Chikarmane Sona A, Tai Ryan, Meyer Jack E, Giess Catherine S
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115; Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215.
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
Acad Radiol. 2017 Apr;24(4):435-441. doi: 10.1016/j.acra.2016.11.008. Epub 2016 Dec 7.
This study aims to determine the prevalence and predictive value of Breast Imaging Reporting and Data System (BI-RADS) 3, 4, and 5 findings on breast magnetic resonance imaging (MRI) and to evaluate the impact of study indication on the predictive value of BI-RADS categories.
This institutional review board approved, Health Insurance Portability and Accountability Act (HIPAA) compliant retrospective review of our breast MRI database from 2009 to 2011, of 5778 contrast-enhanced studies in 3360 patients was performed. At our institution, each breast receives an individual BI-RADS assessment. Breast MRI reports and electronic medical records were reviewed to obtain BI-RADS assessment, patient demographics, and outcomes. Univariate analysis was performed with Fisher exact and chi-square tests.
A total of 9216 BI-RADS assessments were assigned during the study period: 7879 (85.5%) BI-RADS 1 and 2, 567 (6.2%) BI-RADS 3, 715 (7.8%) BI-RADS 4, and 55 (0.6%) BI-RADS 5 assessments. The frequency of BI-RADS 3, 4, and 5 assessments was higher in studies performed for diagnostic (7.8%, 14.6%, 1.6%, respectively) than screening (5.2%, 4.0%, 0.1%) indications (P < 0.01). A total of 663 BI-RADS 4 and 5 lesions were biopsied with 209 (31.5%) malignant and 454 (68.5%) benign outcomes. The overall cancer rate for BI-RADS 3 findings was 1.9% (11 of 567) with no difference observed by study indication (diagnostic, 1.6%; screening, 2.3%; P = 0.76). The positive predictive value (PPV2) of BI-RADS 4 and 5 was higher for diagnostic (29.1%, 154 of 530) than for screening (22.9%, 55 of 240) indications.
Abnormal interpretation rates and PPV2 for MRIs performed for diagnostic indications are higher than for screening indications. Similar to mammography, breast MRI audits should be separated by study indication.
本研究旨在确定乳腺影像报告和数据系统（BI-RADS）3、4和5类结果在乳腺磁共振成像（MRI）中的患病率和预测价值，并评估研究指征对BI-RADS分类预测价值的影响。
本研究经机构审查委员会批准，符合健康保险流通与责任法案（HIPAA）要求，对我们2009年至2011年的乳腺MRI数据库进行回顾性研究，共纳入3360例患者的5778次对比增强检查。在我们机构，每个乳腺均接受单独的BI-RADS评估。回顾乳腺MRI报告和电子病历以获取BI-RADS评估、患者人口统计学信息及结果。采用Fisher精确检验和卡方检验进行单因素分析。
研究期间共进行了9216次BI-RADS评估：7879次（85.5%）为BI-RADS 1和2类，567次（6.2%）为BI-RADS 3类，715次（7.8%）为BI-RADS 4类，55次（0.6%）为BI-RADS 5类评估。诊断性检查（分别为7.8%、14.6%、1.6%）中BI-RADS 3、4和5类评估的频率高于筛查性检查（分别为5.2%、4.0%、0.1%）（P < 0.01）。共对663个BI-RADS 4和5类病变进行了活检，其中209个（31.5%）为恶性，454个（68.5%）为良性。BI-RADS 3类结果的总体癌症发生率为1.9%（567例中有11例），研究指征之间未观察到差异（诊断性检查为1.6%；筛查性检查为2.3%；P = 0.76）。诊断性检查中BI-RADS 4和5类的阳性预测值（PPV2）（29.1%，530例中有154例）高于筛查性检查（22.9%，240例中有55例）。
诊断性检查的MRI异常解读率和PPV2高于筛查性检查。与乳腺X线摄影类似，乳腺MRI审核应按研究指征分开进行。
