Discussion on Detailed Classification of Breast Ultrasonographic BI-RADS Category 4 Lesions_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YUANHong-mei ¹ ,  CHENTian-wu ² , GUPeng ¹ , LIUJian ¹ , YUEWen-sheng ¹ , TANGXue-mei ¹ , GOULing-yun ¹ , LIUXiao-ling ¹

1. Sichuan Key Laboratory of Medical Imaging & Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
2. Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

CHENTian-wu, Email: chentw@aliyun.com

Keywords：

Breast imaging reporting and data system; BI-RADS; Category 4; Ultrasound diagnosis; Detailed classification

DOI：

10.7507/1007-9424.20150247

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Objective To investigate the methods and significances of the breast ultrasonographic breast imaging reporting and data system (BI-RADS) category 4 lesions divided into category 4a, 4b, and 4c, and to assess the risk of malig-nancy of lesions with BI-RADS category 4 in order to improve the accuracy of diagnosis. Methods Two hundred and eighty-eight breast lesions with BI-RADS category 4 confirmed by histopathology were collected. The ultrasonographic characteristics of benign and malignant lesions, containing the shape, aspect ration, margin, calcification, changes of the surrounding tissue, boundary, blood flow characteristics, internal echo, rear echo of the lesions, were comparatively anal-yzed, and the lesions with BI-RADS-US category 4 were divided into 4a, 4b, 4c according to these ultrasonographic charac-teristics and analyzed by statistics. Results There were 192 malignant lesions and 96 benign lesions in the 288 breast lesions. There were statistical significances in the benign and malignant lesions with the shape, aspect ratio, margin, calci-fication, change of surrounding tissue, and boundary (P < 0.05), in other words, the proportion of these ultrasonographic characteristics were higher in the malignant lesions as compared with the benign lesions. But there were no significant differences of internal echo, rear echo, and blood flow characteristics between two lesions (P > 0.05). The positive predictive value of malignant tumor with BI-RADS category 4a, 4b, and 4c were 21.74%, 58.90%, and 91.78%, respectively, and there was significant difference (χ²=106.09, P=0.000). Conclusions The classification of breast lesions with BI-RADS category 4 is refined, it could more accurately assess the risk of benign and malignant breast masses. At the same time, it has an important clinical significance for diagnosis and treatment of benign and malignant breast masses.

Citation： YUANHong-mei, CHENTian-wu, GUPeng, LIUJian, YUEWen-sheng, TANGXue-mei, GOULing-yun, LIUXiao-ling. Discussion on Detailed Classification of Breast Ultrasonographic BI-RADS Category 4 Lesions. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(8): 948-952. doi: 10.7507/1007-9424.20150247 Copy

1.	Mendelson EB, Baum JK, Berg WA, et al. Breast imaging reporting and data system:ultrasound. Reston:American College of Radio-logy, 2003:1-81.
2.	王丹.多普勒超声血流分级在鉴别乳腺肿物良恶性病变中的价值.实用临床医学, 2014, 15(2):95-96.
3.	张义侠, 董慧婷, 康姝, 等.改良乳腺BI-RADS-US分级在乳腺良、恶性病变诊断中的应用.中国介入影像与治疗学, 2012, 9(1):11-14.
4.	徐珊珊, 叶芳燕.常规超声在乳腺病灶良恶性鉴别中的临床应用价值.医学影像学杂志, 2014, 24(3):487-489.
5.	American College of Radiology. Partial protocol contact acrin protocol development and regulatory compliance for a complete protocol. Reston:American College of Radiology, 2004.
6.	Moon HJ, Kim MJ, Kwak JY, et al. Probably benign breast lesions on ultrasonography:a retrospective review of ultrasonographic features and clinical factors affecting the BI-RADS categorization. Acta Radiol, 2010, 51(4):375-382.
7.	陈圆圆, 刘军杰, 魏晏平, 等.彩色多普勒血流显像与超声弹性成像联合诊断BI-RADS 4类乳腺病变.中国医学影像学杂志, 2013, 21(5):332-335.
8.	袁红梅, 刘健, 高砚春, 等.超声引导下Mammotome微创旋切术在乳腺良性病变中的应用.川北医学院学报, 2011, 26(6):493-496.
9.	Sedgwick E. The breast ultrasound lexicon:breast imaging reporting and data system (BI-RADS). Semin Roentgenol, 2011, 46(4):245-251.
10.	刘英姿, 吴秀花. BI-RADS分级超声诊断乳腺病变应用价值.中华实用诊断与治疗杂志, 2010, 24(6):588-589.
11.	彭梅, 詹韵韵, 姜凡, 等.超声乳腺影像报告数据系统3~5级评分标准的初探.中国超声医学杂志, 2014, 30(3):202-206.
12.	Lee HJ, Kim EK, Kim MJ, et al. Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound. Eur J Radiol, 2008, 65(2):293-298.
13.	Raza S, Chikarmane SA, Neilsen SS, et al. BI-RADS 3, 4, and 5 lesions:value of US in management-follow-up and outcome. Radio-logy, 2008, 248(3):773-781.
14.	Yoon JH, Kim MJ, Moon HJ, et al. Subcategorization of ultrasono-graphic BI-RADS category 4:positive predictive value and clinical factors affecting it. Ultrasound Med Biol, 2011, 37(5):693-699.
15.	瞿炜, 王怡, 许萍, 等.乳腺超声图像报告与数据系统在乳腺病灶分类的应用.上海医学影像, 2011, 20(3):186-188.
16.	中国医师协会超声医师分会.血管与浅表器官超声检查指南.北京:人民军医出版社, 2013:103-117.
17.	Gokalp G, Topal U, Kizilkaya E. Power doppler sonography:anything to add to BI-RADS US in solid breast masses? Eur J Radiol, 2009, 70 (1):77-85.
18.	唐智勇, 李艳宁, 廖新红, 等.乳腺病变BI-RADS-US 4级声像图特征及分亚级的探讨.广西医科大学学报, 2014, 31(5):799-801.
19.	李安华.乳腺影像报告与数据系统分类及瘤样病灶的管理:NCCN2012乳腺癌筛查和诊断指南解读.中华医学超声杂志:电子版, 2014, 11(6):439-443.
20.	郑静, 徐金锋, 陈立新, 等.超声乳腺影像报告和数据系统4类乳腺病灶的超声特征.肿瘤基础与临床, 2014, 27(2):142-144.
21.	张丽芝, 曾涵江, 黄子星, 等.乳腺浸润性导管癌的MRI诊断价值.中国普外基础与临床杂志, 2012, 19(9):1008-1011.
22.	Taskin F, Koseoglu K, Ozbas S, et al. Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography. J Clin Ultrasound, 2012, 40(5):261-265.
23.	李安华, 李程.乳腺三维超声成像:值得关注的新技术.中华医学超声杂志:电子版, 2013, 10(12):958-964.
24.	郝少云, 欧冰, 钟文景, 等.超声弹性成像在BI-RADS 4类乳腺肿物中的诊断价值.中国超声医学杂志, 2014, 30(4):303-306.
25.	袁红梅, 余建群, 褚志刚, 等.动态增强MRI、超声及X射线对乳腺良恶性病灶诊断的对比研究.中国普外基础与临床杂志, 2015, 22(2):246-250.

1. Mendelson EB, Baum JK, Berg WA, et al. Breast imaging reporting and data system:ultrasound. Reston:American College of Radio-logy, 2003:1-81.
2. 王丹.多普勒超声血流分级在鉴别乳腺肿物良恶性病变中的价值.实用临床医学, 2014, 15(2):95-96.
3. 张义侠, 董慧婷, 康姝, 等.改良乳腺BI-RADS-US分级在乳腺良、恶性病变诊断中的应用.中国介入影像与治疗学, 2012, 9(1):11-14.
4. 徐珊珊, 叶芳燕.常规超声在乳腺病灶良恶性鉴别中的临床应用价值.医学影像学杂志, 2014, 24(3):487-489.
5. American College of Radiology. Partial protocol contact acrin protocol development and regulatory compliance for a complete protocol. Reston:American College of Radiology, 2004.
6. Moon HJ, Kim MJ, Kwak JY, et al. Probably benign breast lesions on ultrasonography:a retrospective review of ultrasonographic features and clinical factors affecting the BI-RADS categorization. Acta Radiol, 2010, 51(4):375-382.
7. 陈圆圆, 刘军杰, 魏晏平, 等.彩色多普勒血流显像与超声弹性成像联合诊断BI-RADS 4类乳腺病变.中国医学影像学杂志, 2013, 21(5):332-335.
8. 袁红梅, 刘健, 高砚春, 等.超声引导下Mammotome微创旋切术在乳腺良性病变中的应用.川北医学院学报, 2011, 26(6):493-496.
9. Sedgwick E. The breast ultrasound lexicon:breast imaging reporting and data system (BI-RADS). Semin Roentgenol, 2011, 46(4):245-251.
10. 刘英姿, 吴秀花. BI-RADS分级超声诊断乳腺病变应用价值.中华实用诊断与治疗杂志, 2010, 24(6):588-589.
11. 彭梅, 詹韵韵, 姜凡, 等.超声乳腺影像报告数据系统3~5级评分标准的初探.中国超声医学杂志, 2014, 30(3):202-206.
12. Lee HJ, Kim EK, Kim MJ, et al. Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound. Eur J Radiol, 2008, 65(2):293-298.
13. Raza S, Chikarmane SA, Neilsen SS, et al. BI-RADS 3, 4, and 5 lesions:value of US in management-follow-up and outcome. Radio-logy, 2008, 248(3):773-781.
14. Yoon JH, Kim MJ, Moon HJ, et al. Subcategorization of ultrasono-graphic BI-RADS category 4:positive predictive value and clinical factors affecting it. Ultrasound Med Biol, 2011, 37(5):693-699.
15. 瞿炜, 王怡, 许萍, 等.乳腺超声图像报告与数据系统在乳腺病灶分类的应用.上海医学影像, 2011, 20(3):186-188.
16. 中国医师协会超声医师分会.血管与浅表器官超声检查指南.北京:人民军医出版社, 2013:103-117.
17. Gokalp G, Topal U, Kizilkaya E. Power doppler sonography:anything to add to BI-RADS US in solid breast masses? Eur J Radiol, 2009, 70 (1):77-85.
18. 唐智勇, 李艳宁, 廖新红, 等.乳腺病变BI-RADS-US 4级声像图特征及分亚级的探讨.广西医科大学学报, 2014, 31(5):799-801.
19. 李安华.乳腺影像报告与数据系统分类及瘤样病灶的管理:NCCN2012乳腺癌筛查和诊断指南解读.中华医学超声杂志:电子版, 2014, 11(6):439-443.
20. 郑静, 徐金锋, 陈立新, 等.超声乳腺影像报告和数据系统4类乳腺病灶的超声特征.肿瘤基础与临床, 2014, 27(2):142-144.
21. 张丽芝, 曾涵江, 黄子星, 等.乳腺浸润性导管癌的MRI诊断价值.中国普外基础与临床杂志, 2012, 19(9):1008-1011.
22. Taskin F, Koseoglu K, Ozbas S, et al. Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography. J Clin Ultrasound, 2012, 40(5):261-265.
23. 李安华, 李程.乳腺三维超声成像:值得关注的新技术.中华医学超声杂志:电子版, 2013, 10(12):958-964.
24. 郝少云, 欧冰, 钟文景, 等.超声弹性成像在BI-RADS 4类乳腺肿物中的诊断价值.中国超声医学杂志, 2014, 30(4):303-306.
25. 袁红梅, 余建群, 褚志刚, 等.动态增强MRI、超声及X射线对乳腺良恶性病灶诊断的对比研究.中国普外基础与临床杂志, 2015, 22(2):246-250.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Discussion on Detailed Classification of Breast Ultrasonographic BI-RADS Category 4 Lesions

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