A grassroots antiracist program: The motivation and perceived growth of participants in a community-based, intergroup dialogue program.

In the United States, racial segregation still organizes the social lives of most people. This segregation of social life continues reinforcing attitudes and behaviors that sustain racial injustice in the United States. Given the longstanding structural forces sustaining the segregated status quo, why do certain individuals seek out opportunities for 'intentional integration'? And what happens when they do? This qualitative study interviewed racially diverse participants in a community-developed, sustained, and strategic intergroup dialogue program called Touchy Topics Tuesday (TTT), located in St. Louis, Missouri. Overall, participants (N = 30) described three interwoven motivations for involvement in the program-a catalytic moment, a long-term commitment mindset, and/or the influence of their social network. Of all these, participants' social network was the predominant motivating force for individuals across racial lines. Participants also reported three main categories of outcomes: intellectual growth, emotional growth, and relational growth. Each of these categories encompass both attitudinal and behavioral changes. The article interrogates these major findings in the context of the intergroup dialogue literature and studies of attitude change and psychotherapy.

Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study.

BACKGROUND: Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use-related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. OBJECTIVE: This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths' drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. METHODS: We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). RESULTS: We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one's life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3%) and longing (39/249, 15.7%) were the most popular. Most tweets that expressed pride (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47%) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6%). CONCLUSIONS: Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population.

The impact of a radiologist-led workshop on MRI target volume delineation for radiotherapy.

INTRODUCTION: Magnetic resonance imaging (MRI) is increasingly used for target volume delineation in radiotherapy due to its superior soft tissue visualisation compared to computed tomography (CT). The aim of this study was to assess the impact of a radiologist-led workshop on inter-observer variability in volume delineation on MRI. METHODS: Data from three separate studies evaluating the impact of MRI in lung, breast and cervix were collated. At pre-workshop evaluation, observers involved in each clinical site were instructed to delineate specified volumes. Radiologists specialising in each cancer site conducted an interactive workshop on interpretation of images and anatomy for each clinical site. At post-workshop evaluation, observers repeated delineation a minimum of 2 weeks after the workshops. Inter-observer variability was evaluated using dice similarity coefficient (DSC) and volume similarity (VOLSIM) index comparing reference and observer volumes. RESULTS: Post-workshop primary gross tumour volumes (GTV) were smaller than pre-workshop volumes for lung with a mean percentage reduction of 10.4%. Breast clinical target volumes (CTV) were similar but seroma volumes were smaller post-workshop on both supine (65% reduction) and prone MRI (73% reduction). Based on DSC scores, improvement in inter-observer variability was seen for the seroma cavity volume on prone MRI with a reduction in DSC score range from 0.4-0.8 to 0.7-0.9. Breast CTV demonstrated good inter-observer variability scores (mean DSC 0.9) for both pre- and post-workshop. Post-workshop observer delineated cervix GTV was smaller than pre-workshop by 26.9%. CONCLUSION: A radiologist-led workshop did not significantly reduce inter-observer variability in volume delineation for the three clinical sites. However, some improvement was noted in delineation of breast CTV, seroma volumes and cervix GTV.

The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning.

PURPOSE: The purpose of this study was to evaluate the impact of magnetic resonance imaging (MRI) versus computed tomography (CT)-derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiation therapy. METHODS AND MATERIALS: Four WB radiation therapy plans were generated for 28 patients in which PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6-MV tangential intensity modulated radiation therapy technique was used, with plans designated as ideal, acceptable, or noncompliant. Dose metrics for PTVs and organs at risk were compared to analyze any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone). RESULTS: With respect to imaging modality 2/11 whole breast planning target volume (WB_PTV) dose metrics (percentage of PTV receiving 90% and 110% of prescribed dose) displayed statistically significant differences; however, these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan versus a noncompliant plan were higher for the supine position compared with the prone position (P = .026). The minimum distance between the seroma cavity planning target volume (SC_PTV) and the chest wall was increased with prone positioning (P < .001, supine and prone values 1.1 mm and 8.7 mm, respectively). Heart volume was greater in the supine position (P = .005). Heart doses were lower in the supine position than prone (P < .01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone, respectively). Mean lung doses met ideal dose constraints in both positions, but were best spared in the prone position. The contralateral breast maximum dose to 1cc (D1cc) showed significantly lower doses in the supine position (P < .001, 4.64 Gy vs 9.51 Gy). CONCLUSIONS: Planning with PTVs generated from MRI data showed no clinically significant differences from planning with PTVs generated from CT with respect to PTV and doses to organs at risk. Prone positioning within this study reduced mean lung dose and whole heart volumes but increased mean heart and contralateral breast doses compared with supine.

Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions.

PURPOSE: To determine whether T2-weighted MRI improves seroma cavity (SC) and whole breast (WB) interobserver conformity for radiation therapy purposes, compared with the gold standard of CT, both in the prone and supine positions. METHODS AND MATERIALS: Eleven observers (2 radiologists and 9 radiation oncologists) delineated SC and WB clinical target volumes (CTVs) on T2-weighted MRI and CT supine and prone scans (4 scans per patient) for 33 patient datasets. Individual observer's volumes were compared using the Dice similarity coefficient, volume overlap index, center of mass shift, and Hausdorff distances. An average cavity visualization score was also determined. RESULTS: Imaging modality did not affect interobserver variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than supine CTVs (on both MRI and CT). Seroma cavity volumes were larger on CT than on MRI. Seroma cavity volumes proved to be comparable in interobserver conformity in both modalities (volume overlap index of 0.57 (95% Confidence Interval (CI) 0.54-0.60) for CT supine and 0.52 (95% CI 0.48-0.56) for MRI supine, 0.56 (95% CI 0.53-0.59) for CT prone and 0.55 (95% CI 0.51-0.59) for MRI prone); however, after registering modalities together the intermodality variation (Dice similarity coefficient of 0.41 (95% CI 0.36-0.46) for supine and 0.38 (0.34-0.42) for prone) was larger than the interobserver variability for SC, despite the location typically remaining constant. CONCLUSIONS: Magnetic resonance imaging interobserver variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Although the cavity visualization score and interobserver concordance was not significantly higher for MRI than for CT, the SCs were smaller on MRI, potentially owing to clearer SC definition, especially on T2-weighted MR images.

Ovarian and tubal torsion: imaging findings on US, CT, and MRI.

Accurate diagnosis of adnexal torsion is often challenging, as clinical presentation is nonspecific and the differential for pelvic pain is broad. However, prompt diagnosis and treatment is critical to good clinical outcomes and preservation of the ovary and/or fallopian tube. Ultrasound (US) imaging is most frequently used to assess torsion. However, as computed tomography (CT) utilization in the emergency setting has increased, there are times when CT is the initial imaging test. Additionally, the nonspecific clinical presentation may initially be interpreted as gastrointestinal in etiology, where CT is the preferred exam. For these reasons, it is imperative to know the findings of adnexal torsion on CT as well as US. Magnetic resonance imaging (MRI) is helpful in cases where the diagnosis remains unclear and is particularly helpful in the young or pregnant patient with equivocal sonographic findings, as it provides excellent soft tissue contrast without ionizing radiation. This article will illustrate the findings of surgically confirmed ovarian and fallopian tube torsion on US, CT, and MRI, including those in the pregnant patient. Ovarian enlargement, adnexal mass, twisting of the vascular pedicle, edematous and heterogeneous appearance of the ovary, peripheral ovarian follicles, free fluid, uterine deviation towards the side of torsion, adnexal fat stranding, tubal dilatation, and decreased adnexal enhancement will be reviewed. Familiarity with the range of imaging findings across multiple modalities is key to improving the likelihood of timely diagnosis and therefore improved clinical outcomes.

ACR Appropriateness Criteria® acute onset flank pain--suspicion of stone disease.

Low dose (<3 mSv) noncontrast CT (NCCT) is the imaging study of choice for accurate evaluation of patients with acute onset of flank pain and suspicion of stone disease (sensitivity 97%, specificity 95%). NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain such as appendicitis. By comparison, the sensitivity of radiographs (59%) and ultrasound (24-57%) for the detection of renal and ureteral calculi is relatively poor. Ultrasound can accurately diagnose pelvicaliectasis and ureterectasis, but it may take several hours for these findings to develop. In the pregnant patient, however, ultrasound is a first line test as it does not expose the fetus to ionizing radiation. MR is an accurate test for the diagnosis of pelvicaliectasis and ureterectasis, but is less sensitive than CT for the diagnosis of renal and ureteral calculi. For patients with known stone disease whose stones are visible on radiographs, radiographs are a good tool for post-treatment follow-up.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Necessity of hysterosalpingography after Essure microinsert placement for contraception.

OBJECTIVE: The objective of our study was to determine whether hysterosalpingography is necessary after Essure microinsert placement by evaluating the rates of appropriate placement and of satisfactory tubal occlusion in a general population. MATERIALS AND METHODS: We identified all patients who underwent hysterosalpingography after Essure microinsert placement for desired sterility between January 1, 2008, and August 1, 2010. We recorded demographic information and the hysterosalpingographic results. The images and operative reports of all cases with abnormal hysterosalpingographic findings were reviewed. The hysterosalpingographic results were reviewed for appropriate placement of the microinsert, for successful tubal occlusion, and for any additional abnormalities. We also reviewed the medical records for documentation of subsequent pregnancies. RESULTS: Two hundred forty hysterosalpingographic examinations were performed after 237 hysteroscopic microinsert placement procedures in 235 women. The mean age of the subjects was 35 years (range, 20-50 years). Twenty-two examinations (9.2%) were abnormal. Fourteen (5.8%) revealed inappropriate placement: six with tubal occlusion, seven without tubal occlusion, and one with an indeterminate finding for tubal occlusion. Fifteen examinations (6.3%) showed tubal nonocclusion: Microinsert placement was inappropriate in seven cases and appropriate in eight. Of the 22 abnormal hysterosalpingographic examinations, 20 had operative reports available. Eleven (55%) described difficulties with device insertion. Forty-two endometrial abnormalities were described in hysterosalpingographic reports of 38 patients. One subsequent pregnancy was documented in a patient with satisfactory device placement and tubal occlusion on hysterosalpingography. CONCLUSION: Hysterosalpingography after Essure microinsert placement is necessary because 6.3% of examinations showed abnormalities requiring an alternative form of contraception.

MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes.

Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis.

ACR Appropriateness Criteria ® acute onset of scrotal pain--without trauma, without antecedent mass.

Men or boys, who present with acute scrotal pain without prior trauma or a known mass, most commonly suffer from torsion of the spermatic cord; epididymitis or epididymoorchitis; or torsion of the testicular appendages. Less common causes of pain include a strangulated hernia, segmental testicular infarction, or a previously undiagnosed testicular tumor. Ultrasound is the study of choice to distinguish these disorders; it has supplanted Tc-99 m scrotal scintigraphy for the diagnosis of spermatic cord torsion. MRI should be used in a problem solving role if the ultrasound examination is inconclusive. The ACR Appropriateness Criteria ® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

ACR Appropriateness Criteria® posttreatment follow-up of prostate cancer.

Although prostate cancer can be effectively treated, recurrent or residual disease after therapy is not uncommon and is usually detected by a rise in prostate-specific antigen. Patients with biochemical prostate-specific antigen relapse should undergo a prompt search for the presence of local recurrence or distant metastatic disease, each requiring different forms of therapy. Various imaging modalities and image-guided procedures may be used in the evaluation of these patients. Literature on the indications and usefulness of these radiologic studies and procedures in specific clinical settings is reviewed. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy--self-assessment module.

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging evaluation of abdominal pain during pregnancy.

Female infertility: a systematic approach to radiologic imaging and diagnosis.

Imaging plays a key role in the diagnostic evaluation of women for infertility. The pelvic causes of female infertility are varied and range from tubal and peritubal abnormalities to uterine, cervical, and ovarian disorders. In most cases, the imaging work-up begins with hysterosalpingography to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at hysterosalpingography but typically require further characterization with hysterographic or pelvic ultrasonography (US) or pelvic magnetic resonance (MR) imaging. Hysterographic US helps differentiate among uterine synechiae, endometrial polyps, and submucosal leiomyomas. Pelvic US and MR imaging help further differentiate among uterine leiomyomas, adenomyosis, and the various müllerian duct anomalies, with MR imaging being the most sensitive modality for detecting endometriosis. The presence of cervical disease may be inferred initially on the basis of difficulty or failure of cervical cannulation at hysterosalpingography. Ovarian abnormalities are usually detected at US. The appropriate selection of imaging modalities and accurate characterization of the various pelvic causes of infertility are essential because the imaging findings help direct subsequent patient care.

Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients--1997-2006.

PURPOSE: To document the utilization of radiologic imaging in pregnant patients at one academic institution during a 10-year period (1997-2006). MATERIALS AND METHODS: The study was approved by the hospital institutional review board and was compliant with HIPAA. Informed consent was waived. At the authors' institution, pregnant patients exposed to radiation during imaging are recorded in a database compiled by the medical physics department. The authors retrospectively reviewed this database to document the number of patients, number of each type of imaging examination, date of the examination, and the estimated radiation dose to the fetus from 1997 to 2006. The authors searched the institution's medical records to obtain the total number of deliveries by year as a control for the total pregnant patient population. RESULTS: During the 10-year period, 5270 examinations were performed in 3285 pregnant patients (mean age, 28 years). The number of patients and examinations increased from 237 patients undergoing 331 studies in 1997 to 449 patients undergoing 732 examinations in 2006, an increase of 89% in patients and 121% in examinations. The total number of pregnant patients measured by deliveries increased 7%--from 8661 in 1997 to 9264 in 2006. Utilization rates (examinations per 1000 deliveries) of all radiologic examinations increased 107% from 1997 to 2006. The number of conventional radiographic examinations increased by an average of 7% per year, nuclear medicine examinations by 12% per year, and computed tomographic (CT) examinations by 25% per year. The average estimated fetal radiation exposure per examination was 0.43 mGy (range, 0.01-22.5 mGy) for conventional radiography, 4.3 mGy (range, 0.01-43.9 mGy) for CT, and 0.40 mGy (range, 0.01-7.7 mGy) for nuclear medicine examinations. CONCLUSION: For the comparison of 1997 to 2006, the radiologic utilization rate in pregnant patients increased by 107% from 1997 to 2006. The greatest increase was in CT.

Stereotactic breast biopsy: comparison of histologic underestimation rates with 11- and 9-gauge vacuum-assisted breast biopsy.

OBJECTIVE: The purpose of this study was to compare histologic underestimations at stereotactic 11- and 9-gauge vacuum-assisted breast biopsy. MATERIALS AND METHODS: The reports of 1,223 consecutive stereotactic vacuum-assisted breast biopsies were retrospectively reviewed. An 11-gauge device was used to perform 828 and a 9-gauge device to perform 395 biopsies. The pathologic results were reviewed for all cases. Biopsy results of atypical ductal hyperplasia and ductal carcinoma in situ were compared with the pathologic results after surgical excision. Underestimation was defined as the need to upgrade atypical ductal hyperplasia to ductal carcinoma in situ or invasive carcinoma at surgery and to upgrade ductal carcinoma in situ to invasive carcinoma. Statistical significance was determined with the chi-square test and 95% CI. RESULTS: In the 11-gauge group, 12 (26%) of 46 cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ and one (2%) of the cases to invasive carcinoma. In the 9-gauge group, six (22%) of 27 cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ and two (7%) of the cases to invasive carcinoma. In the 11-gauge group, 35 (28.7%) of 122 cases of ductal carcinoma in situ were upgraded to invasive carcinoma. In the 9-gauge group, 10 (23%) of 44 cases of ductal carcinoma in situ were upgraded to invasive carcinoma. CONCLUSION: There was no statistically significant difference between 11-gauge biopsy and 9-gauge biopsy in underestimation of atypical ductal hyperplasia and ductal carcinoma in situ.

CT in the evaluation of nontraumatic abdominal pain in pregnant women.

PURPOSE: To retrospectively determine sensitivity and specificity of computed tomography (CT) for the diagnosis of appendicitis in pregnant women with nontraumatic abdominal pain and retrospectively compare findings at CT and ultrasonography (US) in patients who underwent both examinations, with surgery or clinical follow-up as a reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, and the study was HIPAA compliant. Informed consent was waived. Findings of 80 consecutive CT examinations performed in 78 pregnant women (mean age, 25.9 years; range, 17-43 years) for abdominal pain between September 2000 and October 2004 were compared with findings at prior US (n=52), surgery, and clinical follow-up. Sensitivity and specificity were calculated for the diagnosis of appendicitis. The average fetal radiation dose was 16 mGy (1.6 rad) (range, 4-45 mGy [4-4.5 rad]). RESULTS: CT findings were normal in 51 examinations (64%) and abnormal in 29 (36%). Abnormal findings were appendicitis (n=13), urinary tract calculi (n=6), small-bowel obstruction (n=2), cholelithiasis (n=2), pyelonephritis (n=2), diaphragmatic hernia (n=1), cecal bascule (n=1), ileus (n=1), and metastatic lymphadenopathy (n=1). One surgically confirmed case of appendicitis was not detected at CT. For diagnosis of appendicitis, sensitivity of CT was 92% (12 of 13 examinations), specificity was 99% (66 of 67), and negative predictive value was 99% (66 of 67). Fifty-two CT studies were performed after US. US findings were normal in 46 patients (88%) and abnormal in six (12%). Abnormal findings were cholelithiasis (n=3), obstructive hydronephrosis (n=1), small-bowel dilatation (n=1), and appendicitis (n=1). Among 46 patients with normal US findings, CT findings were abnormal in 14, nine of whom required surgery. CT added important diagnostic information in 14 of 46 patients (30%). CONCLUSION: CT findings established the diagnosis in 35% of examinations in pregnant women with abdominal pain (28 of 80), with a negative predictive value of 99% for appendicitis; when CT followed negative US findings, CT findings established the diagnosis in 30% of patients.

BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value.

PURPOSE: To retrospectively evaluate interobserver variability between breast radiologists by using terminology of the fourth edition of the Breast Imaging Reporting and Data System (BI-RADS) to categorize lesions on mammograms and sonograms and to retrospectively determine the positive predictive value (PPV) of BI-RADS categories 4a, 4b, and 4c. MATERIALS AND METHODS: Institutional review board approval was obtained; informed consent was not required. This study was HIPAA compliant. Ninety-four consecutive lesions in 91 women who underwent image-guided biopsy comprised 59 masses, 32 calcifications, and three masses with calcification. Five radiologists retrospectively reviewed these lesions. Each observer described each lesion with BI-RADS terminology and assigned a final BI-RADS category. Interobserver variability was assessed with the Cohen kappa statistic. A pathologic diagnosis was available for all 94 lesions; 30 (32%) were malignant and 64 (68%) were benign. Pathologic analysis of benign lesions was performed on tissue obtained with image-guided core-needle biopsy. In cases referred for excisional biopsy after needle biopsy because of atypia or discordance, final surgical pathologic analysis was used for correlation with imaging findings. PPV for category 4 or 5 lesions was determined for all readers combined. RESULTS: For ultrasonographic (US) descriptors, substantial agreement was obtained for lesion orientation, shape, and boundary (kappa = 0.61, 0.66, and 0.69, respectively). Moderate agreement was obtained for lesion margin and posterior acoustic features (kappa = 0.40 for both). Fair agreement was obtained for lesion echo pattern (kappa = 0.29). For mammographic descriptors, moderate agreement was obtained for mass shape, mass margin, and calcification distribution (kappa = 0.48, 0.48, and 0.50, respectively). Fair agreement was obtained for calcification description (kappa = 0.32). Slight agreement was obtained for mass density (kappa = 0.18). Fair agreement was obtained for final assessment category (kappa = 0.28). PPVs of BI-RADS category 4 and 5 assignments were as follows: category 4a, six (6%) of 102; category 4b, 17 (15%) of 110; category 4c, 48 (53%) of 91; and category 5, 71 (91%) of 78. CONCLUSION: Interobserver agreement with the new BI-RADS terminology is good and validates the US lexicon. Subcategories 4a, 4b, and 4c are useful in predicting the likelihood of malignancy.

Characterization of breast masses with sonography: can biopsy of some solid masses be deferred?

OBJECTIVE: To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred. METHODS: We prospectively characterized 844 sonographically visible solid breast masses referred for biopsy. Mammographic and sonographic features of the masses were recorded, and all masses were categorized by American College of Radiology Breast Imaging Reporting and Data System classification before biopsy. Of the 844 masses, 148 were categorized as probably benign (Breast Imaging Reporting and Data System category 3). Sonographically guided biopsy (n = 804) or fine-needle aspiration (n = 40) was performed for pathologic correlation. RESULTS: Of the 148 masses that met the sonographic criteria for probably benign masses, there was 1 malignancy, for a negative predictive value of 99.3%. CONCLUSIONS: Follow-up can be an acceptable alternative to biopsy for sonographically probably benign solid masses.