Division of Radiology, Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada.
AJR Am J Roentgenol. 2012 Sep;199(3):W402-8. doi: 10.2214/AJR.11.7374.
The purpose of this study was to compare the efficacy of the sonographic features in the BI-RADS lexicon for predicting malignancy grade of invasive ductal breast carcinoma in women assigned a BI-RADS category of 4 or 5.
Two radiologists retrospectively evaluated 299 consecutive cases of grades 1-3 invasive ductal breast carcinoma presenting as a mass in consensus by using the BI-RADS sonographic lexicon. Histologic grade was established on surgical specimens. Effect sizes were calculated via the Goodman and Kruskal tau, an asymmetric measure of strength of nominal association, and results were interpreted in terms of proportional reduction in error.
Thirty-eight lesions (13%) were grade 1, 153 (51%) were grade 2, and 108 (36%) were grade 3, with the majority of all masses showing an irregular shape (84%) and hypoechoic echotexture (82%). Of the sonographic features examined, malignancy grade was best predicted by posterior acoustics (τ = 0.13, p < 0.001), lesion boundary (τ = 0.05, p < 0.001), and margin (τ = 0.04, p = 0.001). Among grade 3 lesions, there were significantly more lesions with posterior enhancement (53 vs 27.6; adjusted standardized residuals (z(res)) = 7; p < 0.001), abrupt interfaces (68 vs 51.2; z(res) = 4; p < 0.001), and microlobulated margins (12 vs 5.8; z(res) = 3; p = 0.001) than would be expected.
Malignancy grade was slightly to moderately predicted by margin, lesion boundary, and acoustic sonographic features. In particular, grade 3 invasive ductal breast carcinomas were more likely than expected to display microlobulated margins, abrupt interfaces, and posterior enhancement.
本研究旨在比较 BI-RADS 词汇中的超声特征在预测女性 BI-RADS 4 或 5 类别中浸润性导管乳腺癌恶性程度分级的效能。
两位放射科医生使用 BI-RADS 超声词汇对 299 例连续浸润性导管乳腺癌病例进行了回顾性评估，这些病例均为肿块，且在共识中被评估为 1-3 级。组织学分级是基于手术标本建立的。采用 Goodman 和 Kruskal tau 计算效应大小，这是一种衡量名义关联强度的非对称度量，并根据误差减少的比例来解释结果。
38 个病变（13%）为 1 级，153 个病变（51%）为 2 级，108 个病变（36%）为 3 级，所有肿块中大部分呈不规则形状（84%）和低回声回声纹理（82%）。在所检查的超声特征中，恶性程度分级最好由后向回声（τ=0.13，p<0.001）、病变边界（τ=0.05，p<0.001）和边界（τ=0.04，p=0.001）预测。在 3 级病变中，后向增强（53 例比 27.6 例；调整标准化残差（z(res)）=7；p<0.001）、突然的界面（68 例比 51.2 例；z(res)）=4；p<0.001）和微叶状边界（12 例比 5.8 例；z(res)）=3；p=0.001）的病变明显更多。
边界、病变边界和声学超声特征可轻度至中度预测恶性程度分级。特别是，3 级浸润性导管乳腺癌更有可能显示微叶状边界、突然的界面和后向增强。
