Al-Khawari Hanaa, Athyal Reji, Kovacs Agnes, Al-Saleh Mervat, Madda John Patrick
Department of Radiology, Faculty of Medicine, Kuwait University, 13110 Safat, Kuwait.
Ann Saudi Med. 2009 Jul-Aug;29(4):280-7. doi: 10.4103/0256-4947.55310.
Fischer developed a scoring system in 1999 that made identifying malignnant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance (MR) imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data System (MRM BI-RADS) grade and the final diagnosis.
The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging.
There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 (64%), category IV in 7 (28%), and category III in 2 (8%) lesions. Benign lesions were graded as category V in 3 (10%), category IV in 6 (20%), and category III in 3 (10%), category II in 10 (33%) and category I in 8 (27%) lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions.
The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies.
1999年费舍尔开发了一种评分系统，这使得经验不足的放射科医生更容易识别恶性病变。我们开展这项研究是为了评估该评分系统是否有助于初学者在磁共振（MR）成像上准确诊断乳腺病变，并评估磁共振乳腺成像报告和数据系统（MRM BI-RADS）分级与最终诊断之间的相关性。
对41例患者的63个肿块的病变形态和对比剂动力学在MRI上进行评估，并使用费舍尔评分系统给予MRM BI-RADS最终评估类别。在通过组织取样和后续成像获得最终诊断后评估准确性。
有25个恶性病变和30个良性病变。8个病变仅在MRI上可见，由于研究时我们没有MR引导活检设备，所以无法核实其病理情况。在MR乳腺成像上，经证实的癌性病变中，16个（64%）为BI-RADS V类，7个（28%）为IV类，2个（8%）为III类病变。良性病变中，3个（10%）为V类，6个（20%）为IV类，3个（10%）为III类，10个（33%）为II类，8个（27%）为I类病变。MRM BI-RADS类别在92%的病变中准确预测了恶性，在70%的病变中准确预测了良性病理。慢性炎性病变和癌的MRM特征之间的重叠导致诊断良性病变的准确性低于恶性病变。
使用费舍尔评分系统的MRM BI-RADS词典是有用的，具有较高的预测价值，尤其是对于乳腺恶性病变，且易于应用。良性炎性病变和恶性病变之间的重叠特征可能导致炎性病变的诊断准确性降低。
