Bi-rads 4 Risks for Malignancy Vary from study to study.

shabby6485

Hi to all,  Trying to gather as much info as possible on my bi-rads 4a rating.  I have read there is a 10% chance of malignancy.  However, Johns Hopkins Breast Ask an Expert states ... the radiologist would have assigned a birad score to his results. a score of 4a is 20% risk of cancer; 4b is 80% risk. so inquire about the score. the use of the word "suspicious" is obviously worrisome. I am suffer from severe anxiety and I was somewhat comfortable with 10% but 20% scares me.  Anybody know? 

marie5890

Shabby,

I dont think you are going to be able to find a good sense of what the stats are simply because many radiologists dont break down the BIRAD 4 into the A,B, C subcatagories.

They just give the mammos or US the general "BIRAD 4"

leaf

Another problem is that BIRADS ratings are subjective. Different radiologists can rate a mammogram differently. http://www.ncbi.nlm.nih.gov/pubmed/16569780

Look at the kappa (concordance value). 

The Cohen κ statistic was used to assess interreader agreement for all descriptor variables. The guidelines of Landis and Koch were followed in interpreting κ values: 0.00–0.20, slight agreement; 0.21–0.40, fair agreement; 0.41–0.60, moderate agreement; 0.61–0.80, substantial agreement; and 0.80–1.00, almost perfect agreement (7) ....Fair agreement was obtained for category 3 and 4c lesions (κ = 0.32 and 0.26, respectively); however, there was poor agreement between observers for category 4a and 4b lesions (κ = 0.14 and 0.16, respectively).http://radiology.rsna.org/content/239/2/385.long  (emphasis mine)

Beesie

Here's information from the American College of Radiologists, the people who oversee the BIRADs rating:

 BI-RADS® - Mammography, Fourth Edition

Category 4A
Category 4A may be used for a finding needing intervention but with a low suspicion for malignancy. A malignant pathology report not expected and a 6-month or routine follow-up after a benign biopsy or cytology is appropriate. Examples of findings placed in this category may be a palpable, partially circumscribed solid mass with ultrasound features suggestive of a fibroadenoma, a palpable complicated cyst or probable abscess.  (found under Guidance Chapter, page 4)

The ACR don't assign percentages to 4a, 4b and 4c but they do say that anything classified as BI-RADs 3 should represent no more than a 2% risk of BC.  So this means that anything considered to have even just a 3% risk will be classified as BI-RADs 4a. If that's the starting point for 4a, it's highly unlikely that the average would be as high as 20%.

The information from Hopkins appears questionable - it's simply not reasonable that a BI-RADs 4b represents an 80% risk of breast cancer.  From all the studies I've seen, the risk for BI-RADs 4 overall averages between 20% and 40% (usually closer to about 23% - 24%) so there is no way that 4b could be as high as 80%.  Logically, 4b is more likely to be consistent with the average (20% - 40%), with 4a representing a lower risk and 4c representing a higher risk.

I posted earlier one study that showed that only 10% of calcifcations classified as BI-RADs 4a were cancer (Clinical implications of subcategorizing BI-RADS 4 breast lesions associated with microcalcification: a radiology-pathology correlation study).  

I just read another study from Thailand that showed that only 9% of BI-RADs 4a were cancer. (Biopsy Rate and Positive Predictive Value for Breast Cancer in BI-RADS Category 4 Breast Lesions)

Frankly what it comes down to is the individual radiologist and the specific case.  In your case, the radiologist assessed your films as being BI-RADs 4a but the oncology surgeon looked at the same films and didn't see any concern - so my guess is he would have given the film a BI-RADs 3 rating.  What that says to me is that regardless of what the average of BI-RADs 4a rating might be in one study or another, in your case the assessment of your films is at the low end of the risk scale, probably in the 2% - 5% range.  

shabby6485

Thank you guys so much for all this info.  So very helpful for me. XOXOXO

SarahsMom

Beesie, you're the best. Thanks for being out here with us and for your detailed answers.

shabby6485

I agree! Bessie & Leaf you really are such a comfort to those of us in pain right now!

Blahblahblah326

Thank you for sharing this. I just got my report and it said a rate of a BIRAD 4 also! My friend read my report and she is in the medical feild and felt the radiologist was being a bit much on the rating. I have read very conflicting information on the BIRAD 4. I told myself the bottom line is it is either malignant or not. Either way - I am praying for the best, but preparing for the worst!

Gks

So if there is BIRADS 4a finding on imaging and if histopathology is benign is it considered rad path concordance considering that category 4 is suspicious. Though we know that imaging wise 4a is benign.

Moderators

Dear Gks,

We are wondering if you could say a bit more about your situation as your question is not entirely clear. This particular thread has not seen activity since 2012. You may want to start a new topic and add additional information about your situation so as to get the best responses. Let us know if we can assist you. The Mods

Gks

We are analyzing our data and wanted to know whether BIRADS 4A on imaging and histopath as benign pathology can it be labelled as rad path concordance.

MTwoman

Gks, BIRADS 4A suggests a low suspicion for malignancy, but requires a biopsy to give a definitive diagnosis. The pathology came back as benign (as expected). No issue of concordance/discordance.

My understanding is that in the case where a Radiologist goes on record as believing a mass is likely cancerous (based on his/her experience and the characteristics of the mass), and the pathology comes back as benign, then you would have discordance. Even then, unless you had some reason to believe that the sampling missed the area of concern, you would consider to the pathology report to be the final word.

Read through this thread for an idea of what discordance can look like:

https://community.breastcancer.org/forum/83/topics/799887