PT  - JOURNAL ARTICLE
AU  - Ghunaim, Hadeel A.
AU  - Alatawi, Rana E.
AU  - Borhan, Walaa M.
AU  - Daqqaq, Tareef S.
AU  - Alhasan, Ayman S.
AU  - Aboualkheir, Mervat M.
AU  - Elkady, Reem M.
TI  - Accuracy of imaging of BI-RADS 4 subcategorizations in breast lesion diagnosis
AID  - 10.15537/smj.2024.45.11.20240001
DP  - 2024 Nov 01
TA  - Saudi Medical Journal
PG  - 1228--1237
VI  - 45
IP  - 11
4099  - http://smj.org.sa/content/45/11/1228.short
4100  - http://smj.org.sa/content/45/11/1228.full
SO  - Saudi Med J2024 Nov 01; 45
AB  - Objectives: To correlate breast imaging-reporting and data system (BI-RADS) category 4 lesions with histopathology results to assess the accuracy of subcategorization.Methods: A retrospective study was carried out from September 2021 to June 2022. A total of 247 breast lesions were reviewed categorized as BI-RADS 4 using ultrasound (US) and digital mammography. Feature analysis of the lesions were obtained using BI-RADS terminology and assigned to subcategories (4A, 4B, and 4C). Pathological analysis was carried out on tissue obtained through US-guided core biopsy. A p-value of <0.05 was considered significant.Results: Of the 247 lesions, 135 were categorized as subcategory 4A, 68 as 4B, and 44 as 4C. Overall, 41 (16.6%) had malignant lesions, while 206 (83.4%) had benign lesions. The mean age of the patients with benign versus malignant lesions was (43.18±14.02 vs. 51.24±14.15 years; p<0.001). Mean size of benign versus malignant lesions was (1.93±1.65 vs. 3.82±3.89 cm; p<0.001). Findings were compared with histopathology, and the positive predictive value fell within the reference range for subcategories 4C (>70%). High reliability was observed between the 2 readers, with a weighted Cohen’s Kappa value of 0.79 (0.73-0.85). Significant disagreements in the assignment of features on radiological lesion characterization were observed between the 2 readers regarding lesion density, shape, echo pattern, vascularity, and borders.Conclusion: The results of this study contribute to the existing body of knowledge, emphasizing the need for standardized guidelines for the characterization of BI-RADS 4 subcategories and improved diagnostic accuracy in the management of breast lesions.