The Utility of the Fifth Edition of the BI-RADS Ultrasound Lexicon in Category 4 Breast Lesions: A Prospective Multicenter Study in China

作者：Gu, Yang; Tian, Jia-Wei; Ran, Hai-Tao; Ren, Wei-Dong; Chang, Cai; Yuan, Jian-Jun; Kang, Chun-Song; Deng, You-Bin; Wang, Hui; Luo, Bao-Ming; Guo, Sheng-Lan; Zhou, Qi; Xue, En-Sheng; Zhan, Wei-Wei; Zhou, Qing; Li, Jie; Zhou, Ping; Zhang, Chun-Quan; Chen, Man; Gu, Ying; Xu, Jin-Feng; Chen, Wu; Zhang, Yu-Hong; Wang, Hong-Qiao; Li, Jian-Chu; Wang, Hong-Yan^*; Jiang, Yu-Xin

来源：ACADEMIC RADIOLOGY, 2022, 29: S26-S34.

DOI：10.1016/j.acra.2020.06.027

• Ultrasonography
• Breast
• Breast neoplasms
• Breast Imaging-Reporting and Data System (BI-RADS)

Rationale and Objectives: The objective of this study was to evaluate the utility of the fifth edition of the Breast Imaging-Reporting and Data System (BI-RADS) in clinical breast radiology by using prospective multicenter real-time analyses of ultrasound (US) images. @@@ Materials and Methods: We prospectively studied 2049 female patients (age range, 19-86 years; mean age 46.88 years) with BI-RADS category 4 breast masses in 32 tertiary hospitals. All the patients underwent B-mode, color Doppler US, and US elastography examination. US features of the mass and associated features were described and categorized according to the fifth edition of the BI-RADS US lexicon. The pathological results were used as the reference standard. The positive predictive values (PPVs) of subcategories 4a-4c were calculated. @@@ Results: A total of 2094 masses were obtained, including 1124 benign masses (54.9%) and 925 malignant masses (45.1%). For BI-RADS US features of mass shape, orientation, margin, posterior features, calcifications, architectural distortion, edema, skin changes, vascularity, and elasticity assessment were significantly different for benign and malignant masses (p< 0.05). Typical signs of malignancy were irregular shape (PPV, 57.2%), spiculated margin (PPV, 83.7%), nonparallel orientation (PPV, 63.9%), and combined pattern of posterior features (PPV, 60.6%). For the changed or newly added US features, the PPVs for intraductal calcifications were 80%, 56.4% for internal vascularity, and 80% for a hard pattern on elastography. The associated features such as architectural distortion (PPV, 89.3%), edema (PPV, 69.2%), and skin changes (PPV, 76.2%) displayed high predictive value for malignancy. The rate of malignant was 7.4% (72/975) in category 4a, 61.4% (283/461) in category 4b, and 93.0% (570/613) in category 4c. The PPV for category 4b was higher than the likelihood ranges specified in BI-RADS and the PPVs for categories 4a and 4c were within the acceptable performance ranges specified in the fifth edition of BI-RADS in our study. @@@ Conclusion: Not only the US features of the breast mass, but also associated features, including vascularity and elasticity assessment, have become an indispensable part of the fifth edition of BI-BADS US lexicon to distinguish benign and malignant breast lesions. The subdivision of category 4 lesions into categories 4a, 4b, and 4c for US findings is helpful for further assessment of the likelihood of malignancy of breast lesions.

• 单位
  中国医学科学院北京协和医院; 青岛大学; 南昌大学; 武汉大学; 中国医科大学; 西安交通大学; 1; 山东大学; 复旦大学; 上海交通大学; 中山大学; 吉林大学; 华中科技大学; 哈尔滨医科大学