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Congress: ECR25
Poster Number: C-20591
Type: Poster: EPOS Radiologist (scientific)
Authorblock: M. Bobowicz1, M. Rygusik1, K. P. Brzozowski1, K. Rocławska1, P. Kalinowska2, K. Gwozdziewicz1; 1Gdansk/PL, 2Stockholm/SE
Disclosures:
Maciej Bobowicz: Nothing to disclose
Marlena Rygusik: Nothing to disclose
Krystian Paweł Brzozowski: Nothing to disclose
Katarzyna Rocławska: Nothing to disclose
Paulina Kalinowska: Nothing to disclose
Katarzyna Gwozdziewicz: Nothing to disclose
Keywords: Breast, Ultrasound, Decision analysis, Cancer
Purpose Breast cancer is the most common malignancy among women worldwide, and early detection is crucial for improving patient outcomes [1,2]. The Breast Imaging Reporting and Data System (BI-RADS) standardizes malignancy risk assessment in breast ultrasound (BUS). However, the subjective nature of BI-RADS classification—particularly within the 4A-C subcategories—raises concerns about its reliability, especially in patients outside the standard screening age range (<50 and >70 years) [3].This study aims to evaluate the limitations and potential misclassification within BI-RADS 4A-C in non-screening-age populations...
Read more Methods and materials This study retrospectively analyzed 480 female patients who underwent core-needle biopsy for solid breast lesions at the University Clinical Centre in Gdansk, Poland, from 2020 to 2023. Inclusion criteria: BI-RADS 4A-C female patients >18 years of age Availability of: BI-RADS score DICOM BUS images (for verification) Corresponding mammography scans and reports Complete pathology reports Data analysis: Statistical evaluation using Python (pandas, numpy, scikit-learn, SciPy) Pairwise t-tests with Bonferroni correction (p ≤ 0.05 considered significant) Comparative analysis of cancer incidence rates in BI-RADS 4A-C across different age groups Correlation of breast density (ACR classification)...
Read more Results Among 480 patients, BI-RADS scores were distributed as follows: 4A: 324 patients (67.5%) 4B: 81 patients (16.9%) 4C: 75 patients (15.6%) Overall cancer incidence 16.88% (81/480) of BI-RADS 4 patients were diagnosed with breast cancer (invasive and DCIS). Overal cancer rates by BI-RADS category 4A: 5.9% 4B: 21.3% 4C: 56.8% [fig 2] KEY FINDINGS BI-RADS 4A and 4B categories were overused in elderly patients, potentially underestimating malignancy risk. Younger patients (<50 years) were frequently overclassified into BI-RADS 4C, leading to unnecessary biopsies and heightened anxiety. Triple-negative breast cancer (TNBC) was predominant in younger patients, with...
Read more Conclusion This study reveals a significant overuse of BI-RADS 4A and 4B classifications in elderly patients, potentially leading to an underestimation of cancer risk in this group. Conversely, younger patients (<50 years) were often overclassified into BI-RADS 4C, resulting in unnecessary biopsies and increased psychological distress.Key Takeaways: Refining BI-RADS classification to incorporate age-adjusted malignancy risk estimates could enhance diagnostic accuracy. Machine learning-assisted diagnostic tools should be explored to reduce subjectivity in BI-RADS scoring. Enhanced radiologist training and awareness of age-related biases could improve patient...
Read more References [1] Magny SJ, Shikhman R, Keppke AL. Breast Imaging Reporting and Data System. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29083600.[2] Lehman CD, Arao RF, Sprague BL, et al. National performance benchmarks for modern screening digital mammography: Update from the Breast Cancer Surveillance Consortium. Radiology. 2017;283(1):49–58. https://doi.org/10.1148/radiol.2016161174[3] Deng J, Shi M, Wang M, Liao N, Jia Y, Lu W, Yao F, Sun S, Zhang Y. Age‑integrated breast imaging reporting and data system assessment...
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