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Subcategory classifications of Breast Imaging and Data System (BI-RADS) category 4 lesions on MRI
Maya Honda1, Masako Kataoka2, Kosuke Kawaguchi3
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
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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