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。

Category of suspected malignant calcifications with or without punctate/round shapes based on BI-RADS

Objective To explore the category of suspicious calcification with or without punctate/round shape based on the fifth edition of Breast Imaging Reporting and Data System (BI-RADS). Methods All of 289 patients with suspicious calcification or punctate/round calcification detected by mammogram were analyzed retrospectively. All these patients were females, with an average age of 47.2±9.4 years, and pathological results were available. Suspicious calcifications were divided into 2 groups according to with or without punctate/round calcification, namely pure suspected calcifications (without punctate/round calcification) group and mixed suspicious calcifications (with punctate/round calcification) group. The positive predictive value (PPV) and BI-RADS category of suspicious calcifications in two groups under various calcification distribution and morphology were analyzed. Chi-square test or Fisher exact probability test were used to compare the PPV between the 2 groups, while odds ratios (OR) and confidence intervals (CIs) were used to compare the malignant risk between the 2 groups. Results A total of 35 punctate/round calcifications were benign, BI-RADS type 2. There were 254 suspicious calcifications in total, including 104 mixed suspicious calcifications and 150 pure suspicious calcifications. In regional, cluster, linear and segmental distribution, the PPV of mixed suspicious calcification were lower than that of pure suspicious calcification (all P<0.05) and malignant risk were also lower than that of pure suspicious calcification (all OR<1.0). In regional, cluster and segmental distribution, the PPV of mixed fine pleomorphic calcification were lower than that of pure fine pleomorphic calcification (all P<0.05), and malignant risk were also lower than that of pure fine pleomorphic calcification (all OR<1.0). In regional distribution, the mixed and pure amorphous calcification were all BI-RADS 4A; in cluster and segmental distribution, the mixed and pure amorphous calcification were all BI-RADS 4B. In regional, cluster and segmental distribution, the mixed and pure fine pleomorphic calcification were all BI-RADS 4B and 4C respectively. Conclusions Based on BI-RADS, a more detailed analysis of the influence of punctate/round calcification on various suspicious calcifications in each calcification distribution is more helpful to accurately assess the malignant risk of suspicious calcifications.