Burnside Elizabeth S, Ochsner Jennifer E, Fowler Kathryn J, Fine Jason P, Salkowski Lonie R, Rubin Daniel L, Sisney Gale A
Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA.
Radiology. 2007 Feb;242(2):388-95. doi: 10.1148/radiol.2422052130.
To retrospectively evaluate whether microcalcification descriptors and the categorization of microcalcification descriptors in the Breast Imaging Reporting and Data System (BI-RADS) 4th edition help stratify the risk of malignancy, by using biopsy and clinical follow-up as reference standards.
The institutional review board approved this HIPAA-compliant study and waived informed consent. The study included 115 women (age range, 26-82 years; mean age, 55.8 years +/- 10.5 [standard deviation]) who consecutively underwent image-guided biopsy of microcalcifications between November 2001 and October 2002. Screening and diagnostic mammograms (including magnification views) obtained before biopsy were analyzed in a blinded manner by a subspecialty-trained breast imager who recorded BI-RADS descriptors on a checklist. The proportion of malignant cases was used as the outcome variable to evaluate the ability of the descriptors to help capture the risk of malignancy. Fisher exact test was used to calculate the difference among the individual descriptors and descriptor categories.
The positive predictive value of biopsy for malignancy was 21.7%. Each calcification morphologic descriptor was able to help stratify the probability of malignancy as follows: coarse heterogeneous, one (7%) of 14; amorphous, four (13%) of 30; fine pleomorphic, 10 (29%) of 34; and fine linear, 10 (53%) of 19. Fisher exact test results revealed a significant difference among these descriptor categories (P = .005). Significant differences among the risks suggested by microcalcification distribution descriptors (P = .004) and between that of stability descriptors (P = .001) were found.
The microcalcification descriptors and categories in BI-RADS 4th edition help predict the risk of malignancy for suspicious microcalcifications.
通过将活检和临床随访作为参考标准，回顾性评估乳腺影像报告和数据系统（BI-RADS）第4版中的微钙化描述符及微钙化描述符分类是否有助于对恶性风险进行分层。
机构审查委员会批准了这项符合健康保险流通与责任法案（HIPAA）的研究，并豁免了知情同意。该研究纳入了115名女性（年龄范围26 - 82岁；平均年龄55.8岁±10.5[标准差]），她们在2001年11月至2002年10月期间连续接受了影像引导下的微钙化活检。活检前获得的筛查和诊断性乳腺钼靶片（包括放大视图）由一名经过专科培训的乳腺影像医师以盲法进行分析，该医师在检查表上记录BI-RADS描述符。恶性病例的比例用作结果变量，以评估描述符捕捉恶性风险的能力。采用Fisher精确检验计算各个描述符及描述符类别之间的差异。
活检对恶性肿瘤的阳性预测值为21.7%。每个钙化形态描述符能够如下帮助对恶性概率进行分层：粗大不均质型，14例中有1例（占7%）；无定形，30例中有4例（占13%）；细多形性，34例中有10例（占29%）；以及细线性，19例中有10例（占53%）。Fisher精确检验结果显示这些描述符类别之间存在显著差异（P = 0.005）。发现微钙化分布描述符提示的风险之间存在显著差异（P = 0.004），稳定性描述符提示的风险之间也存在显著差异（P = 0.001）。
BI-RADS第4版中的微钙化描述符及类别有助于预测可疑微钙化的恶性风险。
