超声BI-RADS分级在乳腺癌筛查中的应用价值

目的探讨乳腺超声影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)在乳腺癌筛查中的应用价值。方法回顾性分析从化地区5.5万名39~59岁妇女乳腺癌普查的超声BI-RADS分级资料。结果 0级55例(0.1%),1级24533例(44.6%),2级16056例(29.2%),3级13780例(25.1%),4级561例(1.02%),5级15例(0.02%);4、5级共576例(占1.04%)。乳腺癌妇女46例,均经手术病理证实。结论将超声BI-RADS分级应用到乳腺癌筛查当中,不但提高诊断的特异性,而且提高对乳腺恶性肿瘤的敏感性,具有较好的推广应用价值。     

BI-RADS3级乳腺病变的回顾分析

目的 遵循美国放射协会制定的乳腺影像学报告和数据系统(ACR BI-RADS)对乳腺病变的分级标准,观察分为3级病变组中满足此标准的例数,同时评价几种临床因素对BI-RADS分级的影响.方法 对超声检查最初分为BI-RADS 3级病变的487例乳腺肿块患者的声像图特征进行回顾分析.总结最初的超声表现,且对几种临床中可能影响乳腺病变分级的因素,包括患者年龄、病灶的多发性、是否可以扪及、超声医生的经验以及病灶的大小进行评价.结果 487例病例中,479例(98.36%)为良性,8例(1.64%)为恶性.203例(41.68%)(包括8例恶性病灶)经回颐分析,按BI-RADS分级标准再评估为4级.如在最初超声检查分析时,严格按照分级标准,活检阳性率仅3.94%(8/203),而96.06%(195/203)不需要进行活检.年龄40岁以上和病灶多发性再评估为4级的频率更高(分别P=0.008,P=0.006).而病灶是否可以扪及、病灶大小及医生的经验对再评估结果影响的差异则无显著统计学意义.结论 病灶的多发性和年龄对于分为3级病变再分级有明显的影响.

Abstract：

Objective To investigate how many probably benign lesions on ultrasound(US) fulfilled the published criteria and to evaluate how clinical and personal factors influenced the categorization of breast lesions.Methods A total of 487 lesions in 487 women with more than 12 months follow-up after the initial category 3 assessment on US were included.The initial US images were retrospectively reviewed according to previously published criteria,and evaluated several factors that could influence the characterization of breast lesions in clinical practice such as age,multiplicity,palpability,radiologist 's experience,and lesion size.Results Of 487 lesions,479 (98.36%) were benign and 8 (1.64%) were malignant.Of 487 lesions,203(41.68%) including 8 malignancies were reassessed as category 4.If strict criteria had been applied at initial US examination,the positive biopsy rate would have been only 3.94% (8/203) and 96.06% (195 of 203) biopsies would have been unnecessary.Lesions in women 40 years or older and multiple lesions were more frequently reassessed as category 4 (P = 0.008 and P = 0.006,respectively).The presence of palpability,lesion size,and the radiologist 's experience did not significantly influence the categorization of breast lesions on US.Of 487 probably benign lesions,41.68 % could be classified as category 4 lesions when strict criteria were applied in initial practice.Conclusions The multiplicity of the lesion and the patient 's age were found to have a significant influence on the classifcation of probably benign solid masses.     

乳腺良性结节超声BI-RADS分级的可靠性及其影响因素分析

目的 研究超声诊断乳腺良性结节(BI-RADS 3级)的可靠性,分析影响乳腺肿块BI-RADS分级的可能因素及其程度.方法 对792例参照BI-RADS超声影像学特征描述初步分级为可能良性的乳腺结节(BI RADS 3级)、并且有明确病理结果或有2年以上随访记录的患者,回顾性分析超声诊断乳腺良性结节的可靠性;并且结合已由文献推荐的新的分级标准重新对研究对象超声图像进行判读,探讨可能影响其BI-RADS超声分级的多个因素(患者年龄、病灶大小、病灶数目、体表触诊、医师经验).结果 792例病例中,781例(98.6%)为良性,11例(1.4%)为恶性.重新判读后:35.1%(278/792)的病例被调升至BI-RADS 4级,恶性肿瘤的检出率为81.8%(9/11);低年资组判断的良性结节较高年资组者易被调升至4级(P<0.05);年龄≥40岁或多发病灶的患者乳腺结节被调至4级的可能性大(P<0.01);乳腺病灶能否触及、病灶大小则对BI-RADS分级无明显影响.结论 超声对乳腺良性结节(BI-RADS 3级)的判断可靠性较高,医师经验、乳腺结节是否多发以及患者年龄对超声判断良性病灶有影响.

Abstract：

Objective To evaluate the reliability of benign nodules diagnosed by ultrasound and analyze the probable factors of infecting the BI-RADS ultrasound categorization of breast lesions. Methods A total of 792 cases with initial category 3 assessments on BI-RADS ultrasound categorization consistent with more than 2 years follow-up or pathologic results were contained. The reliability of probable benign lesions were studied retrospectively,and several factors that could influence the categorization were explored such as age,breast lumps size,multiplicity,palpability,and US radiologist's experience referring to ACR-BI-RADS and the new categorizations recommendation. Results Of 792 breast nodules, 781 (98.6%) were benign and 11 (1.4%) were malignant. If the new categorizations recommendation was applied, 35. 1% (278/792) of all cased would have been upgraded to BI-RADS 4,81. 8% (9/11)of malignant tumors would have been found. The breast masses diagnosed by the junior radiologists were more frequently upgraded to BI-RADS 4 than senior radiologists' findings (P <0. 05), the nodules in women 40 years or older and multiple lesions were more frequently upgraded to category 4 (P <0. 01). The presence of palpability and mass size had on significantly influence the BI-RADS US categorization of breast nodules. Conclusions BI-RADS-Ultrasound categorization is relatively reliable to diagnose breast benign nodules. The multiplicity of breast nodules,patient's age and US radiologist's experience were found to have significant influences on the categorizations of probably benign breast nodules.     

Clinical application of qualitative assessment for breast masses in shear-wave elastography

Purpose

To evaluate the interobserver agreement and the diagnostic performance of various qualitative features in shear-wave elastography (SWE) for breast masses.

Materials and methods

A total of 153 breast lesions in 152 women who underwent B-mode ultrasound and SWE before biopsy were included. Qualitative analysis in SWE was performed using two different classifications: E values (Ecol; 6-point color score, Ehomo; homogeneity score and Esha; shape score) and a four-color pattern classification. Two radiologists reviewed five data sets: B-mode ultrasound, SWE, and combination of both for E values and four-color pattern. The BI-RADS categories were assessed B-mode and combined sets. Interobserver agreement was assessed using weighted κ statistics. Areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were analyzed.

Results

Interobserver agreement was substantial for Ecol (κ = 0.79), Ehomo (κ = 0.77) and four-color pattern (κ = 0.64), and moderate for Esha (κ = 0.56). Better-performing qualitative features were Ecol and four-color pattern (AUCs, 0.932 and 0.925) compared with Ehomo and Esha (AUCs, 0.857 and 0.864; P < 0.05). The diagnostic performance of B-mode ultrasound (AUC, 0.950) was not significantly different from combined sets with E value and with four color pattern (AUCs, 0.962 and 0.954). When all qualitative values were negative, leading to downgrade the BI-RADS category, the specificity increased significantly from 16.5% to 56.1% (E value) and 57.0% (four-color pattern) (P < 0.001) without improvement in sensitivity.

Conclusion

The qualitative SWE features were highly reproducible and showed good diagnostic performance in suspicious breast masses. Adding qualitative SWE to B-mode ultrasound increased specificity in decision making for biopsy recommendation.     

Effect of a novel segmentation algorithm on radiologists' diagnosis of breast masses using ultrasound imaging

We investigated the effect of using a novel segmentation algorithm on radiologists’ sensitivity and specificity for discriminating malignant masses from benign masses using ultrasound. Five-hundred ten conventional ultrasound images were processed by a novel segmentation algorithm. Five radiologists were invited to analyze the original and computerized images independently. Performances of radiologists with or without computer aid were evaluated by receiver operating characteristic (ROC) curve analysis. The masses became more obvious after being processed by the segmentation algorithm. Without using the algorithm, the areas under the ROC curve (Az) of the five radiologists ranged from 0.70∼0.84. Using the algorithm, the Az increased significantly (range, 0.79∼0.88; p < 0.001). The proposed segmentation algorithm could improve the radiologists’ diagnosis performance by reducing the image speckles and extracting the mass margin characteristics.     

Malignant Lesions Initially Categorized as Probably Benign Breast Lesions: Retrospective Review of Ultrasonographic,Clinical and Pathologic Characteristics

The primary objective of this study was to review the ultrasonographic features of BI-RADS category 3 (“probably benign”) lesions that eventually proved to be malignant. A second objective was to investigate their clinical and pathologic features according to their palpability and time of biopsy. Thirty-two (0.8%) of 4000 women with lesions that were initially classified as “probably benign” proved to be malignant and formed the study group. The most common reason for a false negative assessment on ultrasound was a failure to recognize suspicious margin characteristics (28 of 32 malignancies, 87.5%). Malignancy was more frequent in palpable (2.4%, 21 of 859) than nonpalpable lesions (0.4%, 11 of 3141, p < 0.001). There was no statistical difference in the mean age, mean size of lesions, or tumor stage between patients who underwent early biopsy (n = 19) or biopsy after 6 months (n = 13). Twenty-nine of the lesions (90.6%) were retrospectively recategorized as BI-RADS 4, which calls for early biopsy. BI-RADS 3 lesions require especially careful assessment. (E-mail: ekkim@yuhs.ac)     

BI-RADS词典钙化描述语的应用价值分析

目的：依据乳腺影像报告和数据系统（breast imaging-report and data system,BI-RADS）词典中的钙化描述语,回顾性分析数字钼靶摄影中钙化病灶的恶性度。方法收集126例可疑恶性钙化的病例,由2位影像科医生对数字钼靶摄影中的钙化进行分析,从形态和分布两方面进行描述语记录,之后与术后病理结果对照,分析BI-RADS钙化描述语对恶性度的预测价值。结果126例病例中,恶性61例。形态描述语中,恶性度最高的是细线或细线分支状（93%）;分布描述语中：恶性度最高的是段样（75%）。结论 BI-RADS词典中,钙化描述语能够帮助评估数字钼靶摄影中钙化病灶的恶性度。     

Evaluation of an Automated Information Extraction Tool for Imaging Data Elements to Populate a Breast Cancer Screening Registry

Breast cancer screening is central to early breast cancer detection. Identifying and monitoring process measures for screening is a focus of the National Cancer Institute’s Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) initiative, which requires participating centers to report structured data across the cancer screening continuum. We evaluate the accuracy of automated information extraction of imaging findings from radiology reports, which are available as unstructured text. We present prevalence estimates of imaging findings for breast imaging received by women who obtained care in a primary care network participating in PROSPR (n = 139,953 radiology reports) and compared automatically extracted data elements to a “gold standard” based on manual review for a validation sample of 941 randomly selected radiology reports, including mammograms, digital breast tomosynthesis, ultrasound, and magnetic resonance imaging (MRI). The prevalence of imaging findings vary by data element and modality (e.g., suspicious calcification noted in 2.6 % of screening mammograms, 12.1 % of diagnostic mammograms, and 9.4 % of tomosynthesis exams). In the validation sample, the accuracy of identifying imaging findings, including suspicious calcifications, masses, and architectural distortion (on mammogram and tomosynthesis); masses, cysts, non-mass enhancement, and enhancing foci (on MRI); and masses and cysts (on ultrasound), range from 0.8 to1.0 for recall, precision, and F-measure. Information extraction tools can be used for accurate documentation of imaging findings as structured data elements from text reports for a variety of breast imaging modalities. These data can be used to populate screening registries to help elucidate more effective breast cancer screening processes.     

弹性应变率比值与BI-RADS标准鉴别诊断乳腺肿块的对比研究

目的：探讨弹性应变率比值( SR)诊断乳腺良恶性肿块的最佳界点,对比分析SR与常规超声乳腺影像报告和数据系统( BI-RADS)标准对乳腺肿块的鉴别诊断价值。方法对94例患者共计101个乳腺肿块进行 SR 测定和 BI-RADS标准分级,以病理结果为标准,构建SR的受试者工作特征( ROC)曲线,确定其诊断乳腺肿块良恶性的最佳界点,并比较SR与BI-RADS标准的诊断价值。结果 SR的ROC曲线下面积(AUC)为0．933,最佳诊断界点为3．03,以SR≥3．03诊断为恶性, SR <3．03诊断为良性;良性组 SR 为(1．96±0．88),恶性组SR为(4．74±2．22),两组比较差异有统计学意义( P<0．01)。 SR和BI-RADS标准诊断乳腺肿块的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为92．3%、88．7%、90．1%、83．7%、94．8%及71．8%、87．1%、81．2%、77．8%、83．1%, SR 的诊断敏感度高于 BI-RADS标准( P<0．05)。结论作为一种半定量检查方法, SR比BI-RADS标准具有更高的敏感度,可以提高乳腺恶性肿块的检出率。