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Purpose: The aim of our study was to evaluate the outcomes of sonographic (US) BIRADS category 4 lesions according to subcategories 4A, 4B, and 4C and palpability. Materials and Methods: We retrospectively reviewed the pathology results of 512 US BI-RADS category 4 lesions in 460 patients after ultrasound-guided percutaneous biopsy (n = 435) and surgical biopsy (n = 77). We analyzed the results according to subcategories 4A, 4B, 4C, and palpability, and compared outcomes of five breast radiologists. Results: In BI-RADS 4A lesions (n = 302), biopsy results indicated 48 malignancies (15.9%). In BI-RADS 4B lesions (n = 113), biopsy revealed 69 malignancies (61.1%). Among BI-RADS 4C lesions (n = 97), 87 lesions were malignancies (89.7 %). Palpability had no correlation with the rate of malignancy in BI-RADS category 4 lesions, and the rate of malignancy for category 4A ranged widely from 8.1% - 26.4%. Conclusions: The outcomes of US BI-RADS category 4 lesions according to subcategories varied widely between radiologists, especially for 4A lesions. The US finding itself warrants a BI-RADS 4 subcategory. In category 4 lesions, the malignant rate was the same between palpable and nonpalpable lesions.


Purpose: The aim of our study was to evaluate the outcomes of sonographic (US) BIRADS category 4 lesions according to subcategories 4A, 4B, and 4C and palpability. Materials and Methods: We retrospectively reviewed the pathology results of 512 US BI-RADS category 4 lesions in 460 patients after ultrasound-guided percutaneous biopsy (n = 435) and surgical biopsy (n = 77). We analyzed the results according to subcategories 4A, 4B, 4C, and palpability, and compared outcomes of five breast radiologists. Results: In BI-RADS 4A lesions (n = 302), biopsy results indicated 48 malignancies (15.9%). In BI-RADS 4B lesions (n = 113), biopsy revealed 69 malignancies (61.1%). Among BI-RADS 4C lesions (n = 97), 87 lesions were malignancies (89.7 %). Palpability had no correlation with the rate of malignancy in BI-RADS category 4 lesions, and the rate of malignancy for category 4A ranged widely from 8.1% - 26.4%. Conclusions: The outcomes of US BI-RADS category 4 lesions according to subcategories varied widely between radiologists, especially for 4A lesions. The US finding itself warrants a BI-RADS 4 subcategory. In category 4 lesions, the malignant rate was the same between palpable and nonpalpable lesions.


목적: 초음파 BI-RADS 범주 4병소를 하위 범주 4A, 4B, 4C 및 촉진성에 따라 나눈 결과를 평가해 보고자 하였다. 대상과 방법: 460명의 초음파 BI-RADS 범주 4 병소 512 개의 병변을 대상으로 초음파 유도하의 생검 및 수술적 생검을 실시하여 병리 결과를 살펴보았다. 하위 범주 4A, 4B 및 4C와 촉진성, 그리고 다섯 명의 영상의학과 의사에 따른 결과를 비 교하였다. 결과: 범주별 유방병변들은 범주 4A는 302예, 범주 4B는 113예, 범주 4C는 97예 이었다. 범주별 조직학적 악성률은 각 각 4A는 15.9%(48/302), 4B는 61.1%(69/113), 4C는 89.7%(87/97)이었다. BI-RAD 범주 4A, 4B및 4C에서 각각 병소의 촉진성에 따른 악성률의 차이는 없었으며 하위 범주 4A의 악성률은 8.1%에서 26.4%의 넓은 범위를 보였다. 결론: 하위 분류에 따른 초음파 BI-RADS 범주 4 병소 중, 4A병소에서 영상의학과 의사에 따라 다른 결과를 보였다. 초 음파 소견 자체만이 BI-RADS 범주 4의 하위분류에 영향을 주었으며. 만져지거나 혹은 만져지지 않는 범주 4 병소의 악성 률은 동일했다.