Ultrasound positive predictive values by BI-RADS categories 3–5 for solid masses: An independent reader study

A. Thomas Stavros, Andrea G. Freitas, Giselle G.N. deMello, Lora Barke, Dennis McDonald, Terese Kaske, Ducly Wolverton, Arnold Honick, Daniela Stanzani, Adriana H. Padovan, Ana Paula C. Moura, Marilia C.V. de Campos

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: We assessed multiple readers’ positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c and 5 masses on ultrasound (US) pre- and post-proposed guidelines. Methods: This retrospective, IRB-approved study included four American and four non-American readers who assigned BI-RADS categories for US images of 374 biopsy-proved masses. Readers were offered guidelines and re-classified the masses. We assessed readers’ abilities to achieve ACR benchmarks BI-RADS categories pre- and post-guidelines. Results: PPVs increased with BI-RADS category. The PPVs pre- and post-guidelines were 6.0% and 4.4% for category 3, 27.3% and 30.5% for category 4a, 49.9% and 51.5% for category 4b, 69.0% and 67.4% for category 4c, and 79.3% and 80.1% for category 5. Readers achieved the PPV benchmark for category 4c, but not for categories 3, 4a, 4b and 5, with no significant improvement after guidelines. Regular BI-RADS 4 subcategory users missed benchmarks by less than non-regular users. Conclusion: Pre- and post-guidelines, readers’ PPVs increased with BI-RADS categories, ACR PPV benchmarks were achieved in category 4c, missed in other categories, especially in the critical 4a subcategory, where the PPV was too high. BI-RADS 4 subcategory users performed better than non-users. Key points: • Readers failed to achieve benchmarks for BI-RADS 4 subcategories, especially 4a. • USA and Brazilian readers performed similarly in ACR BI-RADS 4 subcategorization. • Proposed guidelines did not improve overall, USA or Brazilian reader performance. • Regularly BI-RADS 4 subcategory users performed better than did non-users. • US features distinguished between benign and malignant, not BI-RADS 4 subcategories.

Original languageEnglish (US)
Pages (from-to)4307-4315
Number of pages9
JournalEuropean Radiology
Issue number10
StatePublished - Oct 1 2017


  • Breast cancer
  • Breast neoplasms
  • Breast ultrasonography
  • Diagnostic, imaging
  • Tumours, breast

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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