Wanaporn Burivong and Ornsiri Amornvithayacharn
Subcategorizing BI-RADS category 4 lesions are usef ul to inform the level of concern for carcinoma. To determine the accuracy of BI-RADS 4 subcategories, mammographic and ultrasound images of 143 patients were independently and blindly reviewed by two radiologists and later compared with pathologic diagnosis. Sixty-eight of 143 (47%) were classified as subcategory 4A, 54 (37%) were 4B and 21 (14%) were 4C. The positive predictive value aft er consensus evaluation in subcategory 4A, 4B and 4C are 4.4%, 43.3% and 52.1%, respectively. Interob server agreement for mammographic and ultrasound descriptions varies from perfect to fair agreement. We conclude that the malignancy rate in subcategories 4B and 4C was significantly higher th an in subcategory 4A. Interobserver agreement varies from slightly lower to comparable with previ ous studies. The accuracy of mammographic and breast ultrasound interpretation can be improved by consensus evaluation in uncertain cases to reduce underestimated malignancy.
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