title: Ultrasound positive predictive values by BI-RADS categories 3-5 for solid masses: An independent reader study.
abstract: OBJECTIVE
  We assessed multiple readers' positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c and 5 masses on ultrasound (US) pre- and post-proposed guidelines.
  
  
  METHODS
  This retrospective, IRB-approved study included four American and four non-American readers who assigned BI-RADS categories for US images of 374 biopsy-proved masses. Readers were offered guidelines and re-classified the masses. We assessed readers' abilities to achieve ACR benchmarks BI-RADS categories pre- and post-guidelines.
  
  
  RESULTS
  PPVs increased with BI-RADS category. The PPVs pre- and post-guidelines were 6.0% and 4.4% for category 3, 27.3% and 30.5% for category 4a, 49.9% and 51.5% for category 4b, 69.0% and 67.4% for category 4c, and 79.3% and 80.1% for category 5. Readers achieved the PPV benchmark for category 4c, but not for categories 3, 4a, 4b and 5, with no significant improvement after guidelines. Regular BI-RADS 4 subcategory users missed benchmarks by less than non-regular users.
  
  
  CONCLUSIONS
  Pre- and post-guidelines, readers' PPVs increased with BI-RADS categories, ACR PPV benchmarks were achieved in category 4c, missed in other categories, especially in the critical 4a subcategory, where the PPV was too high. BI-RADS 4 subcategory users performed better than non-users.
  
  
  CONCLUSIONS
  • Readers failed to achieve benchmarks for BI-RADS 4 subcategories, especially 4a. • USA and Brazilian readers performed similarly in ACR BI-RADS 4 subcategorization. • Proposed guidelines did not improve overall, USA or Brazilian reader performance. • Regularly BI-RADS 4 subcategory users performed better than did non-users. • US features distinguished between benign and malignant, not BI-RADS 4 subcategories.
authors.affiliation: University of Texas Health Sciences Center, San Antonio, 6522 Camp Bullis Road, #5208, San Antonio, TX, 78256, USA. atstavros@gmail.com.
authors.forename: A Thomas
authors.initials: AT
authors.lastname: Stavros
authors.affiliation: Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910.
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Freitas
authors.affiliation: Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910.
authors.forename: Giselle G N
authors.initials: GGN
authors.lastname: deMello
authors.affiliation: Invision Sally Jobe Breast Centers and Radiology Imaging Associates, 8700 E. Belleview Ave., Suite 200E, Greenwood Village, CO, 80111, USA.
authors.forename: Lora
authors.initials: L
authors.lastname: Barke
authors.affiliation: Sutter Medical Group of the Redwoods Breast Imaging, 625 Steele Lane, Santa Rosa, CA, USA.|Sutter Medical Group, Sacramento, 1500 Expo Parkway, Sacramento, CA, 95815, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: McDonald
authors.affiliation: Invision Sally Jobe Breast Centers and Radiology Imaging Associates, 8700 E. Belleview Ave., Suite 200E, Greenwood Village, CO, 80111, USA.|Gloria Gossard Breast Health Center, 940 Central Park Drive, Steamboat Springs, CO, 80487, USA.
authors.forename: Terese
authors.initials: T
authors.lastname: Kaske
authors.affiliation: Invision Sally Jobe Breast Centers and Radiology Imaging Associates, 8700 E. Belleview Ave., Suite 200E, Greenwood Village, CO, 80111, USA.|Radiology, Section Chief Breast Imaging, University of Colorado Health Sciences Center, Aurora, CO, USA.
authors.forename: Ducly
authors.initials: D
authors.lastname: Wolverton
authors.affiliation: Sutter Medical Group of the Redwoods Breast Imaging, 625 Steele Lane, Santa Rosa, CA, USA.|Mercy Cedar Rapids, Department of Breast Imaging, 701 10th Street SE, Cedar Rapids, IA, 52403, USA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Honick
authors.affiliation: Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910.
authors.forename: Daniela
authors.initials: D
authors.lastname: Stanzani
authors.affiliation: Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910.
authors.forename: Adriana H
authors.initials: AH
authors.lastname: Padovan
authors.affiliation: Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910.
authors.forename: Ana Paula C
authors.initials: APC
authors.lastname: Moura
authors.affiliation: Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910.
authors.forename: Marilia C V
authors.initials: MCV
authors.lastname: de Campos
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary / Q000379:methods
keywords: Breast cancer; Breast neoplasms; Breast ultrasonography; Diagnostic, imaging; Tumours, breast