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.多普勒超聲血流分級在鑒別乳腺腫物良惡性病變中的價值.實用臨床醫學, 2014, 15(2):95-96.
3.	張義俠, 董慧婷, 康姝, 等.改良乳腺BI-RADS-US分級在乳腺良、惡性病變診斷中的應用.中國介入影像與治療學, 2012, 9(1):11-14.
4.	徐珊珊, 葉芳燕.常規超聲在乳腺病灶良惡性鑒別中的臨床應用價值.醫學影像學雜志, 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.	陳圓圓, 劉軍杰, 魏晏平, 等.彩色多普勒血流顯像與超聲彈性成像聯合診斷BI-RADS 4類乳腺病變.中國醫學影像學雜志, 2013, 21(5):332-335.
8.	袁紅梅, 劉健, 高硯春, 等.超聲引導下Mammotome微創旋切術在乳腺良性病變中的應用.川北醫學院學報, 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.	劉英姿, 吳秀花. BI-RADS分級超聲診斷乳腺病變應用價值.中華實用診斷與治療雜志, 2010, 24(6):588-589.
11.	彭梅, 詹韻韻, 姜凡, 等.超聲乳腺影像報告數據系統3~5級評分標準的初探.中國超聲醫學雜志, 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.	瞿煒, 王怡, 許萍, 等.乳腺超聲圖像報告與數據系統在乳腺病灶分類的應用.上海醫學影像, 2011, 20(3):186-188.
16.	中國醫師協會超聲醫師分會.血管與淺表器官超聲檢查指南.北京:人民軍醫出版社, 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, 李艷寧, 廖新紅, 等.乳腺病變BI-RADS-US 4級聲像圖特征及分亞級的探討.廣西醫科大學學報, 2014, 31(5):799-801.
19.	李安華.乳腺影像報告與數據系統分類及瘤樣病灶的管理:NCCN2012乳腺癌篩查和診斷指南解讀.中華醫學超聲雜志:電子版, 2014, 11(6):439-443.
20.	鄭靜, 徐金鋒, 陳立新, 等.超聲乳腺影像報告和數據系統4類乳腺病灶的超聲特征.腫瘤基礎與臨床, 2014, 27(2):142-144.
21.	張麗芝, 曾涵江, 黃子星, 等.乳腺浸潤性導管癌的MRI診斷價值.中國普外基礎與臨床雜志, 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.	李安華, 李程.乳腺三維超聲成像:值得關注的新技術.中華醫學超聲雜志:電子版, 2013, 10(12):958-964.
24.	郝少云, 歐冰, 鐘文景, 等.超聲彈性成像在BI-RADS 4類乳腺腫物中的診斷價值.中國超聲醫學雜志, 2014, 30(4):303-306.
25.	袁紅梅, 余建群, 褚志剛, 等.動態增強MRI、超聲及X射線對乳腺良惡性病灶診斷的對比研究.中國普外基礎與臨床雜志, 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.多普勒超聲血流分級在鑒別乳腺腫物良惡性病變中的價值.實用臨床醫學, 2014, 15(2):95-96.
3. 張義俠, 董慧婷, 康姝, 等.改良乳腺BI-RADS-US分級在乳腺良、惡性病變診斷中的應用.中國介入影像與治療學, 2012, 9(1):11-14.
4. 徐珊珊, 葉芳燕.常規超聲在乳腺病灶良惡性鑒別中的臨床應用價值.醫學影像學雜志, 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. 陳圓圓, 劉軍杰, 魏晏平, 等.彩色多普勒血流顯像與超聲彈性成像聯合診斷BI-RADS 4類乳腺病變.中國醫學影像學雜志, 2013, 21(5):332-335.
8. 袁紅梅, 劉健, 高硯春, 等.超聲引導下Mammotome微創旋切術在乳腺良性病變中的應用.川北醫學院學報, 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. 劉英姿, 吳秀花. BI-RADS分級超聲診斷乳腺病變應用價值.中華實用診斷與治療雜志, 2010, 24(6):588-589.
11. 彭梅, 詹韻韻, 姜凡, 等.超聲乳腺影像報告數據系統3~5級評分標準的初探.中國超聲醫學雜志, 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. 瞿煒, 王怡, 許萍, 等.乳腺超聲圖像報告與數據系統在乳腺病灶分類的應用.上海醫學影像, 2011, 20(3):186-188.
16. 中國醫師協會超聲醫師分會.血管與淺表器官超聲檢查指南.北京:人民軍醫出版社, 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, 李艷寧, 廖新紅, 等.乳腺病變BI-RADS-US 4級聲像圖特征及分亞級的探討.廣西醫科大學學報, 2014, 31(5):799-801.
19. 李安華.乳腺影像報告與數據系統分類及瘤樣病灶的管理:NCCN2012乳腺癌篩查和診斷指南解讀.中華醫學超聲雜志:電子版, 2014, 11(6):439-443.
20. 鄭靜, 徐金鋒, 陳立新, 等.超聲乳腺影像報告和數據系統4類乳腺病灶的超聲特征.腫瘤基礎與臨床, 2014, 27(2):142-144.
21. 張麗芝, 曾涵江, 黃子星, 等.乳腺浸潤性導管癌的MRI診斷價值.中國普外基礎與臨床雜志, 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. 李安華, 李程.乳腺三維超聲成像:值得關注的新技術.中華醫學超聲雜志:電子版, 2013, 10(12):958-964.
24. 郝少云, 歐冰, 鐘文景, 等.超聲彈性成像在BI-RADS 4類乳腺腫物中的診斷價值.中國超聲醫學雜志, 2014, 30(4):303-306.
25. 袁紅梅, 余建群, 褚志剛, 等.動態增強MRI、超聲及X射線對乳腺良惡性病灶診斷的對比研究.中國普外基礎與臨床雜志, 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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