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A bimodal nomogram as an adjunct tool to reduce unnecessary breast biopsy following discordant ultrasonic and mammographic BI-RADS assessment

  • Breast
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A Commentary to this article was published on 06 November 2023

Abstract

Objective

To develop a bimodal nomogram to reduce unnecessary biopsies in breast lesions with discordant ultrasound (US) and mammography (MG) Breast Imaging Reporting and Data System (BI-RADS) assessments.

Methods

This retrospective study enrolled 706 women following opportunistic screening or diagnosis with discordant US and MG BI-RADS assessments (where one assessed a lesion as BI-RADS 4 or 5, while the other assessed the same lesion as BI-RADS 0, 2, or 3) from two medical centres between June 2019 and June 2021. Univariable and multivariable logistic regression analyses were used to develop the nomogram. DeLong’s and McNemar’s tests were used to assess the model’s performance.

Results

Age, MG features (margin, shape, and density in masses, suspicious calcifications, and architectural distortion), and US features (margin and shape in masses as well as calcifications) were independent risk factors for breast cancer. The nomogram obtained an area under the curve of 0.87 (95% confidence interval (CI), 0.83–0.91), 0.91 (95% CI, 0.87 – 0.96), and 0.92 (95% CI, 0.86–0.98) in the training, internal validation, and external testing samples, respectively, and demonstrated consistency in calibration curves. Coupling the nomogram with US reduced unnecessary biopsies from 74 to 44% and the missed malignancies rate from 13 to 2%. Similarly, coupling with MG reduced missed malignancies from 20 to 6%, and 63% of patients avoided unnecessary biopsies. Interobserver agreement between US and MG increased from – 0.708 (poor agreement) to 0.700 (substantial agreement) with the nomogram.

Conclusion

When US and MG BI-RADS assessments are discordant, incorporating the nomogram may improve the diagnostic accuracy, avoid unnecessary breast biopsies, and minimise missed diagnoses.

Clinical relevance statement

The nomogram developed in this study could be used as a computer program to assist radiologists with detecting breast cancer and ensuring more precise management and improved treatment decisions for breast lesions with discordant assessments in clinical practice.

Key Points

• Coupling the nomogram with US and mammography improves the detection of breast cancers without the risk of unnecessary biopsy or missed malignancies.

• The nomogram increases mammography and US interobserver agreement and enhances the consistency of decision-making.

• The nomogram has the potential to be a computer program to assist radiologists in identifying breast cancer and making optimal decisions.

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Abbreviations

ACR:

American College of Radiology

AUC:

Area under the curve

BI-RADS:

Breast Imaging Reporting and Data System

CEUS:

Contrast-enhanced US

CI:

Confidence interval

MG:

Mammography

OR:

Odds ratio

ROC:

Receiver operator characteristic curve

SWE:

Shear wave elastography

US:

Ultrasound

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Funding

This study has received funding by the National Natural Science Foundation of China (82271998 and 82071949), College Students’ Innovative Entrepreneurial Training Plan Program (202212121022), and Guangzhou Municipal Science and Technology Department: 2023 Key research and development plan projects (2023B03J1350).

Author information

Author notes

  1. Ziting Xu, Yue Lin, and Jiekun Huo contributed equally to this work

Authors and Affiliations

  1. Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China

    Ziting Xu, Yue Lin, Yang Gao, Jiayin Lu, Yu Liang, Lian Li, Zhouyue Jiang, Lingli Du, Ting Lang & Yingjia Li

  2. Department of Imaging, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China

    Jiekun Huo & Ge Wen

  3. Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China

    Ge Wen

Authors
  1. Ziting Xu
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  2. Yue Lin
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  4. Yang Gao
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Corresponding authors

Correspondence to Ge Wen or Yingjia Li.

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Guarantor

The scientific guarantor of this publication is Yingjia Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (NFEC-2020-294).

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology

• Retrospective

• Diagnostic study

• Multicentre study

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Xu, Z., Lin, Y., Huo, J. et al. A bimodal nomogram as an adjunct tool to reduce unnecessary breast biopsy following discordant ultrasonic and mammographic BI-RADS assessment. Eur Radiol 34, 2608–2618 (2024). https://doi.org/10.1007/s00330-023-10255-5

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