Positive Predictive Value And Influential Factors Analysis Of BI-RADS-US3Categorization On The Breast Nodules

BackgroundBecause of its safety、stability and reliability, ultrasound exanimation has become one of the most common methods in clinical screening and diagnosis of breast diseases.In2003, American College of Radiology (ACR) drew lessons from the successful experience of mammography, founded and recommended the ultrasonic version of the Breast Imaging Reporting and Data System (BI-RADS-US), the rules of main categories depend on the characteristics of breast nodes, such as shape、edge and micro-calcification etc.the capability of judging breast diseases by ultrasound has got been widely confirmed and recognized. Ultrasound BI-RADS classification is not only solve the problems of the breasts ultrasonic description and diagnosis standardization, and its ladder-like classification standards provide an important reference for the treatment of breast disease.According to the recommended standards of the American College of Radiology, different BI-RADS-US categories have corresponding different clinical assessment and management.Patients suffer from breast mass of BI-RADS3are suggested regular follow-up, BI-RADS4or higher need to biopsy or surgical resection. Therefore, the accuracy of BI-RADS-US category has a great significance for guidance of clinical behavior and risk control of the disease. Clinical colleague and patients hope for the ultrasound radiologists make the right match of nature and scoring of breast masses.There are many retrospective reviews and studies on ultrasonic characteristics of probable malignant breast lumps, patient with BI-RADS4or higher are able to evoke enough alertness and get corresponding clinical treatment usually; however,there are rare reports on the reliability research of BI-RADS3category (probably benign),and the benign judgment based on imaging without pathological confirmation, often make the clinical colleague and patients pay few attention and generally adopt conservative treatment without clear pathological result,out of trace rate high. in2003edition, the ultrasound version was first introduced by ACR,the PPV directly quoted form the number value of X-ray mammography version, just vague infer that the probability of malignant ratio should be less than2%. foreign reports sporadic, and the statistical sample size small. The author didn’t found domestic report on the reliability of the BI-RADS3, and domestic females and white females in the West there was obvious difference in breast size, gland thickness and breast cancer incidence rate, we also need our own data. The purpose of this study is based on the confirmation of a large sample of cases to evaluate the reliability of ultrasound diagnosis of breast lesions, especially the domestic female benign breast lesions. and analyze the all possible factors and extent of which impact of the BI-RADS classification of breast masses.MethodsThis study contains a total of792cases with initial category3assessments on BI-RADS-Ultrasound categorization consistent with more than2years follow-up or pathologic results. We not only retrospectively study the reliability of probable benign lesions; but also explore several factors that could influence the categorization such as age, breast lumps size, multiplicity, palpability, and US radiologist’s experience referring to ACR-BI-RADS and the new categorizations recommendation.Resultsof792breast nodules,781(98.6%) were benign and11(1.4%) were malignant. If the new categorizations recommendation was applied,35.1%(278/792) of all cased would have been upgraded to BI-RADS4,81.8%(9/11) of malignant tumors would have been found; The breast masses diagnosed by the junior radiologists were more frequently upgraded to BI-RADS4than senior radiologists’ findings(P<0.05), the nodules in women40years or older and multiple lesions were more frequently upgraded to category4(P<0.01). The presence of palpability and mass size do not significantly influence the BI-RADS US categorization of breast nodules.ConclusionsThe positive predictive value(PPV) of the BI-RADS-US is1.4%,ultrasonic diagnosis of breast probably benign nodules (BI-RADS3) is relatively reliable 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.