对超声BI-RADS分级在诊断3635例乳腺病变中价值的初步探讨

目的 本文通过对3635例乳腺病变超声BI-RADS(BI-RADS US)分级诊断方法的准确性分析,探讨其在超声诊断乳腺病变中的应用价值.方法 BI-RADS US分级对3 635例乳腺病变进行分级,通过与病理结果对照.分析Ⅱ级、Ⅲ级、ⅣA级中出现假阴性病例的主要原因.结果 BI-RADS US分级对乳腺病变良、恶性鉴别诊断准确性、灵敏度和特异度分别为91.91%(3 341/3 635)、90.38%(1 324/1 465)和92.95%(2 017/2 170).BI-RADS US分级Ⅱ级,Ⅲ级和Ⅳ A级的假阴性率分圳为8.3%(18/217)、5.2%(72/1 376)和9.0%(51/565).结论 原位癌是影响超声诊断灵敏度的主要原因,重视与其它辅助榆查方法结合能提高原位癌的检山率.BI-RADS US分级方法的使用更有利于超声科医师和临床医师以及患者之间的交流.     

Accuracy of assigned BI-RADS breast density category definitions

RATIONALE AND OBJECTIVES: Quantitative criteria for the Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories have recently been defined as <25% dense for almost entirely fatty, 25%-50% dense for scattered fibroglandular densities, 51%-75% for heterogeneously dense, and >75% dense for the extremely dense category. The purpose of this study is to compare the range of percent mammographic densities with radiologist-assigned BI-RADS mammographic density categories and compare with the recently issued definitions. MATERIALS AND METHODS: In this study, 200 consecutive negative analog screening mammograms were assigned BI-RADS mammographic density categories independently by three radiologists blinded to the other readers' density assignment. Quantitative assessment of percent mammographic density was performed using previously validated software. RESULTS: All three readers agreed on BI-RADS mammographic density categories in 98 cases (49%), and two of three readers agreed in all 200 cases. Using two reader's consensus, median mammographic density (range) was 6.0% (0.5%-19.2%) for fatty, 14.8% (1.2%-52.7%) for scattered densities, 51.2% (15.9%-82.2%) for heterogeneously dense, and 78.4% (60.1%-87.9%) for extremely dense breasts. The percent mammographic density ranges for fatty and extremely dense breasts correlated well with BI-RADS definitions, whereas the ranges of densities in the scattered and heterogeneously dense categories were considerably broader. CONCLUSION: Fatty and extremely dense BI-RADS categories compare relatively well to defined criteria, and therefore may be helpful in breast cancer risk models. Scattered fibroglandular densities and heterogeneously dense categories have broad percent mammographic density ranges and may not function well in breast cancer risk models.     

Interobserver reliability of automated breast volume scanner (ABVS) interpretation and agreement of ABVS findings with hand held breast ultrasound (HHUS), mammography and pathology results

Objectives

Handheld breast ultrasound (HHUS) lacks standardization and reproducibility. The automated breast volume scanner (ABVS) could overcome this limitation. To analyze the interobserver reliability of ABVS and the agreement with HHUS, mammography and pathology is the aim of this study.

Methods

All 42 study participants (=84 breasts) received an ABVS examination in addition to the conventional breast diagnostic work-up. 25 breasts (30%) showed at least one lesion. The scans were interpreted by six breast diagnostic specialists blinded to results of breast imaging and medical history. 32 lesions received histological work-up: 20 cancers were detected. We used kappa statistics to interpret agreement between examiners and diagnostic instruments.

Results

On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification of the 84 breasts an agreement (defined as ≥4 of 6 examiners) was achieved in 63 cases (75%) (mk = 0.35) and even improved when dichotomizing the interpretation in benign (BI-RADS 1, 2) and suspicious (BI-RADS 4, 5) to 98% (mk = 0.52). Agreement of ABVS examination to HHUS, mammography and pathology was fair to substantial depending on the specific analysis.

Conclusions

The development of an ABVS seems to be a promising diagnostic method with a good interobserver reliability, as well as a comparable good test criteria as HHUS.     

乳腺癌超声图像报告中的BI-RADS与术后病理结果相关性分析

目的 探讨乳腺癌超声图像报告结果部分的BI-RADS与实行手术后病理结果的联系,分析其相关性。方法选择2014年1月～2019年6月我院收治的51例乳腺疾病患者作为本次研究的对象。给予所有患者手术治疗,患者均在术前进行超声检查,术后对病理组织进行检查,并对术后的病理结果与术前的超声检查结果进行比较,研究术后病理与超声图像报告结果中的BI-RADS之间的相关性。结果 患者的超声图像结果中,9例(17.65%)为BI-RADS 2级,32例(62.74%)为BI-RADS 3级,2例(3.92%)为BI-RADS 4级,8例(15.69%)为BI-RADS 5级。阳性率为19.61%。超声BI-RADS对乳腺恶性病变诊断的特异性为100.00%,敏感度为90.00%,准确度为98.36%。结论 乳腺癌的超声图像结果中包含的BI-RADS可较为准确的诊断乳腺病变的情况,临床上可作为诊断乳腺病变的首选方式,也可用于乳腺癌的早期临床筛查,值得推广应用。     

Patient Perceptions of Breast Cancer Risk in Imaging-Detected Low-Risk Scenarios and Thresholds for Desired Intervention: A Multi-Institution Survey

PurposeTo determine women’s perceptions of breast cancer risk and thresholds for desiring biopsy when considering BI-RADS 3 and 4A scenarios and recommendations, respectively.Materials and MethodsWomen presenting for screening mammography from five geographically diverse medical centers were surveyed. Demographic information and baseline anxiety were queried. Participants were presented with scenarios of short-term imaging follow-up recommendations (ie, BI-RADS 3) and biopsy recommendations (ie, BI-RADS 4A) for low-risk mammographic abnormalities and asked to estimate their breast cancer risk for each scenario. Participants reported the threshold (ie, likelihood of cancer) where they would feel comfortable undergoing short-term imaging follow-up and biopsy and their anticipated regret for choosing short-term follow-up versus biopsy.ResultsAnalysis of 2,747 surveys showed that participants estimated breast cancer risk of 32.8% for a BI-RADS 3 and 41.1% for a BI-RADS 4A scenarios are significantly greater rates than clinically established rates (<2% [P < .001] and 2%-10% [P < .001], respectively). Over one-half (55.4%) of participants reported they would never want imaging follow-up if there was any chance of cancer; two-thirds (66.2%) reported they would desire biopsy if there was any chance of cancer. Participants reported greater anticipated regret (P < .001) and less relief and confidence (P < .001) with the decision to undergo follow-up imaging versus biopsy.ConclusionWomen overestimate breast cancer risk associated with both BI-RADS 3 and 4A scenarios and desire very low biopsy thresholds. Greater anticipated regret and less relief and confidence was reported with the choice to undergo short-term imaging follow-up compared with biopsy.     

Diagnostic interplay of proton magnetic resonance spectroscopy and diffusion weighted images with apparent diffusion coefficient values in suspicious breast lesions

Aim of the work

To study the diagnostic performance of combined single voxel 1H-MRS and DW-MRI with ADC values as a non-contrast diagnostic tool, compared to the DCE-MRI, in suspicious breast lesions.

Disparities Associated With Patient Adherence to BI-RADS 3 Assessment Follow-up Recommendations for Mammography and Ultrasound

ObjectiveTo assess the relationship between sociodemographic factors and adherence rates in patients with a BI-RADS 3 assessment.MethodsThis retrospective cohort study reviewed data from all patients with a BI-RADS 3 assessment on mammography and ultrasound examinations at a single, multisite academic institution, which serves a diverse urban-suburban population, from January 1, 2015, to December 13, 2017. Appropriate follow-up was defined as returning for the first follow-up examination 3 to 9 months after the index examination. Associations between BI-RADS 3 adherence rates and patient sociodemographic characteristics were evaluated using logistic regression.ResultsThere were 4,038 patients in our study period; 2,437 patients (60%) had appropriate follow-up, 765 (19%) patients had delayed follow-up, and 836 patients (21%) were lost to follow-up. The overall malignancy rate was 1.4% (46 of 3,202). Older age, retired employment status, and Medicare insurance status were associated with increased adherence to BI-RADS 3 follow-up recommendations. Black race, single relationship status, Medicaid and self-pay insurance status, and living in a top 15% disadvantaged zip code were associated with decreased adherence. On multivariate analysis, older age remained associated with increased adherence and Medicaid insurance status with decreased adherence. Time between index examination and cancer diagnosis was shorter in patients who had timely follow-up (202 days [interquartile range 183-358] versus 392 days [interquartile range 365-563], P ≤ .001), although there was not a significant difference in stage at diagnosis (P = .46).DiscussionMultiple sociodemographic factors are associated with low adherence to BI-RADS 3 follow-up recommendations suggesting that more frequent and targeted interventions are needed to close disparity gaps.     

Automatically Correlating Clinical Findings and Body Locations in Radiology Reports Using MedLEE

In this paper, we describe and evaluate a system that extracts clinical findings and body locations from radiology reports and correlates them. The system uses Medical Language Extraction and Encoding System (MedLEE) to map the reports’ free text to structured semantic representations of their content. A lightweight reasoning engine extracts the clinical findings and body locations from MedLEE’s semantic representation and correlates them. Our study is illustrative for research in which existing natural language processing software is embedded in a larger system. We manually created a standard reference based on a corpus of neuro and breast radiology reports. The standard reference was used to evaluate the precision and recall of the proposed system and its modules. Our results indicate that the precision of our system is considerably better than its recall (82.32–91.37% vs. 35.67–45.91%). We conducted an error analysis and discuss here the practical usability of the system given its recall and precision performance.