Similar Diagnostic Accuracy and Reproducibility of BIRADS 4 and 5 Lesions in Radial and Meander-Like Breast Ultrasound

Abstract

Breast ultrasound is crucial in the diagnostics of breast cancer. While meander-like Ultrasound (m-US) is most commonly used, radial Ultrasound (r- US) is emerging as suitable alternative. Breast lesions category BI-RADS 4 and 5 are suspicious and highly suggestive of malignancy, respectively, and mandate breast biopsy. We compare m-US and r-US in real-time with regard to diagnostic accuracy, examination time and the agreement in location, size and final BIRADS classification of BI-RADS 4 and 5 lesions. Out of 1948 dual examinations (m-US and r-US), 57 lesions were classified as BI-RADS 4 or 5 either by r-US or m-US or by both scanning methods. For breast lesions category BI-RADS 4 or 5, sensitivity (both scan methods 94.1%), specificity (m-US 21.7%, r-US 39.1%), cancers missed rate (both 5.9%), accuracy (m-US 64.9%, r-US 71.9%), positive predictive value (m-US 64.0%, r-US 69.6%) and negative predictive value (both 100%) were similar. In m-US, the malignancy rate for category BI-RADS 5 was 93.8% versus for 50.0% for BI-RADS 4 whereas in r-US, malignancy rates were 88.2% and 58.6% for category BI-RADS 5 and 4, respectively. The examination was significantly shorter (p<0.01) for r-US (13.6 minutes) compared to m-US (27.8 minutes). Our results support radial ultrasound as an alternative to meander-like ultrasound in breast lesions category BI-RADS 4 and 5 where patients benefit from a significantly shorter examination time.