1 Department of Radiology, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
2 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.
AJR Am J Roentgenol. 2017 Oct;209(4):943-948. doi: 10.2214/AJR.16.17518. Epub 2017 Aug 10.
The objective of our study was to determine the impact of 5th edition BI-RADS breast density assessment guidelines on density reporting patterns in our clinical practice.
PenRad reporting system was used to collect mammographic breast density data reported by five radiologists: 16,907 density assignments using 5th edition BI-RADS guidelines were compared with 19,066 density assessments using 4th edition guidelines. Changes in the density assessment pattern were noted between the 4th and 5th edition guidelines, and agreement in density distribution was compared using the intraclass correlation coefficient. A chi-square analysis was conducted for each reader to examine the change in the proportion of dense versus nondense assignments and on each category type to examine specific changes in proportion of density assignments from the 4th to the 5th edition. All reported p values are two-sided, and statistical significance was considered at the p < 0.001 threshold.
Using the 5th edition, there was an overall 5.0% decrease in fatty assessments (p < 0.001), 2.8% increase in scattered densities (p < 0.001), 2.6% increase in heterogeneously dense (p < 0.001), and 0.4% decrease in extremely dense assessments (p = 0.15). Comparing the dense with nondense categories, there was a 2.3% overall increase in the dense assessments (p < 0.001) using 5th edition guidelines, mainly in the heterogeneously dense category. Two radiologists showed increased dense assessments (p < 0.001) using the 5th edition, and three radiologists showed no change (p = 0.39, 0.67, and 0.76).
There was an overall increase in the dense assessments using the 5th edition, but individual radiologists in our clinical practice showed a variable adaptation to new guidelines.
本研究的目的是确定第五版 BI-RADS 乳腺密度评估指南对我们临床实践中密度报告模式的影响。
使用 PenRad 报告系统收集了五位放射科医生报告的乳腺钼靶密度数据：使用第五版 BI-RADS 指南进行了 16907 次密度评估，与使用第四版指南进行的 19066 次密度评估进行了比较。在第四版和第五版指南之间，注意到密度评估模式的变化，并使用组内相关系数比较密度分布的一致性。对每位读者进行卡方分析，以检查致密与非致密分配的比例变化，并对每个类别类型进行分析，以检查从第四版到第五版的密度分配比例的具体变化。所有报告的 p 值均为双侧，当 p<0.001 时认为具有统计学意义。
使用第五版，脂肪评估总体下降 5.0%（p<0.001），散在密度增加 2.8%（p<0.001），不均匀密度增加 2.6%（p<0.001），极致密评估减少 0.4%（p=0.15）。比较致密与非致密类别，第五版指南下致密评估总体增加 2.3%（p<0.001），主要在不均匀致密类别。两位放射科医生使用第五版后致密评估增加（p<0.001），三位放射科医生没有变化（p=0.39、0.67 和 0.76）。
使用第五版时，致密评估总体增加，但我们临床实践中的个别放射科医生对新指南的适应程度不同。
