Integration of ultrasound protrusion count and age for improved differentiation of BI-RADS 4A breast nodules

Abstract

Objective To investigate the diagnostic value of the integration of the protrusion number on ultrasound images with age (using 40 years as the cutoff) in the differentiation of benign and malignant BI-RADS 4A breast nodules. Methods Retrospective analysis was conducted on BI-RADS 4A breast nodule cases that were confirmed by pathology. The number of protrusions was recorded, and the receiver operating characteristic curve was employed to determine the optimal cutoff value. Additionally, a combined diagnostic model was constructed, in which age served as a risk factor alongside the evaluation of its sensitivity, specificity, and the area under the curve (AUC). Results The number of protrusions was significantly higher in the malignant group, versus the benign group (P < 0.05), and patients age≥40 years exhibited a higher proportion of malignancy (P < 0.01). The combined model with the incorporation of age and protrusion count (6) demonstrated an AUC of 0.824, with a sensitivity of 71.3% and specificity of 83.0%. Conclusion Integrating protrusion count (≥6) with age stratification (≥40 years) appeared to improve diagnostic discrimination for BI-RADS 4A breast nodules in this retrospective cohort. This quantitative approach offers a practical tool for malignancy risk assessment, potentially reducing unnecessary biopsies while prioritizing early intervention.