  
  RESULTS
  Of 186 lesions, 38.7% were malignant and 61.2% were benign. PPVs according to subcategories 4A, 4B, and 4C were 19.5%, 41.5%, and 74.3%, respectively. Microlobulated, indistinct, and angular margins, posterior acoustic features, and echo pattern were nonspecific signs for nonpalpable BI-RADS 4 lesions. Typical signs of malignancy were irregular shape (PPV, 66%), spiculated margin (PPV, 80%) and nonparallel orientation (PPV, 58.9%). Typical signs of benign lesions were oval shape (NPV, 77.1%), circumscribed margin (NPV, 67.5%), parallel orientation (NPV, 70%), and abrupt interface (NPV, 67.6%).
  
  
  CONCLUSIONS
  BI-RADS criteria are not sufficient for discriminating between malignant and benign lesions, and biopsy is required. Subcategories 4A, 4B, and 4C are useful in predicting the likelihood of malignancy. However, objective and clear subclassification rules are needed.
authors.affiliation: Department of Radiology, Numune Training and Research Hospital, Ankara, Turkey. edayavuz@hotmail.com.
authors.forename: Eda
authors.initials: E
authors.lastname: Elverici
authors.forename: Ayşe Nurdan
authors.initials: AN
authors.lastname: Barça
authors.forename: Hafize
authors.initials: H
authors.lastname: Aktaş
authors.forename: Arzu
authors.initials: A
authors.lastname: Özsoy
authors.forename: Betül
authors.initials: B
authors.lastname: Zengin
authors.forename: Mehtap
authors.initials: M
authors.lastname: Çavuşoğlu
authors.forename: Levent
authors.initials: L
authors.lastname: Araz
mesh_terms: D000328:Adult; D001706:Biopsy; D001941:Breast Diseases / Q000473:pathology* / Q000652:urine*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D018226:Fibroadenoma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012984:Software; D016217:Ultrasonography, Mammary / Q000379:methods
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