{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:01:38Z","timestamp":1788454898004,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The BI\u2010RADS classification provides a standardized way to describe ultrasound findings in breast cancer diagnostics. However, there is little information regarding which BI\u2010RADS descriptors are most strongly associated with malignancy, to better distinguish BI\u2010RADS 3 (follow\u2010up imaging) and 4 (diagnostic biopsy) breast masses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were recruited as part of an international, multicenter trial (NCT02638935). The trial enrolled 1294 women (6 excluded) categorized as BI\u2010RADS 3 or 4 upon routine B\u2010mode ultrasound examination. Ultrasound images were evaluated by three expert physicians according to BI\u2010RADS. All patients underwent histopathological confirmation (reference standard). We performed univariate and multivariate analyses (chi\u2010square test, logistic regression, and Krippendorff's alpha).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Histopathologic evaluation showed malignancy in 368 of 1288 masses (28.6%). Upon performing multivariate analysis, the following descriptors were significantly associated with malignancy (<jats:italic>P<\/jats:italic>\u00a0&lt;\u2009.05): age \u226550\u2009years (OR 8.99), non\u2010circumscribed indistinct (OR 4.05) and microlobulated margin (OR 2.95), nonparallel orientation (OR 2.69), and calcification (OR 2.64). A clinical decision rule informed by these results demonstrated a 97% sensitivity and missed fewer cancers compared to three physician experts (range of sensitivity 79\u201395%) and a previous decision rule (sensitivity 59%). Specificity was 44% versus 22\u201383%, respectively. The inter\u2010reader reliability of the BI\u2010RADS descriptors and of the final BI\u2010RADS score was fair\u2010moderate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A patient should undergo a diagnostic biopsy (BI\u2010RADS 4) instead of follow\u2010up imaging (BI\u2010RADS 3) if the patient is 50\u2009years or older or exhibits at least one of the following features: calcification, nonparallel orientation of mass, non\u2010circumscribed margin, or posterior shadowing.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jum.15722","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T07:09:40Z","timestamp":1620112180000},"page":"427-436","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["A New Practical Decision Rule to Better Differentiate <scp>BI\u2010RADS<\/scp> 3 or 4 Breast Masses on Breast Ultrasound"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6140-9895","authenticated-orcid":false,"given":"Andr\u00e9","family":"Pfob","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Barr","sequence":"additional","affiliation":[{"name":"Department of Radiology Northeast Ohio Medical University  Ravenna Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Duda","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics University of Marburg  Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"B\u00fcsch","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Informatics (IMBI) Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bruckner","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Informatics (IMBI) Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Spratte","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Nees","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riku","family":"Togawa","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of Virginia School of Medicine  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Fastner","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Riedel","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Schaefgen","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Hennigs","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Heil","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-0060","authenticated-orcid":false,"given":"Michael","family":"Golatta","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00774-6"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.388"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2018.01.022"},{"key":"e_1_2_8_5_1","volume-title":"ACR BI\u2010RADS\u00ae Atlas, Breast Imaging Reporting and Data System","author":"Mendelson EB","year":"2013"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.196.1.7784555"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316447003000105"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2018.07.018"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-13-159"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2523080670"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2007.04.008"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-014-3509-9"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2013.03.005"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-017-5235-8"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(19)30123-2"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004862"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2020.11.006"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/CCI.20.00088"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2016.05.006"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S198435"}],"container-title":["Journal of Ultrasound in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jum.15722","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jum.15722","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jum.15722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T08:58:11Z","timestamp":1693213091000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jum.15722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,4]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1002\/jum.15722"],"URL":"https:\/\/doi.org\/10.1002\/jum.15722","archive":["Portico"],"relation":{},"ISSN":["0278-4297","1550-9613"],"issn-type":[{"value":"0278-4297","type":"print"},{"value":"1550-9613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,4]]},"assertion":[{"value":"2021-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}