探讨血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检的价值

目的探讨彩色多普勒血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检的价值。方法回顾性分析120例超声诊断为BI-RADS4级的乳腺病灶患者,结合彩色多普勒观察乳腺病灶内部及周边的血流分布,形态,数量,按照Adler的半定量方法,对血流进行分级,所有病例均进行了超声引导下穿刺活检。结果 120例超声活检结果,良性62例,恶性58例,BI-RADS4a、4b、4c的阳性预测值(positive predictive value,PPV)分别为10.8%、39.0%、90.5%,各个级别间比较均有统计学意义(P0.05),2级和3级血流的乳腺病灶PPV(79.7%)与BI-RADS4级的总PPV(48.3%)比较,差异具有统计学意义(P0.05)。BI-RADS4级乳腺病灶的良恶性在血流分级的分布具有差异性,差异具有统计学意义(P0.05)。2级和3级血流的BI-RADS4b乳腺病灶的PPV(70.0%)和总体BI-RADS4b乳腺病灶的PPV(39.0%)比较,差异有统计学意义(P0.05)。结论血流分级对超声引导下BI-RADS4级乳腺病灶穿刺活检具有指导价值,4a的PPV较低,可以短期随访观察,但对于伴有2级和3级血流的BI-RADS4a级乳腺病灶,由于其PPV比整体BI-RADS4a级乳腺病灶的PPV高,建议穿刺活检;对于2级和3级血流的4b乳腺病灶,由于其PPV较高,一定要尽早穿刺活检,明确良恶性;对于2级和3级的4c乳腺病灶,由于其PPV很高,不建议穿刺活检,直接手术处理。     

超声引导下细针穿刺活检与弹性成像在诊断乳腺肿块中的应用价值

目的对比研究超声引导下细针穿刺活检及超声弹性成像(UE)评分法对乳腺肿块的诊断价值。方法回顾性分析经病理证实120例乳腺肿块患者,比对两种方法(超声弹性成像评分法作为对照组)的结果与最终病理结果一致性。结果 120例乳腺肿块患者超声弹性成像评分为(4.23±0.49)分,诊断为恶性的符合率为86%(103/120)。超声引导下细针穿刺活检符合率为96.5%(116/120)。采用超声引导下乳腺穿刺活检术的研究组阳性检出率与对照组数值表差异(P0.05)。结论超声引导下乳腺穿刺活检技术具有更高的诊断价值,对临床治疗有积极地指导意义。     

乳腺影像学报告及数据系统评分联合超声弹性成像对乳腺浸润性癌的诊断价值

目的 探讨乳腺影像学报告及数据系统(BI-RADS)评分联合超声弹性成像乳腺浸润性癌的鉴别价值。方法 回顾性分析我院2021年5月至2022年5月期间收治的乳腺肿块患者108例(108个肿块)BI-RADS评分以及超声弹性成像资料，以病理为金标准，采用χ²检验对比BI-RADS评分、超声弹性成像单独及联合对乳腺浸润性特殊癌鉴别的价值，采用t检验对比良恶性肿块超声弹性评分、BI-RADS评分等参数。结果乳腺恶性肿块共58个，占58/108(53.7%)，其中乳头状癌18例、小管癌9例、髓样癌20例、鳞状细胞癌11例；乳腺良性肿块共50个，占50/108(46.3%)，其中乳腺纤维腺瘤27例、乳腺叶状肿瘤14例和乳腺腺瘤9例。与BI-RADS评分、超声弹性成像单独检查相比，BI-RADS评分联合超声弹性成像对乳腺浸润性癌诊断敏感度、阳性预测值更高(χ²=4.83,P=0.03；χ²=3.28,P=0.05；χ²=4.49,P=0.03；χ²=2.94,P=0.05)；恶性肿块的弹性...     

乳腺自动全容积在乳腺多发结节中偶发癌的诊断中的临床价值

目的探讨自动乳腺全容积成像(automated breast volume scanner,ABVS)在乳腺多发结节中偶发癌诊断中的临床应用价值。方法对本院因乳腺疾病就诊82例患者的临床资料进行分析,按照BI-RADS分级标准进行评估,比较常规超声和自动乳腺全容积成像在术前诊断乳腺多发结节中偶发癌的效果。结果 251个结节中,常规超声检出BIRADS分级为4b级及以上病灶20个,其中良性病灶4个,恶性病灶16个。常规超声检出BI-RADS分级为4b级以下病灶231个,其中良性病灶226个,恶性病灶5个。根据上述常规超声检出BI-RADS分级结果在良恶性病灶间比较存在明显差异,且差异具有统计学意义。根据BI-RADS 4b级以上为诊断恶性病变标准进行常规超声诊断效果分析,结果显示常规超声诊断乳腺多发结节中偶发癌的敏感性、特异性及准确性76.19%,98.26%,96.41%。251个结节中,自动乳腺全容积成像检出BI-RADS分级为4b级及以上病灶22个,其中良性病灶2个,恶性病灶20个。自动乳腺全容积成像检出BI-RADS分级为4b级以下病灶229个,其中良性病灶228个,恶性病灶1个。根据上述自动乳腺全容积成像检出BIRADS分级结果在良恶性病灶间比较存在明显差异,且差异具有统计学意义。根据BI-RADS 4b级以上为诊断恶性病变标准进行自动乳腺全容积成像诊断效果分析,结果显示自动乳腺全容积成像诊断乳腺多发结节中偶发癌的敏感性、特异性及准确性95.24%,99.13%,98.80%。自动乳腺全容积成像诊断乳腺多发结节中偶发癌的敏感性明显高于常规超声,且差异具有统计学意义。而两种检查方法的特异性和准确性比较则无明显差异。结论 ABVS系统作为一种新的超声检查方式,其结合BI-RADS 4b级作为标准提高了超声对乳腺多发结节中偶发癌的诊断灵敏度,诊断效能较常规超声明显提高。     

血氧功能成像系统与联合高频多普勒超声检查对乳腺病灶的诊断价值

目的探讨血氧功能成像系统(BOFIS)与高频多普勒超声(US)联合检查在乳腺肿瘤早期发现及良恶性鉴别中的应用价值。资料与方法应用血氧功能成像系统和高频多普勒超声对226例患者的231个乳腺病灶进行检查,超声综合二维及多普勒征象进行乳腺图像和报告数据体系(BI-RADS)分级,并将BI-RADSⅣb级以上诊断为恶性病灶,Ⅳa级以下为良性;血氧功能成像系统通过显示病灶灰影的边缘特征、内部结构、微血管数量及其血含量和氧含量的变化来鉴别良恶性。全部病例均经手术或穿刺活检病理证实。结果经病理确诊良性病灶149个,恶性病灶82个。①高频多普勒超声与血氧功能成像系统对乳腺病灶良恶性鉴别的敏感性和阴性预测值分别为84.2%、91%和78.1%、87.1%,联合后分别为95.1%、96.5%,与前两者比较,差异有统计学意义(P<0.05);②乳腺图像和报告数据体系(BI-RADS)分级为Ⅲ、Ⅳ、Ⅴ级的乳腺病灶,高频多普勒超声符合率分别98.7%、71.5%、96.9%,血氧功能成像系统符合率分别为86.8%、76.4%、75%;③高频多普勒超声及血氧功能成像系统对<2cm的早期乳腺癌的敏感性分别为73%、67.6%,联合后为89.2%,与前两者比较,差异均有统计学意义(P<0.05)。结论高频多普勒超声与血氧功能成像系统联合应用在减少早期乳腺癌漏诊以及提高乳腺肿块良恶性鉴别准确率方面有一定的临床应用价值。     

超声弹性成像面积比在BI-RADS 4类乳腺肿块诊断中应用价值研究

目的探讨超声弹性成像面积比(AR)在BI-RADS4类乳腺肿块鉴别中的应用价值。方法选取自2015年7月至2018年10月宣城市人民医院经常规超声检查发现的79例乳腺肿块患者为研究对象,共96个BI-RADS 4类乳腺肿块。计算超声弹性成像图像与常规超声二维灰阶图像的AR,并与病理结果比较。基于病理结果为"金标准"构建受试者工作特征曲线(ROC),以找到诊断BI-RADS 4类乳腺肿块良恶性的最佳截断点。结果经病理诊断,96个BI-RADS 4类乳腺肿块中良性54个,恶性42个。AR为1.095时为最佳诊断截断点,特异度为91.1%,灵敏度为74.5%,诊断符合率为82.3%,ROC曲线下面积为0.848。结论 AR在鉴别BI-RADS 4类乳腺肿块中具有较高的临床应用价值。     

超声弹性成像显示1786个不可触及的乳腺肿物:在决定活检方面的诊断价值

正摘要目的通过超声弹性成像与组织病理学的相关性,比较其与常规超声在决定活检方面的诊断价值。方法经组织病理学证实的1538名妇女共1786个不可触及的乳腺肿物(良性1523个,恶性263个)均进行常规超声成像及超声弹性成像,并进行BI-RADS分级及弹性评分。以决定活检为标准比较两种     

BI-RADS 3-5级在乳腺肿瘤临床诊断中的作用分析

目的探讨超声乳腺影像报告和数据系统(BI-RADS)3-5级在乳腺肿瘤临床诊断中的作用。方法选取本院乳腺肿物超声诊断为BI-RADS 3-5级的乳腺肿瘤患者63例。以病理结果为金标准,判断BI-RADS 3-5级在乳腺肿瘤中诊断价值。结果结果显示,41例为良性病变,22例为恶性病变;以病理结果为标准,BI-RADS 5级中恶性病变符合率高于3级、4级,且4级符合率高于3级,差异有统计学意义(P0.05);BI-RADS 4c组恶性病变符合率高于4a组、4b组,差异有统计学意义(P0.05);声像图特征上,BI-RADS 3级肿块形态规则,边缘清晰,纵横比≧1,无微钙化、后方回声衰减;BI-RADS 4级肿块大多形态规则、边缘清晰,纵横比多≧1,少部分存在微钙化、后方回声衰减;BI-RADS 5级肿块形态不规则,边缘模糊,纵横比多1,大多存在微钙化、后方回声衰减。结论 BI-RADS 3-5级可为良恶性乳腺肿瘤诊断、鉴别提供可靠依据。     

BI-RADS 3-5级实体肿瘤的超声阳性预测值:一项独立研究

正摘要目的本研究旨在评估不同阅片者在参考指南前后,对超声(US)美国放射学会(ACR)乳腺影像报告和数据系统(BI-RADS)分级为3、4a、4b、4c和5级肿块诊断的阳性预     

超声造影定性分析联合剪切波弹性成像对乳腺BI-RADS 4类肿块的鉴别应用

目的 探讨超声造影（CEUS）定性分析联合剪切波弹性成像（SWE）对乳腺影像报告和数据系统（BI-RADS）4类肿块的鉴别价值。方法 选取BI-RADS 4类的乳腺肿块患者62例,其中良性33例（良性组）,恶性29例（恶性组）。所有患者均经病理检查证实,且行CEUS和SWE检查。结果 CEUS诊断乳腺肿块准确率为67.74%,SWE诊断乳腺肿块准确率为62.90%,CEUS联合SWE诊断乳腺肿块准确率为88.71%。CEUS联合SWE诊断乳腺肿块准确率高于CEUS与SWE检查,差异有统计学意义（P<0.05）。恶性组CEUS评分高于良性组,差异有统计学意义（P<0.05）。恶性组SWE参数Esd、Emean、Emax和Eratio高于良性组,差异有统计学意义（P<0.05）。CEUS联合SWE诊断恶性乳腺肿块灵敏度和特异度高于CEUS和SWE,差异有统计学意义（P<0.05）。结论 CEUS定性分析联合SWE可提高对BI-RADS4类肿块良恶性鉴别诊断准确率。     

Characterisation of indeterminate focal breast lesions on grey-scale ultrasound: role of ultrasound elastography

Purpose

This study was undertaken to evaluate the role of ultrasound (US) elastography in characterising focal breast lesions classified as indeterminate on B-mode US.

Materials and methods

Eighty-four focal breast lesions, 64 benign and 20 malignant (mean diameter, 15.1 mm), detected but not characterised on B-mode US in 72 women, Breast Imaging Reporting and Data System (BI-RADS) US category 3 (n=56) or category 4 (n=28), were studied with US elastography and classified in consensus by two radiologists according to a five-point colour scale. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of US elastography compared with conventional US were calculated in relation to microhistology (n=67) and cytology (n=17), which were used as the reference standard.

Results

A total of 65/84 (77.4%) lesions were correctly classified as benign or malignant using US elastography, whereas the remaining 19/84 (22.6%) were incorrectly assessed. There were no statistically significant differences between US elastography and B-mode US with regard to sensitivity (70% vs. 68.4%), specificity (79.6% vs. 78.5%), PPV (51.8% vs. 48.1%) and NPV 89% vs. 89.5% (p>0.5). By contrast, a statistically significant difference was noted in the evaluation of BI-RADS 3 lesions, in which US elastography had 50% sensitivity, 86% specificity, 30% PPV and 93.5% NPV compared with BI-RADS 4 lesions (78.6%, 57.1%, 64.7% and 72.7%) (p<0.5).

Conclusions

The high NPV of US elastography may help reduce the use of biopsy in BI-RADS 3 lesions, but its low PPV in BI-RADS 4 lesions does not allow avoidance of biopsy on the basis of the US elastographic score alone in this group of lesions.     

Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses?

Objective

To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses.

Materials and methods

Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria.

Results

Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p < 0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p < 0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively.

Conclusion

PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.

Abstract：

Objective To study the value of breast imaging reporting and data system (BI-RADS)in Chinese breast cancer screening. Methods A total number of 3483 women participated in breast cancer screening with mammography in Hexi district in Tianjin from August to December 2009, which was organized by ministry of public health. BI-RADS assessment categories and recommendations were compared with histological findings. The precision, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Among 3483 screening mammography cases, 267 were almost entirely fat breast, 1245 were scauered fibroglandular, 1890 were dense and 81 extremely dense.There were 1011 patients(29.0%) with category 1, 1741 (50.0%) with category 2, 383 (11.0%) with category 3, 59 patients(1. 7%) with category 4 and 16 (0. 5%) with category 5 according to BI-RADS assessment categories. Totally, 71 women with 77 lesions were confirmed by histological examinations. There were 29 malignant and 48 benign lesions. The diagnostic precision, sensitivity, specificity of BI-RADS were 63. 6% (49/77) , 93. 1% (27/29) and 45.8% (22/48) . The general PPV of BI-RADS was 50. 9%(27/53). The PPV of categories 0, 4, 5 were 25.0% (1/4), 36. 4% (12/33) and 87. 5% (14/16). The NPV of categories 2 and3 were90.9% (10/11), 100.0% (12/12). Conclusions B1-RADS is of much value in assessing the breast malignancy. It is applicable in Chinese breast cancer screening.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.     

Could ultrasonic elastography help the diagnosis of small (≤2 cm) breast cancer with the usage of sonographic BI-RADS classification?

Objectives

To evaluate the additive value of ultrasound strain elastography (USE) to BI-RADS for the differentiation of benign and malignant breast small lesions.

Methods

Breast masses (≤2 cm) with histological diagnosis examined by ultrasonography and USE in our department from April 2004 to December 2009 were reviewed. Conventional B-mode ultrasound findings were classified according to the BI-RADS classification. USE findings were classified according to the 5-point scale. Histological diagnosis was used as the reference standard.

Results

401 (246 benign (61.3%), 155 malignant (38.7%)) from 370 consecutive patients were included in the study. Sensitivity and specificity were 90.3%, 68.3% for BI-RADS; 72.3%, 91.9% for USE. The sensitivity of BI-RADS was better than that of USE (P < 0.05), while the specificity of USE was better than that of BI-RADS (P < 0.05). A revised BI-RADS combined with USE results was proposed in this study. Sensitivity and specificity were 83.9% and 87.8% for revised BI-RADS. The diagnostic performance of revised BI-RADS was better than BI-RADS (P < 0.05).

Conclusions

USE could give BI-RADS some help in the differentiation of benign and malignant breast small lesions. The addition of elastography to BI-RADS could improve the diagnostic performance in <2 cm lesions.     

Application of deep learning to establish a diagnostic model of breast lesions using two-dimensional grayscale ultrasound imaging

PurposeThere are currently few specific artificial intelligence (AI) studies for Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions. This study aimed to establish an AI diagnostic model of breast lesions using two-dimensional grayscale ultrasound imaging and to compare its performance with that of radiologists.MethodsThe ultrasound images of 1311 lesions were evaluated by radiologists according to the BI-RADS categories, using pathology results as reference. Two classification standards (standards 1 and 2) for benign and malignant lesions were defined and used to calculate the diagnostic performance of radiologists, altogether and individually. The breast lesion images were also used to develop an AI diagnostic model.ResultsThe diagnostic performance of AI and that of the radiologists were compared using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). All parameters of diagnostic performance, except for sensitivity and NPV, improved with standard 2. For the 202 lesions in the test set, the diagnostic performance of the AI model had 77.0% accuracy, 82.0% sensitivity, 71.7% specificity, 79.3% PPV, 75.1% NPV, and an AUC of 0.846. When the AI model was used to analyze category 4A lesions, the PPV was 9.3%, which was better than that of the radiologists, although not significantly.ConclusionsDeep learning technology shows a good performance in classifying benign and malignant breast lesions. It may be potentially used in practice to improve diagnostic accuracy and reduce unnecessary biopsies of breast lesions.     

The negative predictive value of electrical impedance scanning in BI-RADS category IV breast lesions

OBJECTIVES: We sought to prospectively assess the value of electrical impedance scanning (EIS) in discriminating benign from malignant lesions classified as BI-RADS category IV in mammography in comparison with ultrasound (US), with a special focus on negative prediction. MATERIALS AND METHODS: EIS was performed on 128 BI-RADS category IV lesions in 121 women (mean, 51.8 years). The newly developed EIS software 2.67 calculates a BI-RADS-like level of suspicion (LOS) on a 5-grade scale. LOS 1, 2, and 3 were considered negative; LOS 4 and 5 were considered positive. Histopathologic results were obtained in all lesions. RESULTS: Histology proved 37 lesions malignant, 91 benign. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EIS compared with US were 94.6%, 74.7%, 80.5%, 60.3%, 97.1% versus 90.5%, 33.8%, 47.2%, 29.7%, 92.0%, respectively. In 43 lesions sized < or = 10 mm, EIS demonstrated better sensitivity, specificity, accuracy, PPV, and NPV of 100%, 83.3%, 90.7%, 82.6%, and 100%, respectively. Although NPV was also high, US showed no sufficient results in 39 (30.5%) lesions because of microcalcifications. Receiver operating curve analysis revealed best results for a combined use of US and EIS. CONCLUSIONS: With a NPV of 97.1% of EIS in BI-RADS category IV breast lesions, a negative result in these lesions could be firm indication to manage them as BI-RADS-category III and refer patients for a 6-month short-interval follow-up rather than performing a biopsy. The best adjunctive diagnostic performance can be achieved by a combination of US and EIS. Costs and patient morbidity could be minimized.