Lacquement M A, Mitchell D, Hollingsworth A B
University of Oklahoma Institute for Breast Health, Department of Surgery, Oklahoma City 73104, USA.
J Am Coll Surg. 1999 Jul;189(1):34-40. doi: 10.1016/s1072-7515(99)00080-0.
The American College of Radiology has established guidelines for outcomes monitoring known as the Breast Imaging Reporting and Data System (BIRADS). These recommendations include calculation of positive predictive values (PPV) and tracking of both benign and malignant histology. We collected this data for 688 radiographically guided biopsies and organized it according to the BIRADS assessment categories. The objective was to evaluate the contribution of the BIRAD System when used to stratify PPV, histology, and biopsy modality data according to the overall assessment rating.
This study included data from 688 image-guided biopsies. Mammographic studies were either assigned a BIRADS rating at the time of examination or, if the image was taken before our use of BIRADS, examined retrospectively and rated. In these retrospective cases, the histologic outcomes of the biopsy remained unknown to the radiologist until ratings were assigned. Positive predictive value was calculated for each BIRADS category.
The overall PPV for the sample was 0.23. The PPVs increased with increasing level of suspicion as follows: category 1 (0.0), category 2 (0.04), category 3 (0.03), category 4 (0.23), category 5 (0.92). Category 1 lesions represented 0.1% of the biopsies; category 2, 3.6%; category 3, 46.8%; category 4, 34.0%; and category 5, 15.4%. The most common histologic diagnoses of benign lesions biopsied were fibroadenoma and fibrocystic changes-proliferative and nonproliferative. The most common histologic diagnoses of malignant lesions biopsied were infiltrating ductal carcinoma and ductal carcinoma in situ. Utilization rates of the biopsy techniques varied by BIRADS category.
Our study revealed that BIRADS does improve the quality of the risk assessment information by making the PPV more specific to a patient's mammogram rather than simply related to an overall PPV. Our histology analysis showed category 3 and category 4 benign biopsies were predominantly because of fibrocystic changes. Category 5 lesions were predominantly invasive ductal carcinoma. Analysis of biopsy modalities indicated the preferred method for management of radiographically detected lesions evolved from stereotactic core biopsy to directional, vacuum-assisted biopsy over the course of the study.
美国放射学会制定了名为乳腺影像报告和数据系统（BIRADS）的结果监测指南。这些建议包括计算阳性预测值（PPV）以及追踪良性和恶性组织学情况。我们收集了688例影像学引导活检的数据，并根据BIRADS评估类别进行整理。目的是评估BIRADS系统在根据总体评估等级对PPV、组织学和活检方式数据进行分层时的作用。
本研究纳入了688例影像引导活检的数据。乳腺钼靶检查在检查时被赋予BIRADS评级，或者，如果图像是在我们使用BIRADS之前拍摄的，则进行回顾性检查并评级。在这些回顾性病例中，在给出评级之前，放射科医生对活检的组织学结果并不知晓。计算每个BIRADS类别的阳性预测值。
样本的总体PPV为0.23。PPV随着怀疑程度的增加而升高，如下所示：1类（0.0），2类（0.04），3类（0.03），4类（0.23），5类（0.92）。1类病变占活检的0.1%；2类，3.6%；3类，46.8%；4类，34.0%；5类，15.4%。活检的良性病变最常见的组织学诊断是纤维腺瘤和纤维囊性变——增殖性和非增殖性。活检的恶性病变最常见的组织学诊断是浸润性导管癌和导管原位癌。活检技术的利用率因BIRADS类别而异。
我们的研究表明，BIRADS通过使PPV更针对患者的乳腺钼靶检查，而不是简单地与总体PPV相关，确实提高了风险评估信息的质量。我们的组织学分析表明，3类和4类良性活检主要是由于纤维囊性变。5类病变主要是浸润性导管癌。活检方式分析表明，在研究过程中，对影像学检测到的病变进行处理的首选方法从立体定位芯针活检演变为定向真空辅助活检。
