CE-MRA与BI-RADS分类在乳腺癌诊断中的应用

目的:评价联合使用乳腺血管数目及BI-RADS分类提高乳腺癌诊断特异度的价值。方法:对52例乳腺病变患者进行磁共振动态增强扫描。乳腺血管在增强磁共振血管造影像计数,计数评价从0～3级(按血管丰富程度)。所有病例按照MRI BI-RADS分类,分为Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ类。结果:52例患者中,24(42.2%)例为恶性病变,28(57.8%)例为良性病变。良恶性病变乳腺血管数有明显差别(P=0.000<0.05)。采用0～1级诊断为良性病灶,2～3级诊断为恶性病灶,诊断的特异度为78.6%,灵敏度为83.3%。按照BI-RADS分类诊断为:特异度71.4%灵敏度:87.5%。BI-RADS分类与血管数目结合后特异度为85.7%灵敏度:83.3%。结论:乳腺良恶性病变血管数目在磁共振血管造影上有明显的差异,结合MRI BI-RADS分类可以提高MRI诊断乳腺癌的特异度。     

Detection of breast cancer with conventional mammography and contrast-enhanced MR imaging

The aim of this study was to compare the diagnostic performance of conventional mammography and dynamic contrast-enhanced fast 3D gradient-echo (GRE) MRI regarding the detection and characterization of breast lesions relative to histopathologic analysis and to assess the results of a combined evaluation of both methods. fifty consecutive patients with 63 histopathologically verified breast lesions underwent dynamic contrast-enhanced GRE MRI in addition to routine conventional mammography. All lesions were classified by both methods on a five-point scale as benign or malignant, and the results were correlated to histopathology. Conventional mammography and dynamic MRI yielded a sensitivity and specificity of 82 and 64 %, and 92 and 76 %, respectively. The difference between the results was statistically not significant (p > 0.05) with areas under the receiver-operating-characteristics curves of 0.807 for mammography and 0.906 for MR imaging. Combination of the results of both methods slightly increased the sensitivity for detection of breast cancer to 95 % but decreased specificity to 52 %. In this selected patient subset, including only patients referred for excisional biopsy, contrast-enhanced dynamic MRI proved more sensitive and specific than conventional mammography regarding the detection of malignancy. While a combination of both methods yields a slightly improved sensitivity, specificity is vastly reduced. Received 5 May 1997; Revision received 14 July 1997; Accepted 7 August 1997     

Sonoelastography versus dynamic magnetic resonance imaging in evaluating BI-RADS III and IV breast masses

Background

Several clinical studies showed that sonoelastography was useful for the differentiation of benign and malignant breast lesions. Contrast-enhanced MRI has emerged as a promising tool in the detection, diagnosis, and staging of breast cancer.

Aim of work

To study the role of sonoelastography versus dynamic MRI in evaluating BI-RADS III, IV breast masses and detect which modality is of better sensitivity and specificity trying to guide the patient either to follow-up the lesion or proceed to lesion excision.

Subjects and methods

The study included 50 Egyptian patients (age ranged from 32 to 58 years) who presented by breast masses and categorized as BI-RADS III, IV by mammography and ultrasound. Sonoelastography and dynamic MRI were done for all the patients.

Results

Differentiation between BI-RADS III and IV by US elastography had 84% sensitivity and 84% specificity and by MRI had 88% sensitivity and 80% specificity.

Conclusion

Regarding the sonoelastography, it is an easy and cheap modality. The elasticity score is an important parameter for lesion characterization. Combination of morphologic and dynamic MRI studies is very important for the breast lesion evaluation. MRI is more sensitive but less specific than sonoelastography. Finally if we find any suspicious character elicited by either sonoelastography or MRI (BI-RADS IV), lesion excision is recommended.     

Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions

PURPOSE: To prospectively evaluate accuracy of gadobenate dimeglumine-enhanced magnetic resonance (MR) mammography for depiction of synchronous contralateral breast cancer in patients with newly diagnosed unilateral breast cancer or high-risk lesions, with histologic analysis or follow-up as reference. MATERIALS AND METHODS: The study had ethics committee approval; all patients provided written informed consent. One hundred eighteen consecutive women (mean age, 52 years) with unilateral breast cancer or high-risk lesions and negative findings in the contralateral breast at physical examination, ultrasonography, and conventional mammography underwent gadobenate dimeglumine-enhanced 1.5-T MR mammography. Transverse three-dimensional T1-weighted gradient-echo images were acquired before and at 0, 2, 4, 6, and 8 minutes after gadobenate dimeglumine administration (0.1 mmol per kilogram body weight). Breast Imaging Reporting and Data System (BI-RADS) was used to categorize breast density and the level of suspicion for malignant contralateral breast lesions. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values for contrast-enhanced MR mammography were evaluated. RESULTS: Contrast-enhanced MR mammography revealed contralateral lesions in 28 (24%) of 118 patients. Twenty-four lesions were detected in patients with dense breasts (BI-RADS breast density category III or IV). Lesions in eight (29%) of 28 patients were BI-RADS category 4; patients underwent biopsy. Lesions in 20 (71%) patients were BI-RADS category 5; patients underwent surgery. At histologic analysis, 22 lesions were confirmed as malignant; six lesions were fibroadenomas. No false-negative lesions were detected; none of the fibroadenomas were BI-RADS category 5. The sensitivity, specificity, accuracy, and positive and negative predictive values of contrast-enhanced MR mammography for depiction of malignant or high-risk contralateral lesions were 100%, 94%, 95%, 79%, and 100%, respectively. Follow-up findings (12-24 months) confirmed absence of contralateral lesions in 90 of 118 patients with negative contrast-enhanced MR mammographic findings in the contralateral breast. CONCLUSION: Contrast-enhanced MR mammography is accurate for detection of synchronous contralateral cancer or high-risk lesions in patients with newly diagnosed breast cancer or high-risk lesions.     

Dynamic contrast-enhanced and ultra-high-resolution breast MRI at 7.0 Tesla

Objective

To assess the feasibility of 7-T contrast-enhanced breast MRI in patients with suspicious masses.

Methods

Twenty patients with 23 suspicious breast masses on conventional imaging (mean size 13 mm, range 5–27 mm) were examined at 7 T. The MRI protocol included a dynamic series with injection of 0.1 mmol/kg gadobutrol (seven consecutive 3D T1-weighted gradient echo sequences, resolution 1?×?1?×?2 mm³, temporal resolution 63 s) and ultra-high-resolution imaging (T1-weighted 3D gradient echo sequence, resolution 0.45?×?0.57?×?0.45 mm³). Two observers (R1 and R2) independently judged the examinations on image quality and classified lesions according to BI-RADS. The added value of ultra-high-resolution imaging was assessed.

Results

The image quality was deemed excellent in 1 and 0, good in 10 and 12, sufficient in 8 and 8, and insufficient in 1 and 0 for R1 and R2 respectively. Twenty of the 23 lesions were identified at 7-T MRI by both observers. All histopathologically proven malignant lesions (n?=?19) were identified and classified as BI-RADS-MRI 4 or 5. Ultra-high-resolution imaging increased reader confidence in 88 % (R1) and 59 % (R2) of acquisitions.

Conclusion

The study shows the feasibility of dynamic contrast-enhanced 7-T breast MRI, where all malignant mass lesions were identified by two observers.

Key Points

? Magnetic resonance imaging is important in the evaluation of breast cancer. ? Recently, 7-T MRI has become available. ? The 7-T dynamic contrast-enhanced breast MRI is feasible in patients. ? The 7-T breast examinations are amenable to evaluation according to BI-RADS.     

Assessment of suspected breast cancer by MRI: a prospective clinical trial using a combined kinetic and morphologic analysis

OBJECTIVE: The objective of our study was to assess the incremental value of contrast-enhanced MRI in the diagnosis and treatment planning using both a three-time point kinetic and morphologic analysis in addition to mammography and sonography in patients thought to have early-stage breast cancer. SUBJECTS AND METHODS: Contrast-enhanced bilateral breast MRI was performed prospectively on 65 patients with highly suspicious imaging findings (BI-RADS category 4 or 5). All enrolled patients were believed to be candidates for breast conservation on the basis of clinical examination, mammography, and sonography. The primary index lesion's characteristics, size, and extent were assessed. Also, additional lesions detected by MRI that could represent potential malignancies in both the ipsilateral and contralateral breast were evaluated. Morphologic assessment and kinetic analysis were performed on each lesion using dedicated postprocessing and display software. The patients were reevaluated as to whether they were still candidates for breast-conservation therapy after the MRI examination and subsequent biopsies. RESULTS: There were 46 patients (71%) whose primary breast lesion (detected by mammography, sonography, or both) was found to be malignant (39 invasive breast cancers, five intraductal cancers, and two lymphomas). For the primary index lesions, the sensitivity for MRI was 100% (44/44) for predicting a breast malignancy and the specificity was 73.7% (14/19) for predicting benign lesions. MRI detected an additional 37 lesions, of which 23 were cancerous, beyond those suspected on mammography or sonography. One or more additional ipsilateral breast cancers were detected in 32% (14/44) of breast cancer patients and contralateral breast cancers in 9% (4/44) of the breast cancer patients. MRI also resulted in an incremental recommendation of mastectomy in 18% (8/44) of the pathologically confirmed breast cancer patients. MRI resulted in additional biopsy of only 14 benign lesions, six of which were shown to be atypical ductal hyperplasia. CONCLUSION: When added to the standard evaluation of clinical examination, mammography, and sonography in patients thought to have early-stage breast cancer, contrast-enhanced MRI using both a kinetic and morphologic analysis will often result in changes in recommended patient management and better treatment planning and will result in no significant increase in biopsies of benign lesions. In addition, there is a significant detection rate of occult contralateral breast cancers.     

MRI of the breast: state of the art

Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5–12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prothesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication. Received 7 October 1997; Revision received 14 November 1997; Accepted 17 November 1997     

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound

Purpose

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI).

Materials and methods

Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up.

Results

Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered.

Conclusions

Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.     

Low-field versus high-field MRI in diagnosing breast disorders

We evaluated the performance of low-field MRI in breast disorders by comparing it with high-field MRI and biopsy results. Twenty-eight consecutive patients who were able to undergo two magnetic resonance examinations on following days were examined by high-field and low-field MRI. After T1-weighted sagittal images had been obtained a dynamic 3D axial study was performed followed by the acquisition of contrast-enhanced T1-weighted sagittal images. The images were analyzed separately by two radiologists paying attention to lesion morphology and enhancement kinetics. Six patients had problems in both breasts (34 breasts studied). The results were compared with biopsy results of 27 breasts. There were 16 malignant lesions, two fibroadenomas and nine other benign lesions. The inter-magnetic-resonance-scanner value was 0.77 (substantial agreement), while the interobserver value was 0.86 and 0.81 at low and high field, respectively (excellent agreement). The sensitivity was 100 and 100%, the specificity was 82 and 73% and the accuracy was 93 and 89% at low and high field, respectively. The mean lesion size was 2 cm and the smallest malignant lesion was 8 mm in diameter. Low-field MRI is a promising tool for breast imaging. Larger materials and smaller lesions are needed to evaluate its true sensitivity and specificity.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.     

Microcalcifications in clinically normal breast: the value of high field,surface coil,Gd-DTPA-enhanced MRI

State-of-the-art screening mammography allows the detection of nonpalpable breast lesions in approximately 30 % of patients. The presence of clustered microcalcifications without evidence of solid tumors usually requires further investigations, mainly biopsy. A 1.5-T magnet with a single breast coil was used to evaluate 32 patients with indeterminate mammography suggestive of microcalcifications prior to surgery. Both spin-echo (SE) and gradient-echo (GE; 2D fast low-angle short [FLASH]) techniques were utilized before and after injection of 0.2 mmol/kg Gd-DTPA. Upon surgery tumor diameters ranged between 3 and 10 mm. Use of MRI demonstrated 87.5 % overall accuracy, 83.3 % sensitivity, and 92.9 % specificity. False-negative MRI results were in situ carcinomas less than 5 mm in size. All the correctly diagnosed carcinomas measured between 5 and 10 mm. Partial volume is probably the greatest limit of this technique and lesions equal to or smaller than 5 mm are only rarely detected. The GE and SE sequences demonstrated comparable results. Correspondence to: J.DD. Tesoro-Tess     

Breast ultrasound elastography—Results of 193 breast lesions in a prospective study with histopathologic correlation

Purpose

To evaluate the diagnostic performance of ultrasound elastography in breast masses.

Material and methods

193 lesions (129 benign, 64 malignant) were analyzed with the EUB 8500 Logos-ultrasonic-unit (Hitachi Medical, Japan) and a linear-array-transducer of 7.5-13-MHz. Standard of reference was cytology (FNAfine needle aspiration) or histology (core biopsy). The elastic-score was classified according to a 6-point colour-scale (Ueno classification; 1-3 = benign, 4-5 = malignant). Conventional B-mode ultrasound (US) findings were classified according to the BI-RADS classification. Statistical analysis included sensitivity, specificity, ROC-analysis and kappa-values for intra-/interobserver reliability.

Results

The mean score for elasticity was 4.1 ± 0.9 for malignant lesions, and 2.1 ± 1.0 for benign lesions (p < 0.001). With a best cut-off point between elasticity scores 3 and 4, sensitivity was 96.9%, and specificity 76%. Setting a best cut-off point for conventional US between BI-RADS 4 and 5, sensitivity was 57.8%, and specificity 96.1%. Elastography provided higher sensitivity and lower specificity than conventional US, but two lesions with elasticity score 1 were false negative, whereas no lesion scored BI-RADS 1-3 were false negative. ROC-curve was 0.884 for elastography, and 0.820 for conventional US (p < 0.001). Weighted kappa-values for intra-/interobserver reliability were 0.784/0.634 for BI-RADS classification, and 0.720/0.561 for elasticity scores.

Conclusion

In our study setting, elastography does not have the potential to replace conventional B-mode US for the detection of breast cancer, but may complement conventional US to improve the diagnostic performance.     

Combined contrast-enhanced magnetic resonance and diffusion-weighted imaging reading adapted to the “Breast Imaging Reporting and Data System” for multiparametric 3-T imaging of breast lesions

Objective

To develop and assess a combined reading for contrast-enhanced magnetic resonance (CE-MRI) and diffusion weighted imaging (DWI) adapted to the BI-RADS for multiparametric MRI of the breast at 3 T.

Methods

A total of 247 patients with histopathologically verified breast lesions were included in this IRB-approved prospective study. All patients underwent CE-MR and DWI at 3 T. MRIs were classified according to BI-RADS and assessed for apparent diffusion coefficient (ADC) values. A reading method that adapted ADC thresholds to the assigned BI-RADS classification was developed. Sensitivity, specificity, diagnostic accuracy and the area under the curve were calculated. BI-RADS-adapted reading was compared with previously published reading methods in the same population. Inter- and intra-reader variability was assessed.

Results

Sensitivity of BI-RADS-adapted reading was not different from the high sensitivity of CE-MRI (P?=?0.4). BI-RADS-adapted reading maximised specificity (89.4 %), which was significantly higher compared with CE-MRI (P?<?0.001). Previous reading methods did not perform as well as the BI-RADS method except for a logistic regression model. BI-RADS-adapted reading was more sensitive in non-mass-like enhancements (NMLE) and was more robust to inter- and intra-reader variability.

Conclusion

Multiparametric 3-T MRI of the breast using a BI-RADS-adapted reading is fast, simple to use and significantly improves the diagnostic accuracy of breast MRI.

Keypoints

? Multiparametric breast 3-T MRI with BI-RADS-adapted reading improves diagnostic accuracy. ? BI-RADS-adapted reading of CE-MRI and DWI is based on established reporting guidelines. ? BI-RADS-adapted reading is fast and easy to use in routine clinical practice. ? BI-RADS-adapted reading is robust to intra- and inter-reader variability.     

乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

目的 探讨乳腺影像报告和数据系统(BI-RADS)评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值(PPV)和阴性预测值(NPV).结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273(7.8%)、1011(29.0%)、1741(50.0%)、383(11.0%)、59(1.7%)和16(0.5%)名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%(49/77),敏感度为93.1%(27/29),特异度为45.8%(22/48),BI-RADS总体PPV为50.9%(27/53),0类、4类和5类的PPV分别为25.0%(1/4)、36.4%(12/33)和87.5%(14/16),2类、3类的NPV分别为90.9%(10/11)和100.0%(12/12).结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.

Abstract：

Objective To study the value of breast imaging reporting and data system (BI-RADS)in Chinese breast cancer screening. Methods A total number of 3483 women participated in breast cancer screening with mammography in Hexi district in Tianjin from August to December 2009, which was organized by ministry of public health. BI-RADS assessment categories and recommendations were compared with histological findings. The precision, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Among 3483 screening mammography cases, 267 were almost entirely fat breast, 1245 were scauered fibroglandular, 1890 were dense and 81 extremely dense.There were 1011 patients(29.0%) with category 1, 1741 (50.0%) with category 2, 383 (11.0%) with category 3, 59 patients(1. 7%) with category 4 and 16 (0. 5%) with category 5 according to BI-RADS assessment categories. Totally, 71 women with 77 lesions were confirmed by histological examinations. There were 29 malignant and 48 benign lesions. The diagnostic precision, sensitivity, specificity of BI-RADS were 63. 6% (49/77) , 93. 1% (27/29) and 45.8% (22/48) . The general PPV of BI-RADS was 50. 9%(27/53). The PPV of categories 0, 4, 5 were 25.0% (1/4), 36. 4% (12/33) and 87. 5% (14/16). The NPV of categories 2 and3 were90.9% (10/11), 100.0% (12/12). Conclusions B1-RADS is of much value in assessing the breast malignancy. It is applicable in Chinese breast cancer screening.     

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.     

Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions?

AIM: To build and evaluate predictive models for contrast-enhanced ultrasound (CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system (BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve (ROC). RESULTS: Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant (P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively. CONCLUSION: The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BI-RADS classification.     

Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

Objective:

Biopsy has long been the standard approach in Breast Imaging Reporting and Data System® (BI-RADS) 4 or BI-RADS 5 (American College of Radiology, Reston, VA) lesions despite a wide variation in reported incidence of malignancy in BI-RADS 4 lesions. This study examined the diagnostic value of breast MRI as well as its ability to decrease unnecessary biopsies in patients with solid breast lesions who had an indication for biopsy.

Methods:

In this retrospective study, 277 breast lesions with a documented histological diagnosis as established by ultrasound-guided biopsy were included. All patients were female, and biopsy was performed owing to a BI-RADS score of 4 or 5 on ultrasonography. In addition, all patients had undergone MRI before biopsy. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting malignancy were calculated.

Results:

When all lesions were analysed, sensitivity, specificity, NPV and PPV of MRI in detecting malignancy were 94.2%, 56.1%, 90.7% and 68.1%, respectively. When only ultrasonographic BI-RADS 4 lesions are considered, the corresponding figures were as follows: 90.9%, 56.7%, 93.8% and 46.4%, respectively. False-negative rate of MRI for the latter group of lesions was 2.6%. 42% of unnecessary biopsies were avoided in sonographic BI-RADS 4 lesions.

Conclusion:

Despite promising results obtained in this study, dynamic MRI currently does not seem to be effective in ruling out the need for biopsy in the assessment of sonographic BI-RADS 4 lesions. However, advanced MRI techniques may assist in improving possible benefits of MRI in this patient group.According to data from the American Cancer Society, Atlanta, GA, benign lesions account for nearly 80% of all breast biopsies performed. Although mammography is effective in detecting occult breast cancer, it is also associated with false-positive findings, resulting in the detection of different types of benign tissue in approximately 71–75% of the cases undergoing biopsy owing to suspicious mammography.¹ This usually prompts the clinicians to use ultrasound or MRI to obtain additional information on the character of the lesions. However, this approach has resulted in higher cancer detection yields in females who are at increased risk of breast cancer at the expense of increased false-positivity rates.^2,3Although it may be appropriate to monitor Breast Imaging Reporting and Data System® (BI-RADS) 3 (American College of Radiology, Reston, VA) (probably benign) lesions radiologically owing to their low cancer risk (0.3–1.7%),^4–8 biopsy has long been the standard approach in BI-RADS 4 or BI-RADS 5 lesions. The reported risk of malignancy for BI-RADS 5 lesions is >95%, while a wide variation in reported incidence of malignancy is noted in BI-RADS 4 lesions (from 2% to 95%). Biopsy is recommended for any lesion with an estimated risk of malignancy exceeding 2% based on imaging findings. Therefore, most of the solid lesions visualized through imaging modalities are candidates for biopsy. In recent years, a good deal of research has been devoted to the combined use of different imaging modalities in order to decrease false-positive biopsies and to improve the well-known low specificity of radiological imaging techniques in general and ultrasound in particular. In this regard, breast MRI has been shown to provide a high negative predictive value (NPV) that may help safely exclude a diagnosis of malignancy.^9–12In this study, the diagnostic value of breast MRI as well as its ability to decrease unnecessary biopsies has been examined in a group of patients with solid breast lesions who had an indication for biopsy based on ultrasound results.     

Identification of occult breast lesions detected by magnetic resonance imaging with targeted ultrasound: A prospective study

Objective

To verify the capacity of targeted ultrasound (US) to identify additional lesions detected on breast magnetic resonance imaging (MRI), but occult to initial mammography, US and clinical examinations.

Methods

This prospective study included 68 additional relevant breast lesions identified on MRI of 49 patients. As an inclusion criterion, breast US and mammography were required and performed up to six months before MRI. These lesions were then subjected to targeted “second-look” US up to 2 weeks after MRI, performed by one or two radiologists with expertise on breast imaging. Lesions were evaluated according to the established Breast Imaging Report and Data System (BI-RADS) lexicon.

Results

Targeted US identified 46/68 (67.6%) lesions revealed by MRI. No significant associations were observed between US identification and the type of lesion, dimensions, morphological characteristics and enhancement pattern according to MRI findings. Targeted US identified 100% of BI-RADS category 5 lesions, 90% of category 4 lesions, and just over 50% of category 3 lesions (p < 0.05). There was significant agreement (p < 0.001) between MRI and US BI-RADS classification for all three categories.

Conclusion

Targeted US can identify a large proportion of the lesions detected by breast MRI, especially those at high risk of malignancy, when performed by a professional with experience in both breast US and MRI.