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Sonographic Glandular Tissue Component: A Potential Imaging Marker for Upgrading BI-RADS 4A Breast Masses
Yuan Zhong1, Yin-Ting Chen1, Yi-de Qiu1
1Department of Medical Ultrasound, The First People's Hospital of Foshan, No.81 Lingnan Avenue North, Foshan 528010, China (Y.Z., Y.T.C., Y.D.Q., Y.S.X., X.D.C., Y.Y.X., J.Y.Y., W.J.H.).
Purpose:
To investigate whether sonographic glandular tissue component (GTC) can optimize the management of breast imaging reporting and data system (BI-RADS) 4A breast masses.
Materials And Methods:
We reviewed the patients with BI-RADS 4A breast masses confirmed by ultrasound and pathology reports from January to December 2020. Based on conventional breast ultrasound images, GTC was categorized into GTC-Low and GTC-High. The consistency of the GTC classification between two radiologists was evaluated using a kappa test. Propensity score matching (PSM) was applied to adjust for unbalanced characteristics between the two groups. Logistic regression was used to analyze the relationship between sonographic GTC and the likelihood of BI-RADS 4A masses being benign or malignant.
Results:
Of the 319 patients included finally in the study, the agreement between the two radiologists regarding the GTC classification was good (weighted kappa: 0.736/0.716). The malignancy rate in the GTC-High group (32.7%, 16/49) was significantly higher than that in the overall cohort (14.1%, 45/319; P=0.001). After PSM adjustment to balance relevant covariates between the GTC-High and GTC-Low groups, 45 GTC-High patients were matched with 45 GTC-Low patients. After matching, univariate and multivariate logistic regression analyses identified sonographic GTC as an independent variable associated with malignancy in BI-RADS 4A masses (P=0.012). After matching, the malignancy rate in the GTC-High group (35.6%,16/45) was significantly higher (P=0.014) than that in the GTC-Low group (13.3%, 6/45).
Conclusion:
Sonographic GTC is an independent predictor of malignancy in BI-RADS 4A breast masses. Masses initially classified as BI-RADS 4A may warrant reclassification to BI-RADS 4B when identified as GTC-High.
