AUTHOR=Xie Yamie , Zhu Ying , Chai Weimin , Zong Shaoyun , Xu Shangyan , Zhan Weiwei , Zhang Xiaoxiao 

TITLE=Downgrade BI-RADS 4A Patients Using Nomogram Based on Breast Magnetic Resonance Imaging, Ultrasound, and Mammography

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.807402

DOI=10.3389/fonc.2022.807402

ISSN=2234-943X

ABSTRACT=Objectives
Study how to downgrade the BI-RADS 4A patients by constructing a nomogram using R software.
Materials and Methods
The institutional review board of Shanghai Ruijin Hospital approved the retrospective study and abandoned the requirement to obtain patient approval or written informed consent to review medical records or images. 1717 patients were retrospectively analyzed who underwent preoperative ultrasound, mammography, and magnetic resonance examinations in our hospital from August 2019 to September 2020, and a total of 458 patients of category BI-RADS 4A (mean age, 47 years; range 18-84 years; all women) were included. Multivariable logistic regression was used to screen out the independent influencing parameters that affect the benign and malignant tumors, and the nomogram was constructed by R language to downgrade BI-RADS 4A patients to eligible category.
Results
59.6% (273/458) of BI-RADS 4A patients were degraded to category 3. The malignancy rate of these 273 lesions is 1.5% (4/273) (<2%), and the sensitivity reduced to 99.6%, the specificity increased from 4.41% to 45.3%, and the accuracy increased from 63.4% to 78.8%. 
Conclusion
By constructing a nomogram, some patients can be downgraded to avoid unnecessary biopsy.