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Ultrasound positive predictive values by BI-RADS categories 3–5 for solid masses: An independent reader study

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Abstract

Objective

We assessed multiple readers’ positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c and 5 masses on ultrasound (US) pre- and post-proposed guidelines.

Methods

This retrospective, IRB-approved study included four American and four non-American readers who assigned BI-RADS categories for US images of 374 biopsy-proved masses. Readers were offered guidelines and re-classified the masses. We assessed readers’ abilities to achieve ACR benchmarks BI-RADS categories pre- and post-guidelines.

Results

PPVs increased with BI-RADS category. The PPVs pre- and post-guidelines were 6.0% and 4.4% for category 3, 27.3% and 30.5% for category 4a, 49.9% and 51.5% for category 4b, 69.0% and 67.4% for category 4c, and 79.3% and 80.1% for category 5. Readers achieved the PPV benchmark for category 4c, but not for categories 3, 4a, 4b and 5, with no significant improvement after guidelines. Regular BI-RADS 4 subcategory users missed benchmarks by less than non-regular users.

Conclusion

Pre- and post-guidelines, readers’ PPVs increased with BI-RADS categories, ACR PPV benchmarks were achieved in category 4c, missed in other categories, especially in the critical 4a subcategory, where the PPV was too high. BI-RADS 4 subcategory users performed better than non-users.

Key points

• Readers failed to achieve benchmarks for BI-RADS 4 subcategories, especially 4a.

• USA and Brazilian readers performed similarly in ACR BI-RADS 4 subcategorization.

• Proposed guidelines did not improve overall, USA or Brazilian reader performance.

• Regularly BI-RADS 4 subcategory users performed better than did non-users.

• US features distinguished between benign and malignant, not BI-RADS 4 subcategories.

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Author information

Authors and Affiliations

  1. University of Texas Health Sciences Center, San Antonio, 6522 Camp Bullis Road, #5208, San Antonio, TX, 78256, USA

    A. Thomas Stavros

  2. Department of Diagnostic Imaging, Fleury Medicina e Saúde, Rua Cincinato Braga 232, São Paulo, Brazil, 01333-910

    Andrea G. Freitas, Giselle G. N. deMello, Daniela Stanzani, Adriana H. Padovan, Ana Paula C. Moura & Marilia C. V. de Campos

  3. Invision Sally Jobe Breast Centers and Radiology Imaging Associates, 8700 E. Belleview Ave., Suite 200E, Greenwood Village, CO, 80111, USA

    Lora Barke, Terese Kaske & Ducly Wolverton

  4. Sutter Medical Group of the Redwoods Breast Imaging, 625 Steele Lane, Santa Rosa, CA, USA

    Dennis McDonald & Arnold Honick

  5. Sutter Medical Group, Sacramento, 1500 Expo Parkway, Sacramento, CA, 95815, USA

    Dennis McDonald

  6. Gloria Gossard Breast Health Center, 940 Central Park Drive, Steamboat Springs, CO, 80487, USA

    Terese Kaske

  7. Radiology, Section Chief Breast Imaging, University of Colorado Health Sciences Center, Aurora, CO, USA

    Ducly Wolverton

  8. Mercy Cedar Rapids, Department of Breast Imaging, 701 10th Street SE, Cedar Rapids, IA, 52403, USA

    Arnold Honick

Authors
  1. A. Thomas Stavros
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  2. Andrea G. Freitas
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  3. Giselle G. N. deMello
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  4. Lora Barke
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  5. Dennis McDonald
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  6. Terese Kaske
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  7. Ducly Wolverton
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  8. Arnold Honick
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  9. Daniela Stanzani
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  10. Adriana H. Padovan
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  11. Ana Paula C. Moura
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  12. Marilia C. V. de Campos
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Corresponding author

Correspondence to A. Thomas Stavros.

Ethics declarations

Guarantor

The scientific guarantor of this publication is A. Thomas Stavros, MD, FACR.

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.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Jonathan Duggins and Sandy Ferber of Array Biostatistics, Inc provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cobservational

• multicenter study

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Stavros, A.T., Freitas, A.G., deMello, G.G.N. et al. Ultrasound positive predictive values by BI-RADS categories 3–5 for solid masses: An independent reader study. Eur Radiol 27, 4307–4315 (2017). https://doi.org/10.1007/s00330-017-4835-7

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  • DOI: https://doi.org/10.1007/s00330-017-4835-7

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