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Subcategory classifications of Breast Imaging and Data System (BI-RADS) category 4 lesions on MRI

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

Category 4 in BI-RADS for magnetic resonance imaging (MRI) has a wide range of probabilities of malignancy, extending from > 2 to < 95%. We classified category 4 lesions into three subcategories and analyzed the positive predictive value (PPV) of malignancy in a tertiary hospital.

Materials and methods

This retrospective study included 346 breast MRIs with 434 category 2–5 lesions. All enhancing lesions were classified as category 2 (0% probability of malignancy), 3 (> 0%, ≤ 2%), 4 (> 2%, < 95%) and 5 (≥ 95%); category 4 lesions were further subcategorized into 4A (> 2%, ≤ 10%), 4B (> 10%, ≤ 50%) and 4C (> 50%, < 95%) at the time of diagnosis. Radiological and pathological reports were retrospectively analyzed, and the PPVs were calculated.

Results

We included 149 malignant and 285 benign lesions. The PPVs of subcategories 4A, 4B and 4C were 1.8%, 11.8% and 67.5%, respectively. The PPVs were higher for lesions coexisting with category 5 or 6 lesions compared with those for isolated lesions.

Conclusion

Category 4 lesions can be classified into three subcategories depending on the likelihood of malignancy. Lesions coexisting with category 5 or 6 lesions are more likely to be malignant.

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Acknowledgments

We would like to thank Sakurako Onaka for her help in organizing data. We thank Libby Cone, MD, MA, from Edanz Group Japan (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan

    Maya Honda, Masako Kataoka, Mami Iima, Kanae Kawai Miyake, Ayami Ohno Kishimoto, Rie Ota & Yuji Nakamoto

  2. Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan

    Kosuke Kawaguchi & Masakazu Toi

  3. Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-7507, Japan

    Mami Iima

  4. Department of Radiology, National Hospital Organization Kyoto Medical Center, 1-1, Fukakushamukaihatacho, Fishimi-ku, Kyoto, 612-8555, Japan

    Akane Ohashi

Authors
  1. Maya Honda
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  2. Masako Kataoka
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  3. Kosuke Kawaguchi
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  4. Mami Iima
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  5. Kanae Kawai Miyake
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  6. Ayami Ohno Kishimoto
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  7. Rie Ota
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  8. Akane Ohashi
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  9. Masakazu Toi
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  10. Yuji Nakamoto
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Contributions

All authors above contributed to the study conception and design. Data collection and analysis were performed by MH and MK. The first draft of the manuscript was written by MH and all the other authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masako Kataoka.

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Conflict of interest

M. Toi received honorarium from Eli Lilly and research funding from Chugai, Astellas, AstraZeneca, AFI technology, Shimadzu and Kyowa-Kirin. The remaining authors declare no conflicts of interest.

Informed consent

The need for informed consent was waived because we retrospectively analyzed the reports of clinically acquired breast MRI scans.

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Honda, M., Kataoka, M., Kawaguchi, K. et al. Subcategory classifications of Breast Imaging and Data System (BI-RADS) category 4 lesions on MRI. Jpn J Radiol 39, 56–65 (2021). https://doi.org/10.1007/s11604-020-01029-w

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  • DOI: https://doi.org/10.1007/s11604-020-01029-w

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