多模态X线影像组学模型对乳腺BI-RADS4类肿块良恶性的辅助诊断价值

目的 探讨多模态X线影像组学模型在鉴别乳腺BI-RADS 4类肿块型病变良恶性方面的价值.方法 回顾性分析山东省千佛山医院2017年8月至2020年4月,经全屏数字化乳腺X线摄影(FFDM)和数字乳腺断层合成摄影(DBT)检查诊断为BI-RADS 4类乳腺病变并经病理证实的120例女性患者(4A 41例,良性34例、恶...     

Stratification of mammographic computerized analysis by BI-RADS categories

The Breast Imaging Reporting and Data System (BI-RADS) was implemented to standardize characterization of mammographic findings. The purpose of the present study was to evaluate in which BI-RADS categories the changes recommended by computerized mammographic analysis are most beneficial. Archival cases including, 170 masses (101 malignant, 69 benign) and 63 clusters of microcalcifications (MCs; 36 malignant, 27 benign), were evaluated retrospectively, using the BI-RADS categories, by several radiologists, blinded to the pathology results. A computerized system then automatically extracted from the digitized mammogram features characterizing mammographic lesions, which were used to classify the lesions. The results of the computerized classification scheme were compared, by receiver operating characteristics (ROC) analysis, to the conventional interpretation. In the "low probability of malignancy group" (excluding BI-RADS categories 4 and 5), computerized analysis improved the A_z of the ROC curve significantly, from 0.57 to 0.89. In the "high probability of malignancy group" (mostly category 5) the computerized analysis yielded an ROC curve with an A_z of 0.99. In the "intermediate probability of malignancy group" computerized analysis improved the A_z significantly, from 0.66 for to 0.83. Pair-wise analysis showed that in the latter group the modifications resulting from computerized analysis were correct in 83% of cases. Computerized analysis has the ability to improve the performance of the radiologists exactly in the BI-RADS categories with the greatest difficulties in arriving at a correct diagnosis. It increased the performance significantly in the problematic group of "intermediate probability of malignancy" and pinpointed all the cases with missed cancers in the "low probability" group. Electronic Publication     

乳腺实质X线分型法与BI-RADS分类法在农村妇女乳腺癌筛查中的相关性研究

目的:探讨乳腺实质X线分型法(mammographic parenchymal patterns,MPP)与乳腺影像报告和数据系统法(breast imaging reporting and data system,BI-RADS)在农村妇女乳腺癌筛查中分类结果的相关性及应用意义。方法:2 619例本地区农村妇女,其X线检查结果行MPP分型和BI-RADS分类法分类,将MPP的Ⅲc、Ⅳc型及BI-RADS分类法Ⅲ^Ⅴ类定为高危患者。对BI-RADS分类Ⅰ、Ⅱ类的MPP高危妇女,随访2年后重新行BI-RADS分类,比较2种分类方法的关联性及随访差异。结果:2 619例农村妇女MPP所得各型结果及其包含BI-RADS分类法高危结果:Ⅰa 66例/5例,Ⅰb 189例/3例;Ⅱa 354例/6例,Ⅱb 96例/1例;Ⅲa 153例/6例,Ⅲb 132例/1例,Ⅲc 93例/6例;Ⅳa 474例/14例,Ⅳb 564例/45例,Ⅳc 66例/9例。2种分类方法关联分析有意义(P<0.05),Spearman秩相关分析无意义(P>0.05)。207例BI-RADS分类非高危的MPP高危妇女,随访有6例BI-RADS分类评价为高危(P<0.05)。结论:MPP用于农村妇女乳腺癌筛查有意义,与BI-RADS分类法所得结果有关联,但不密切。     

A dedicated BI-RADS training programme: effect on the inter-observer variation among screening radiologists

Introduction

The Breast Imaging Reporting and Data System (BI-RADS) was introduced in the Dutch breast cancer screening programme to improve communication between medical specialists. Following introduction, a substantial variation in the use of the BI-RADS lexicon for final assessment categories was noted among screening radiologists. We set up a dedicated training programme to reduce this variation. This study evaluates whether this programme was effective.

Materials and methods

Two comparable test sets were read before and after completion of the training programme. Each set contained 30 screening mammograms of referred women selected from screening practice. The sets were read by 25 experienced and 30 new screening radiologists. Cohen's kappa (κ) was used to calculate the inter-observer agreement. The BI-RADS 2003 version was implemented in the screening programme as the BI-RADS 2008 version requires the availability of diagnostic work-up, and this is unavailable.

Results

The inter-observer agreement of all participating radiologists (n = 55) with the expert panel increased from a pre-training κ-value of 0.44 to a post-training κ-value of 0.48 (p = 0.14). The inter-observer agreement of the new screening radiologists (n = 30) with the expert panel increased from κ = 0.41 to κ = 0.50 (p = 0.01), whereas there was no difference in agreement among the 25 experienced radiologists (from κ = 0.48 to κ = 0.46, p = 0.60).

Conclusion

Our training programme in the BI-RADS lexicon resulted in a significant improvement of agreement among new screening radiologists. Overall, the agreement among radiologists was moderate (guidelines Landis and Koch). This is in line with results found in the literature.     

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.     

基于BI-RADS评估伴或不伴点状/圆形钙化的可疑恶性钙化分类研究

目的 基于第5版乳腺影像报告与数据系统（BI-RADS）,探讨各钙化分布中伴或不伴点状/圆形钙化的各种可疑钙化的分类。方法 回顾性分析经乳腺X线摄影检出可疑钙化或点状/圆形钙化并有病理活检结果的女性病人289例,平均（47.2±9.4）岁。将可疑钙化根据是否伴有点状/圆形钙化分为2组,即单纯可疑钙化（不伴有）组和混合可疑钙化（伴有）组。对处于不同钙化分布及形态下的2组可疑钙化的阳性预测值（PPV）及BI-RADS分类进行分析。2组钙化间PPV比较采用χ²检验或Fisher确切概率检验,2组钙化间恶性风险比较以优势比（OR）和95%可信区间（CI）表示。结果 35处点状/圆形钙化均为良性,为BI-RADS 2类。可疑钙化共254处,其中混合可疑钙化104处,单纯可疑钙化150处。混合可疑钙化在区域性、成簇、线样和段样分布中的PPV均低于单纯可疑钙化（均P<0.05）,且恶性风险也低于单纯可疑钙化（均OR<1.0）。区域性、成簇及段样分布中,混合细小多形性钙化的PPV均低于单纯细小多形性钙化（均P<0.05）,且恶性风险也均较单纯细小多形性钙化更低（均OR<1.0）。区域性分布中,混合及单纯无定形钙化均为BI-RADS 4A类;成簇分布和段样分布中,混合及单纯无定形钙化均为BI-RADS 4B类。区域性、成簇、段样分布中混合及单纯细小多形性钙化均为BI-RADS 4B类及4C类。结论 依据BI-RADS,更细化分析点状/圆形钙化对各钙化分布中各种可疑钙化的影响,对精准评估可疑钙化恶性风险具有更大帮助。     

BI-RADS: use in the French radiologic community. How to overcome with some difficulties

In the United States, BI-RADS (Breast Imaging Reporting and Data System) has been set up as a quality assurance system for better communication between professionals and for the follow-up of breast screening programs. It has become a reference in the field of mammographic imaging and has been adopted by several countries throughout the world. It has been translated in French. The aim of this article is to discuss the difficulties in using it in the French radiologic communities. There are few problems with vocabulary excepted for microcalcifications. BI-RADS includes a guidance chapter giving some recommendations for using properly the lexicon. Classification of normal breast remains of concern, as it is difficult to evaluate precisely the content of fat and as the final image is also dependant of technical factors. The main difficulties are related to final classification in BI-RADS categories as the lexicon does not explicit which mammographic features should be included in the categories from three to five. In France, a table concerning the classification of mammographic abnormalities has been established by the HAS (former ANAES) which represents the highest scientific health authority in France. There are no major problems for using the BI-RADS for US and MRI. BI-RADS is suitable for different categories of women and for male and training has an important impact on acceptance and proper use of the lexicon.     

The positive predictive value of the breast imaging reporting and data system (BI-RADS) as a method of quality assessment in breast imaging in a hospital population

Evaluation of the diagnostic performance of mammography and US in our hospital, based upon the positive predictive value (PPV) for breast cancer of the breast imaging reporting and data system (BI-RADS) final assessment categories, has been performed. A follow-up study of 2,762 mammograms was performed, along with 955 diagnostic exams and 1,807 screening exams. Additional US was performed in 655 patients (23.7%). The combined reports were assigned a BI-RADS category. Follow-up was obtained by pathologic examination, mammography at 12 months or from PALGA, a nationwide network and registry of histo- and cytopathology. Overall sensitivity was 85% (specificity 98.7%); sensitivity of the diagnostic examinations was 92.9% (specificity 97.7%) and of the screening examinations 69.2% (specificity 99.2%). The PPV of BI-RADS 1 was 5 of 1,542 (0.3%), and of BI-RADS 2, it was 6 of 935 (0.6%). BI-RADS 3 was 6 of 154 (3.9%), BI-RADS 4 was 39 of 74 (52.7%) and BI-RADS 5 was 57 of 57 (100%). The difference between BI-RADS 1 and 2 vs. BI-RADS 3 was statistically significant (P<0.01). Analysis of BI-RADS 3 cases revealed inconsistencies in its assignment. Evaluation of the BI-RADS final assessment categories enables a valid analysis of the diagnostic performance of mammography and US and reveals tools to improve future outcomes.     

乳腺X线摄影BI-RADS 0级诊断的分析探究

目的：对乳腺影像报告和数据系统BI-RADS 0级诊断的成因进行探索。方法收集我院2012年10月～2013年5月期间,乳腺摄影BI-RADS诊断为0级的女性患者53位,0级病灶共55例,回顾性分析此类病灶的影像学表现并统计各种表现中恶性病变所占比例。结果诊断为BI-RADS 0级的病灶均出现在致密型（33例）或混合型腺体（22例）中,无脂肪型腺体。乳腺摄影BI-RADS 0级病灶的常见影像表现有：①腺体局部结构异常（不对称致密或结构扭曲紊乱）20例;②边界不清的可疑结节影28例;③可疑钙化灶28例。各种影像可单独或合并存在,恶性病变所占比例由高到低分别为：仅表现为可疑钙化者57．1％（4/7）,可疑结节伴可疑钙化者27．3％（3/11）,腺体局部结构异常伴可疑钙化者20％（2/10）,仅表现为腺体局部结构异常者10％（1/10）,仅表现为可疑结节者5．9％（1/17）。结论由于各种主客观原因,乳腺摄影的BI-RADS 0级诊断无法避免。对于致密或混合型腺体,需要特别注意上述BI-RADS 0级病灶的常见影像表现,尤其是可疑钙化灶的存在。     

Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation

Aim

Assess accuracy of contrast enhanced spectral mammography (CESM) versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation.

BI-RADS分级在临床不可触及的乳腺病变活检中的应用

目的:探讨乳腺影像报告及数据系统(BI-RADS)分级对影像学发现的亚临床乳腺病变的诊断及治疗价值.材料和方法:50例乳腺X线发现异常而临床不可触及肿块的患者,运用BI-RADS分级系统为乳腺影像评分,为所有患者行乳腺X线引导下导丝定位病灶活检术,对比影像诊断与病理结果,分析影像学对病理结果的预测价值.结果:2例BI-RADS 5级,5例BI-RADS 4级与1例BI-RADS 3级病变证实为恶性,13例BI-RADS 4级和1例BI-RADS 3级病灶诊断为癌前病变,22例BI-RADS 4级和6例BI-RADS 3级病灶最终诊断为良性病变.结论:BI-RADS 3～5级的亚临床病变,通过导丝引导下病灶定位切除活检术,能够帮助发现早期乳腺癌.     

Assessing the degree of collinearity among the lesion features of the MRI BI-RADS lexicon

Purpose

To retrospectively assess collinearity among lesion feature of the MRI BI-RADS lexicon. Collinearity denotes a situation in which two or more (independent) variables are correlated to some degree, thus partly conveying the same information. Collinearity may cause problems in the interpretation of logistic regression models.

Materials and methods

We analysed the BI-RADS features of 351 lesions in 325 consecutive patients. Patients with biopsy proven breast disease or treated with chemotherapy were excluded. All lesion features were dichotomised into “present” or “not present”. Correlation matrices were generated for mass and non-mass lesions separately, focus lesions were omitted. The phi coefficient was used as measure for correlation.

Results

There were 253 mass (175 malignant, 78 benign), 66 non-mass (21 malignant, 45 benign) and 32 focus (5 malignant, 27 benign) lesions among the study population. The strongest inter-subgroup correlations among mass lesion features were: slow initial enhancement with persistent kinetics, phi = 0.64 (0.56–0.71), rapid initial enhancement with washout kinetics, phi = 0.52 (0.43–0.61) and rapid initial enhancement with persistent kinetics, phi = −0.43 (−0.53 to −0.32). The strongest inter-subgroup correlation among non-mass lesion features were: rapid initial enhancement with washout kinetics, phi = 0.51 (0.30–0.67), slow initial enhancement with persistent kinetics, phi = 0.43 (0.21–0.61) and rapid initial enhancement with persistent kinetics, phi = −0.41 (−0.18 to −0.60).

Conclusion

There is a noticeable overlap of information, especially between kinetic features and initial enhancement types for both, mass and non-mass lesions. This should be considered when generating logistic regression models with the MRI BI-RADS lesion features.     

Clinical impact of BI-RADS classification in Taiwanese breast cancer patients: BI-RADS 5 versus BI-RADS 0-4

Objective

The aim of this study was to analyze and determine the prognostic value of the Breast Imaging Reporting and Data System (BI-RADS) classification in Taiwanese patients with breast cancer.

Patients and methods

Nine hundred ninety-eight patients with breast cancer were diagnosed between January 1, 1999, and August 31, 2005, and 491 (49%) of them were classified as BI-RADS 5. Overall survival and disease-free survival were estimated with the Kaplan–Meier method and compared across the two groups (BI-RADS 5 versus BI-RADS 0–4) using the log-rank test. Univariate and multivariate analyses were used to identify the prognostic factors.

Results

The median follow-up time was 81.8 months. Kaplan–Meier analysis showed a significant difference between the two subgroups in five-year overall survival (P = 0.001) and five-year disease-free survival (P < 0.0001). On univariate analysis, the mammographic findings (BI-RADS 5 versus BI-RADS 0–4) were statistically significantly associated with five-year overall survival and disease-free survival, as were tumor size, lymph-node status, tumor grade, estrogen-receptor status, progesterone-receptor status, and HER-2 status. On multivariate analysis, only the mammographic findings, lymph-node status, HER-2 status, and tumor grade were significant factors related to five-year overall survival and disease-free survival.

Conclusion

The BI-RADS classification is a reliable prognostic and predictive factor. Patients with BI-RADS 5 breast cancer showed a worse pattern of relapse than that of BI-RADS 0–4 breast cancer patients.     

Intraobserver interpretation of breast ultrasonography following the BI-RADS classification

Purpose

To use the BI-RADS ultrasound classification in an intraobserver retrospective study of the interpretation of breast images.

Materials and Methods

The study used 40 breast ultrasound images recorded in orthogonal planes, obtained from patients with an indication for surgery. Eight professionals experienced in breast imaging analysis retrospectively reviewed these lesions, in three rounds of image interpretation (with a 3-6 months interval between rounds). Observers had no access to information from medical records or histopathological results, and, without their knowledge, in each new round were assigned the same images previously interpreted by them. Fleiss-modified Kappa measures were the study main concordance index. Besides the BI-RADS, a scale grouping its categories 2-3 and 4-5 was also used. The statistical analysis concerned the intraobserver agreement.

Results

Kappa values ranged from 0.37 to 0.75 (original categories) and from 0.73 to 0.87 (grouped categories). Overall, out of the 8 observers, 7 presented moderate to substantial concordance (Kappa values 0.51 to 0.74).

Conclusion

The BI-RADS is a reporting tool that provides a standardized terminology for US exams. In this study, moderate to substantial concordance in Kappa values was found, in agreement with other studies of the literature.     

Variability and errors when applying the BIRADS mammography classification

To standardize mammographic reporting, the American College of Radiology mammography developed the Breast Imaging Reporting and Data System (BIRADS) lexicon. However, wide variability is observed in practice in the application of the BIRADS terminology and this leads to classification errors. This review analyses the reasons for variations in BIRADS mammography, describes the types of errors made by readers with illustrated examples, and details BIRADS category 3 which is the most difficult category to use in practice.     

Imaging findings of breast augmentation with injected hydrophilic polyacrylamide gel: Patient reports and literature review

Hydrophilic polyacrylamide gel (PAAG) is a nonresorbable soft tissue filler that has been used as implant material for breast augmentation in some countries, particularly from the Asian continent. Many complications associated with hydrogel use have been reported in the clinical literature including inflammation, persistent mastodynia, formation of multiple lumps, poor cosmetic results, glandular atrophy, and significant spread of hydrogel into the surrounding tissue. Data on long-term toxicity is currently unavailable.The radiologic features of PAAG injection mammoplasty frequently constitute a diagnostic challenge for radiologists. Indeed, the imaging appearances of uncomplicated PAAG implants may mimic conventional implants on mammography, sonography and MRI, with some distinguishing features. The location and local spread of the injected PAAG, and the eventual detection of local inflammation, are best evaluated by ultrasonography and especially MRI, considered the most sensitive technique for assessment of PAAG mammoplasty. MRI clearly depicts the volume and the distribution of gel within the breast; contrast medium enhancement allows delineation of areas of inflammation and infection. It is important to be familiar with the spectrum of imaging findings in order to make an accurate diagnosis and offer proper management.This paper aims to review the normal and abnormal mammographic, sonographic, and MR imaging characteristics of PAAG augmentation mammoplasty through presented patient reviews of three women having undergone direct PAAG injection.     

Infiltrating syringomatous adenoma presenting as microcalcification in the nipple on screening mammogram: case report and review of the literature of radiologic features

Infiltrating syringomatous adenoma (ISA) of the nipple, first described by Rosen in 1983 (Am J Surg Pathol, 1983, 7, 739–745), is a rare benign tumor that can be misdiagnosed as a malignancy. ISA is characterized by its specific location in the subareolar region, its distinct histologic appearance resembling sweat duct or syringomatous tumors, and its locally infiltrating growth. We describes a case of ISA of the nipple presenting as microcalcification that was found on screening mammography. We also reviewed previously reported radiologic features of ISA.     

Breast ultrasound computer-aided diagnosis using BI-RADS features

RATIONALE AND OBJECTIVES: Based on the definitions in mass category of Breast Imaging Reporting and Data System developed by American College of Radiology, eight computerized features including shape, orientation, margin, lesion boundary, echo pattern, and posterior acoustic feature classes are proposed. MATERIALS AND METHODS: Our experimental database consists of 265 pathology-proven cases including 180 benign and 85 malignant masses. The capacity of each proposed feature in differentiating malignant from benign masses was validated by Student's t test and the correlation between each proposed feature and the pathological result was evaluated by point biserial coefficient. Binary logistic regression model was used to relate all proposed features and pathological result as a computer-aided diagnosis (CAD) system. The diagnostic value of each proposed feature in the CAD system was further evaluated by the feature selection methods. Additionally, the likelihood of malignancy for each individual feature was also estimated by binary logistic regression. RESULTS: On each proposed feature, the malignant cases were significantly different from the benign ones. The correlation between the angular characteristic and pathological result was indicated as very high. Three substantial correlations appear in features irregular shape, undulation characteristic, and degree of abrupt interface, but the relationship for orientation feature is low. For the constructed CAD system, the performance indices accuracy, sensitivity, specificity, PPV, and NPV were 91.70% (243 of 265), 90.59% (77 of 85), 92.22% (166 of 180), 84.62% (77 of 91), and 95.40% (166 of 174), respectively, and the area index in the ROC analysis was 0.97. Compared with the significant contribution of angular characteristic, the diagnostic values of posterior acoustic feature and orientation feature were relatively low for the CAD system. When three or more angular characteristics are discovered or the degree of abrupt interface is lower than 18, the likelihood of malignancy could be predicted as greater than 40%. CONCLUSION: The computerized BI-RADS sonographic features conform to the sign of malignancy in the clinical experience and efficiently help the CAD system to diagnose the mass.