Raza Sughra, Chikarmane Sona A, Neilsen Sarah S, Zorn Lisa M, Birdwell Robyn L
Department of Radiology, Brigham & Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
Radiology. 2008 Sep;248(3):773-81. doi: 10.1148/radiol.2483071786. Epub 2008 Jul 22.
To evaluate the use, final outcome, and positive biopsy rate of American College of Radiology ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4, and 5 recommended for breast masses.
At US, consecutive masses, palpable and nonpalpable, categorized as BI-RADS 3, 4, and 5 between January 1, 2003, and December 31, 2004, were retrospectively reviewed with institutional review board approval. Medical records provided imaging and histologic information.
After patients lost to follow-up were excluded, the study population was 767 patients with 926 masses (476 palpable, 450 nonpalpable). In BI-RADS 3 masses (n = 356), imaging follow-up of 252 masses documented stability for 6-24 months. Aspiration of 24 masses revealed cysts. Biopsy in 80 masses revealed three malignancies, all of which were diagnosed within 6 months of the index examination, were smaller than 1 cm, and were node negative (negative predictive value = 99.2%). In BI-RADS 4 masses (n = 524), aspiration results indicated 35 cysts; biopsy in 455 revealed 85 malignancies (positive predictive value [PPV] = 16.2%). Imaging follow-up only in 34 revealed no cancers 2 and more years later. Among BI-RADS 5 masses (n = 46), 43 were malignant and three benign (PPV = 93.4%).
Inconsistent use of BI-RADS category 3 occurred in 14.0% of cases when biopsy was recommended. Although biopsy was performed in almost equal numbers of palpable and nonpalpable masses, only 11% of palpable BI-RADS 3 and 4 masses were malignant, as compared with 22% of nonpalpable masses. Strict adherence to lexicon characteristics of probably benign lesions should improve specificity.
评估美国放射学会超声（US）乳腺影像报告和数据系统（BI-RADS）3、4和5类乳腺肿块的使用情况、最终结果及活检阳性率。
在超声检查中，对2003年1月1日至2004年12月31日期间连续发现的、经机构审查委员会批准后进行回顾性研究的、触诊及非触诊的BI-RADS 3、4和5类肿块进行回顾。病历提供了影像和组织学信息。
排除失访患者后，研究人群为767例患者，共926个肿块（476个可触及，450个不可触及）。在BI-RADS 3类肿块（n = 356）中，对252个肿块进行影像随访，记录显示其在6 - 24个月内保持稳定。对24个肿块进行抽吸显示为囊肿。对80个肿块进行活检发现3例恶性肿瘤，所有这些肿瘤均在首次检查后6个月内被诊断出来，直径小于1 cm，且无淋巴结转移（阴性预测值 = 99.2%）。在BI-RADS 4类肿块（n = 524）中，抽吸结果显示35个为囊肿；对455个肿块进行活检发现85例恶性肿瘤（阳性预测值[PPV] = 16.2%）。仅对34个肿块进行影像随访，2年及更长时间后未发现癌症。在BI-RADS 5类肿块（n = 46）中，43个为恶性，3个为良性（PPV = 93.4%）。
在建议进行活检的病例中，14.0%的情况对BI-RADS 3类的使用不一致。尽管对可触及和不可触及肿块进行活检的数量几乎相等，但可触及的BI-RADS 3和4类肿块中只有11%为恶性，而不可触及肿块中这一比例为22%。严格遵循可能为良性病变的词典特征应可提高特异性。
