From the Department of Radiology, New York University Langone Medical Center, 765 Stewart Ave, Garden City, NY 11530 (C.S.L.); Departments of Computational and Systems Biology (J.M.B.) and Radiology (W.A.B.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; and Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pa (W.A.B.).
Radiology. 2021 Jun;299(3):550-558. doi: 10.1148/radiol.2021204031. Epub 2021 Mar 30.
Background Breast Imaging Reporting and Data System (BI-RADS) category 3 (BR3) (probably benign) mammographic assessments are reserved for imaging findings known to have likelihood of malignancy of 2% or less. Purpose To determine the effect of age, finding type, and prior mammography on cancer yield for BR3 findings in the National Mammography Database (NMD). Materials and Methods This HIPAA-compliant retrospective cohort institutional review board-exempt study evaluated women recalled from screening mammography followed by BR3 assessment at diagnostic evaluation from January 2009 to March 2018 and from 471 NMD facilities. Only the first BR3 occurrence was included for women with biopsy or imaging follow-up of at least 2 years. Women with a history of breast cancer or who underwent biopsy at time of initial BR3 assessment were excluded. Women were stratified by age in 10-year intervals. Cancer yield was calculated for each age group, with (for presumed new findings) and without prior mammographic comparison, and by lesion type, where available. Linear regression with weighted-age binning was performed to assess for differences between groups; < .05 was indicative of a significant difference. Results A total of 1 380 652 (18.2%) women were recalled after screening mammography, of whom 157 130 (11.4%) were given a BR3 assessment within 90 days after screening. Of these, 43 628 women (median age, 55 years; age range, 25-90 years) had adequate follow-up for analysis. Cancer yield increased with increasing age decile, ranging from 0.51% (six of 1167) in women aged 30-39 years to 4.63% (41 of 885) in women aged 80-90 years; cancer yield exceeded 2% at and after age 59.7 years for baseline findings and at and after age 53.6 years for presumed new findings, although there was no effect on stage distribution. Cancer yield for baseline BR3 masses was 10 of 2111 (0.47% [95% CI: 0.24, 0.90]) versus 47 of 3003 (1.57% [95% CI: 1.16, 2.09]) with prior comparisons ( < .001); cancer yield for baseline calcifications was eight of 929 (0.86% [95% CI: 0.40, 1.76]) versus 84 of 2999 (2.80% [95% CI: 2.23, 3.47]) with prior comparisons ( < .001). Difference in cancer yield was 0.51% (95% CI: 0.16, 0.86) between women with and women without prior comparison at the same age ( = .006). Conclusion Cancer yield exceeded the 2% threshold for women aged 60 years or older and reached 4.6% for women aged 80-89 years. Breast Imaging Reporting and Data System 3 findings in women with a prior comparison had higher cancer yield than in those without a prior comparison at the same age. © RSNA, 2021
背景 乳腺成像报告和数据系统（BI-RADS）类别 3（BR3）（可能良性）乳腺评估保留用于已知恶性可能性为 2%或更低的影像学发现。目的 确定年龄、发现类型和先前的乳房 X 线摄影对国家乳房 X 线摄影数据库（NMD）中 BR3 发现的癌症检出率的影响。
材料和方法 这项符合 HIPAA 规定的回顾性队列机构审查委员会豁免研究评估了 2009 年 1 月至 2018 年 3 月期间从筛查性乳房 X 线摄影中召回并在诊断评估中进行 BR3 评估的女性，以及来自 471 个 NMD 设施的女性。对于至少有 2 年活检或影像学随访的女性，仅包括第一次 BR3 发生情况。排除有乳腺癌病史或在首次 BR3 评估时接受过活检的女性。按 10 年间隔的年龄分层。计算每个年龄组的癌症检出率，包括（对于假定的新发现）和不包括先前的乳房 X 线摄影比较，并在有条件的情况下按病变类型进行比较。使用加权年龄分组进行线性回归，以评估组间差异； <.05 表示差异有统计学意义。
结果 在筛查性乳房 X 线摄影后，共有 1380652 名（18.2%）女性被召回，其中 157130 名（11.4%）在筛查后 90 天内接受了 BR3 评估。其中，43628 名（中位年龄为 55 岁；年龄范围为 25-90 岁）有足够的随访进行分析。癌症检出率随年龄十位数的增加而增加，从 30-39 岁女性的 0.51%（1167 例中 6 例）到 80-89 岁女性的 4.63%（885 例中 41 例）；基线发现时，年龄超过 59.7 岁，假定新发现时，年龄超过 53.6 岁，癌症检出率超过 2%。基线 BR3 肿块的癌症检出率为 2111 例中有 10 例（0.47%[95%CI：0.24，0.90]），而与之前比较时为 3003 例中有 47 例（1.57%[95%CI：1.16，2.09]）（ <.001）；基线钙化的癌症检出率为 929 例中有 8 例（0.86%[95%CI：0.40，1.76]），而与之前比较时为 2999 例中有 84 例（2.80%[95%CI：2.23，3.47]）（ <.001）。同一年龄有和没有先前比较的女性之间的癌症检出率差异为 0.51%（95%CI：0.16，0.86）（ =.006）。
结论 年龄在 60 岁或以上的女性癌症检出率超过 2%，年龄在 80-89 岁的女性癌症检出率达到 4.6%。与没有先前比较的女性相比，有先前比较的女性的 BR3 发现的癌症检出率更高。
