Quantitative Evaluation Of BI-RADS And Its Combination With Blood-oxygen Functional Image In The Diagnosis Of Breast Lesions

Objective1.To investigate the value of breast imaging and reporting data system(BI-RADS)based on the scoring of breast lesions’ sonographic features.2. To evaluate theapplication of blood-oxygen functional imaging system (BOFIS)combined withhigh-frequency ultrasound（US） in the diagnosis of early breast cancer andidentification of benign and malignant lesions.Materials and MethodsPart1:The ultrasonic images of1005breast lesions confirmed by pathology wereretrospectively reviewed. The features of sonographic images including lesion’s shape,margin, echo, height/width, halo, acoustic shadow, microcalcification, flow, lymph nodeand the age of patients were analyzed, then the scores were obtained according to thefeatures. And the lesions were divided into different groups on the basis of the scores. Ineach group, the malignant predictive value was compared with theoretical risk degree ofmalignant lesions assessed by BI-RADS to get the relationship between them.Part2:226patients with231lesions were analyzed by BOFIS and US, and theywere confirmed by surgical or pathological results. In the ultrasonic images, the lesionswere scored by the ten features mentioned above, and they were evaluated by BI-RADS(including categoryⅢ、Ⅳ a、Ⅳ b、Ⅳ c、Ⅴ). The lesionsgraded as BI-RADS Ⅳb、Ⅳ c、Ⅴ were diagnosed as malignant, while BI-RADSⅢ、 Ⅳa were diagnosed as benign. Thegray shadow images were analyzed by the tri-operators and the blood-oxygen functionalimage technology, and they were diagnosed as malignant or benign according to theirdifferent features. The two methods were combined to assess the breast lesions and thelesions were divided into two groups (＜2cm，＞2cm)。Results Part1:(1)The proportion of malignant lesions in different scores varying from≤3,4,5,6,7,8,9,10,11,12,13to≥14were0,1.6,4.3,8.8,29.5,42.1,55.3,69.7,79.2,73.0,77.8and94.8%, respectively.(2)The category Ⅱ, Ⅲ, Ⅳ a, Ⅳb, Ⅳc and Ⅴ of BI-RADScorresponded to the score≤3,4,5-7,8-9,10-13and≥14,respectively.(3)While taking thescore8or BI-RADS Ⅳ bas the cut-off value of ultrasonography to differentiate betweenmalignant and begin breast lesions, the sensitivity, specificity, accuracy, negativepredictive value and positive predictive value were90.2%,90.1%,90.2%,95.3%and80.7%, respectively.Part2: Pathological examination showed that149lesions were benign and82lesions were malignant.⑴The sensitivity,specificity, accuracy, positive predictivevalue and negative predictive value were78.1%,81.9%,80.5%,70.3%and87.1%detectedby BOFIS,84.2%,87.9%,86.6%,79.3%and91%by US, there was no significantdifference between the two groups(P＞0.05). By combining the two methods，thesensitivity,specificity, accuracy, positive predictive value and negative predictive valuewere95.1%,74.5%,81.8%,67.2%and96.5%, the sensitivity(95.1%) was higher thanthat of BOFIS or US(P<0.05),and the NPV (96.5%) was higher than that of BOFIS(P<0.05).⑵Compared with pathological results, the accuracy of the breast lesions whichwere graded as BI-RADS Ⅲ, Ⅳ and Ⅴ were98.7%,71.5%and96.9%respectively byUS,86.8%,76.4%and75%by BOFIS. In the lesions graded as BI-RADS Ⅲ and Ⅴ, theaccuracy of US was higher than that of BOFIS (P<0.05), while in the lesions graded asBI-RADS Ⅳ, the accuracy of BOFIS was higher than US(P<0.05).⑶In the37malignant lesions which diameters were less than2cm, the sensitivity of US and BOFISwere73%and67.7%. The sensitivity of combining the two methods was significantlyimproved to89.2%(P<0.05).Conclusion1.BI-RADS assessment system based on the scoring of breast lesions’ sonographicfeatures can standardize ultrasonic reports to a certain degree and offer comparativelyreliable guiding information for diagnosis and clinical treatments.2.BOFIS combined with US could improve the diagnostic accuracy and it canassist the detection and the diagnosis of breast cancer especially for the lesions category as BI-RADS Ⅳ.3.Combing the two methods can remedy defects, decrease the missed diagnosis rateand increase the accuracy of differentiating between malignant and benign lesions whichhas a significant value of clinical application.