Tumor size impacts the performance of ultrasound BI-RADS classification in breast cancer patients

Tumor size impacts the performance of ultrasound BI-RADS classification in breast cancer patients INTRODUCTIONBreast cancer has high mortality and morbidity rates in women (1,2) .However, many diagnostic methods are frequently limited due to their poor accuracy in the detection of early breast cancer.Ultrasound (US) is a sensitive examination method for newly diagnosed breast cancers (3) .However, it strongly depends on the US operators and their experience in detecting, describing and interpreting the US features of breast mass (3) .The visual effect of US image significantly influences their judgments while screening the breast mass, therefore, the mass size is an influential factor for operators in US examination.US has limitations related to small size, including limited field of view, high operator dependency and low accuracy (4,5) .However, the tumor size is rarely considered during US examination and evaluation of breast cancer.Breast Imaging Reporting And Data System (BI-RADS) was first published in 2003, which provided three standardized US lexicons including shape, margin and growth orientation for the classification of breast mass (6)(7)(8) .With the development of US technology, the lexicons of BI-RADS have been greatly complemented by adding valuable features of echo pattern, posterior features, calcifications and elasticity in the fifth edition of BI-RADS released in 2013, which further improved the diagnostic performance of US (9)(10)(11) .In terms of the diagnosis of breast mass, the US examination primarily assesses the BI-RADS category to help the clinician to choose the appropriate treatment protocol (6,12) .However, the uncertain US features greatly affect the accuracy of BI-RADS category in a small mass compared to a larger mass (13) .The size of breast mass is not considered as an influencing factor in the diagnosis of BI-RADS category.Moreover, few studies discussed the relationship of the mass size and BI-RADS in patients with breast mass (14,15) .This is the first study to analyze tumor size as an influencing factor for US BI-RADS category.This novel idea can further improve the diagnostic performance of BI-RADS category in the patients with breast cancer.