Ultrasound Int Open 2016; 02(03): E83-E89
DOI: 10.1055/s-0042-110657
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions

S. Ackermann
1   Gynecology & Obstetrics, Hôpital de Morges, Morges, Switzerland
C.-A. Schoenenberger
2   Department of Chemistry, University of Basel, Basel, Switzerland
R. Zanetti-Dällenbach
3   Gynecology & Obstetrics, University Hospital Basel, Basel, Switzerland
› Author Affiliations
Further Information

Publication History

received 16 December 2015

accepted 06 June 2016

Publication Date:
19 July 2016 (online)



Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings could provide additional information that would help determine further diagnostic steps in breast lesions.

Materials and Methods:

We conducted a retrospective study by exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimally invasive breast biopsy (MIBB) from January 2002 to December 2011.


The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%, respectively. In 506 BI-RADS 3 lesions, histology revealed 15 malignancies (2.4% malignancy rate), which corresponds to a false-negative rate (FNR) of 2.6%. Clinical evaluation and patient requests critically influenced the further diagnostic procedure, thereby prevailing over the recommendation given by the BI-RADS 3 classification.


Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures such as short-term follow-up or MIBB in patients with lesions classified as US-BI-RADS 3.