{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T07:33:11Z","timestamp":1774510391672,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the relevant factors associated with malignancy in Breast Imaging Reporting and Data System (BI\u2010RADS) 4A and to determine whether it was possible to establish a safe follow\u2010up guideline for lower\u2010risk 4A lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective study, patients categorized as BI\u2010RADS 4A on ultrasound who underwent ultrasound\u2010guided biopsy or\/and surgery between June 2014 and April 2020 was analyzed. Classification\u2010tree method and cox regression analysis were used to explore the possible correlation factors of malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 9965 patients enrolled, 1211 (mean age, 44.3\u2009\u00b1\u200913.5 years; range, 18\u201391 years) patients categorized as BI\u2010RADS 4A were eligible. The result of cox regression analysis revealed the malignant rate was only associated with patient age (hazard ratio (HR)\u2009=\u20091.038, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, 95% confidence interval (CI): 1.029\u20131.048) and the mediolateral diameter of the lesion (HR\u2009=\u20091.261, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, 95% CI: 1.159\u20131.372). The malignant rate for patients (\u2264\u200936 y) with BI\u2010RADS 4A lesions (the mediolateral diameter\u2009\u2264\u20090.9\u00a0cm) was 0.0% (0\/72). This subgroup included fibrocystic disease and adenosis in 39 patients (54.2%), fibroadenoma in 16 (22.2%), intraductal papilloma in 8 (11.1%), inflammatory lesions in 6 (8.3%), cyst in 2 (2.8%), and hamartoma in 1 (1.4%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patient age and lesion size are associated with the rate of malignancy in BI\u2010RADS 4A. For patients with lower\u2010risk BI\u2010RADS 4A lesions (\u2264\u20092% likelihood of malignancy), short\u2010term follow\u2010up with ultrasound may be offered as an acceptable alternative to immediate biopsy or surgery.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-023-07037-x","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T12:03:16Z","timestamp":1682683396000},"page":"2161-2168","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Can Short\u2010term Follow\u2010up with Ultrasound be Offered as an Acceptable Alternative to Immediate Biopsy or Surgery for Patients with First Ultrasound Diagnosis of BI\u2010RADS 4A Lesions?"],"prefix":"10.1002","volume":"47","author":[{"given":"Ping","family":"He","sequence":"first","affiliation":[{"name":"Department of Ultrasound Peking University Third Hospital 100191 Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Peking University Third Hospital 100191 Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010Gang","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Peking University Third Hospital 100191 Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Epidemiology Peking University Third Hospital 100191 Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2018.12.008"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2392042127"},{"key":"e_1_2_8_4_1","first-page":"179","article-title":"BI\u2010RADS((R)) fifth edition: a summary of changes, Diagn Interv","volume":"98","author":"Spak 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April 2023","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2023","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective study was approved by our institutional review board and the requirement to obtain informed consent was waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}