{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:42:17Z","timestamp":1785926537991,"version":"3.56.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The probability of malignancy in women who are diagnosed with a Breast Imaging Reporting and Data System (BI-RADS) 4A score is low. Application of a second opinion ultrasound (SOUS), which is low in cost and minimally invasive, may lower the biopsy rate for patients who fall into this category. This study aimed to apply SOUS to patients with a BI-RADS score of 4A and predict the pathological results of a biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One hundred seventy-eight patients were analyzed. Univariate and multivariate analyses were performed to screen for predictive factors that are associated with malignancy. Categorical alteration of downgraded, unchanged, or upgraded was made after SOUS results. Changes in category were compared with biopsies to determine their predictive value of benignancy or malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Independent factors associated with malignancy were age (&gt;50 years), tumor size (\u226520\u2009mm), margin (not circumscribed), orientation (not parallel), and peripheral location, and an upgraded categorical alteration from SOUS. Downgraded categorical alterations were associated with benignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In BI-RADS 4A cases, a biopsy is recommended when independent factors are associated with malignancy. A downgraded result from an SOUS examination is a protective factor, supporting the likelihood of benignancy in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03000605211024452","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T02:22:07Z","timestamp":1624501327000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Application of a second opinion ultrasound in Breast Imaging Reporting and Data System 4A cases: can immediate biopsy be avoided?"],"prefix":"10.1177","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4768-5273","authenticated-orcid":false,"given":"Yantao","family":"Cai","sequence":"first","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenfang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianqian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Shanghai Ninth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanyu","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Ninth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,6,23]]},"reference":[{"key":"bibr1-03000605211024452","unstructured":"American College of Radiology. BI-RADS: ultrasound, 1st ed. In: Breast imaging reporting and data system atlas. 4th ed. Reston, VA: American College of Radiology, 2003."},{"key":"bibr2-03000605211024452","unstructured":"American College of Radiology. BI-RADS: ultrasound, 2nd ed. In: Breast imaging reporting and data system atlas. 5th ed. 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