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MR影像报告和数据系统(BI-RADS-MBI)的临床应用

近年来乳腺癌发病率呈逐年上升趋势,现已居妇女恶性肿瘤之首.乳腺X线、超声和MRI是乳腺检查的主要手段.     

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.     

乳腺疾病超声与钼靶 X线诊断回顾性分析

目的：探讨超声、钼靶X线在乳腺疾病中的诊断价值。方法回顾性分析102例患者超声及钼靶影像资料,并且以临床病理结果作为对照标准。结果乳腺疾病超声诊断符合率87．3％,X线钼靶诊断符合率84．3％,两者联合应用诊断符合率92．2％。结论超声与钼靶对乳腺疾病诊断均有较大价值,乳腺超声可作为乳腺疾病普查首选方法,两者联合应用可提高乳腺疾病诊断符合率。     

超声与钼靶BI-RADS分级对乳腺浸润性导管癌的诊断

目的:研究超声与钼靶BI-RADS分级对乳腺浸润性导管癌(IDC)的诊断。方法:回顾分析98例105个术后病理证实的IDC病灶的超声与钼靶BI-RADS 3~5分级影像图,比较两者以及两者联合对IDC的诊断价值。结果:超声与钼靶分级以及两者联合诊断IDC的准确性分别为85.7%(90/105)、77.1%(81/105)、95.2%(100/105);超声与钼靶BI-RADS分级对IDC的诊断,两者之间有统计学意义(P0.05),超声与钼靶两者联合诊断,诊断价值高于单一方法(P0.05)。结论:本组研究中,超声和钼靶按BI-RADS分级,均对IDC有较高的的诊断价值,两者联合诊断IDC的准确率更高。     

超声造影检查在乳腺BI-RADS 4类的乳腺肿块良恶性鉴别诊断中的价值

目的:探讨超声造影检查在常规超声诊断为乳腺BI-RADS 4类的乳腺肿块良恶性鉴别诊断中的价值。方法:对2016年7月至2017年10月在西安交通大学第一附属医院门诊就诊并经常规超声诊断为乳腺BI-RADS 4类的76例患者共76个乳腺肿块进行超声造影检查,以穿刺活检或手术切除病理结果为金标准建立诊断试验分析。结果:最终病理证实良性病变53例（良性组）,恶性病变23例（恶性组）。超声造影特点如形态不规则、边界不清晰、有穿入或扭曲血管、对比剂不均匀性增强、内部有充盈缺损及造影后面积较二维增大在恶性组的比例显著高于良性组,差异有统计学意义（P<0.05）。超声造影诊断乳腺BI-RADS 4类病灶良恶性鉴别诊断的敏感度、特异度及准确性分别为96%、85%和88%。结论:良恶性乳腺肿块的超声造影特征明显不同,超声造影可以有效鉴别BI-RADS 4类乳腺病灶的良恶性,有望提高穿刺活检的恶性检出率。     

BI-RADS系统在乳腺钼靶普查的应用价值

目的:探讨BI-RADS系统在乳腺钼靶普壹的应用价值.方法:对910饲参加乳腺普查的妇女采用BI-RADS报告系统,结合本院全数字化乳腺X线影像特征进行评估分级.结果:根据BI-RADS数据系统分类和统计.其中0级197例,Ⅰ级421例,Ⅱ级21C例,Ⅲ级57例,Ⅳ级23倒,ⅤV级2例,结论:BI-RADS报告系统对乳腺疾病的普查有重要意义.     

A Systematic Approach for Using DICOM Structured Reports in Clinical Processes: Focus on Breast Cancer

This paper describes a methodology for redesigning the clinical processes to manage diagnosis, follow-up, and response to treatment episodes of breast cancer. This methodology includes three fundamental elements: (1) identification of similar and contrasting cases that may be of clinical relevance based upon a target study, (2) codification of reports with standard medical terminologies, and (3) linking and indexing the structured reports obtained with different techniques in a common system. The combination of these elements should lead to improvements in the clinical management of breast cancer patients. The motivation for this work is the adaptation of the clinical processes for breast cancer created by the Valencian Community health authorities to the new techniques available for data processing. To achieve this adaptation, it was necessary to design nine Digital Imaging and Communications in Medicine (DICOM) structured report templates: six diagnosis templates and three summary templates that combine reports from clinical episodes. A prototype system is also described that links the lesion to the reports. Preliminary tests of the prototype have shown that the interoperability among the report templates allows correlating parameters from different reports. Further work is in progress to improve the methodology in order that it can be applied to clinical practice.     

First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability?

ObjectivesTo evaluate the outcome of repeated short-term follow-up with ultrasound in no high-risk young patients with a BI-RADS3 lesion at first examination.MethodsIn this IRB-approved study 492 women, aged 18–34 years (mean ± standard deviation, 28 ± 4.5 years) with first breast ultrasound examination in 2012–2014 were retrospectively evaluated. Inclusion criteria were: at least one BI-RADS3 lesion and (a) biopsy/surgical excision or (b) follow-up of at least 18 months (including a 6-month follow-up). BI-RADS category assigned during follow-up and pathologic findings in cases undergoing biopsy/surgical excision were collected. At the 6- and 18-month follow-up the recommended biopsy rates (RBR) and the corresponding positive predictive value (PPV) were calculated.ResultsIn 97 patients, 151 BI-RADS3 lesions were identified. Biopsy/surgical excision was initially performed in 25/151 (16.5%) lesions. After 6-month, category was downgraded to BI-RADS1/2 in 23/126 (15.3%) and upgraded to BI-RADS4 in 9/126 lesions (7.1%). Pathological diagnosis of these lesions was fibroadenoma in 5 and benign phyllodes tumor in 4 cases (RBR 7%, PPV_bio 44.4%). After 18-month one lesion was classified BI-RADS4 and pathological diagnosis was fibroadenoma (RBR 1.1%, PPV_bio 0%).ConclusionsOur preliminary data show that follow-up imaging performed after 18 months from a first BI-RADS3 diagnosis does not affect clinical treatment and 6-month follow-up may be sufficient to assess the stability of probably benign lesions.     

BI-RADS分级在彩超检查乳腺良、恶性肿瘤中的规范化应用

目的:通过彩超检查手段,探讨BI-RADS分级在乳腺肿瘤中的规范化应用及其价值。方法:回顾性分析多例经手术、病理证实的乳腺良、恶性肿瘤患者的超声表现及彩色多普勒血流特点,重点是恶性肿瘤及交界性肿瘤的界定,规范其诊断时的应用标准。结果:经手术及活检病理诊断,经过术前BI-RADS分级方法筛查,超声诊断符合率为89.5%,其中误诊为良性54例(6.2%),误诊为恶性36例(4.2%),主要是4级(a,b,c)结节的鉴定存在误诊及偏差。结论:乳腺恶性肿瘤在声像图中的可疑征象:形态不规则、边缘不光整、高回声晕、垂直生长、后方回声衰减、瘤体内微钙化、血供丰富,其中形态不规则、边缘毛刺、边缘成角、肿瘤内微钙化为预测恶性肿瘤的主要指标,其余改变可作为次要指标。通过对上述指标的合理应用,使用统一的专业术语、标准的诊断归类及检查程序,达到早期、准确的诊断乳腺疾病尤其是恶性肿瘤。