A Comparative Study Of BI-RADS Classification,ultrasound And Pathology In Breast MRI

Part OneTHE FEASIBILIT OF BI-RADS-MRI SUB CLASSIFICATION BY FISCHER’S SCORE COMBINED WITH ADC VALUE AND VASCULAR SIGNObjective:We want to use Fischer’s scoring method combined with ADC value to sub classify BI-RADS-MRI 4 lesions with mass enhancement,and use Fischer’s scoring method combined with dynamic enhanced scanning vascular sign to sub classify BI-RADS-MRI 4 lesions without mass enhancement,and compare with Fischer’s scoring method to prove its feasibility,so as to improve the accuracy of BI-RADS classification.Method:From September 2014 to September 2019,a total of 458 patients with breast MRI examination in our hospital were collected(Excluding the influence of menstruation),380 of them had pathological results,10 patients without ultrasound diagnosis results were excluded,and 370 patients were finally included in the study.Before operation,all patients underwent plain MRI,multi-phase dynamic contrast-enhanced MRI and DWI.After scanning,the lesions were analyzed in morphology,including shape,edge,size,and enhancement mode;dynamic enhancement curve,early maximum enhancement rate,ADC value,vascular sign and other data were measured and recorded.First of all,according to the Fischer’s scoring standard,combined with the best diagnostic threshold value of ADC value determined in previous studies,the BI-RADS-MRI 4 lesions with mass like enhancement were scored,and the BI-RADS-MRI 4 lesions without mass like enhancement were scored with the help of Fischer’s scoring method and dynamic enhanced scanning vascular sign.Draw and compare ROC curve of Fischer’s scoring method and ROC curve of magnetic resonance sub classification method,and use Z test to compare the area under ROC curve of both methods.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of various diagnostic methods were calculated with pathological results as the gold standard.The results of the two methods were consistent with the pathological results.Kappa was used to analyze the consistency between the results of various diagnostic methods and pathological results.Results:1、Comparison of two classification methods:According to previous studies,ADC value=1.08 X 10-3 mm2/s was used as the boundary value of breast benign and malignant lesions for mass like enhancement lesions,while vascular sign was used as the boundary value of breast benign and malignant lesions for Mr sub classification for non mass like enhancement lesions,and ROC curve of Mr sub classification and Fischer’s scoring method were drawn and analyzed.the area under the ROC curve of Mr sub classification method and Fischer’s scoring method was 0.949 and 0.864 respectively.The AUC of Mr sub classification was significantly higher than that of Fischer’s scoring(Z=6.401,P<0.0001).The kappa value of Fischer’s scoring method is 0.571,which is moderately consistent with the pathological results.The kappa value of magnetic resonance sub classification method is 0.833,which is highly consistent with the diagnosis of pathological results.Therefore,the consistency of magnetic resonance sub classification method and pathological results is better than that of Fischer’s scoring method and pathological results.2.Positive predictive value of magnetic resonance sub classification 4a,4b,4C lesions:Among 370 lesions,163 were BI-RADS-MRI.Among them,44 cases were classified as 4A,41 as benign and 3 as malignant;42 as 4B,22 as benign and 20 as malignant;77 as 4C,74 as malignant and 3 as benign.The positive predictive values of 4A,4B and 4C lesions were 6.8%,47.6%and 96.1%,respectively.Conclusion:Fischer’s score combined with ADC value and vascular sign can significantly improve the specificity of BI-RADS-MRI 4classification while maintaining high sensitivity,and the data shows that the positive rate of magnetic resonance sub classification methods 4A,4B,4C is consistent with BI-RADS The sub classification standard of four kinds of lesions can further improve the diagnostic value of breast MRI,reduce the rate of misdiagnosis and missed diagnosis,and avoid unnecessary puncture and biopsy.At the same time,this research method is simple,applicable,convenient and convenient,and easy to be widely used in clinical practice.Therefore,we can try to use this sub classification method for classification,so as to reduce unnecessary invasive examination for patientsPart TwoBI-RADS-MRI4 SUB CLASSIFICATION WAS COMPARED WITH ULTRASOUND AND PATHOLOGY.Objective:Using the first part of the research content,we can make a reasonable sub classification of BI-RADS-MRI 4 types of lesions,take pathology as the gold standard,compare with BI-RADS-US 4 types of lesions,find out the advantages and disadvantages of the two,To help clinical choose a reasonable examination method,in order to improve the accuracy of diagnosis,reduce missed diagnosis and misdiagnosis,and reduce the rate of puncture biopsy.Method:From September 2014 to September 2019,458 cases of breast MRI were collected from our hospita(Excluding the influence of menstruation)1,380 of them had pathological results,and 10 of them were excluded from the study because they did not have ultrasound results.297 cases were classified into 4 types by ultrasound,including 84 cases of 4A type,107 cases of 4B type and 106 cases of 4C type.Before operation,all patients were examined by plain MRI,multi-phase dynamic contrast-enhanced scan,DWI and ultrasound.MRI was diagnosed by sub classification method,and ultrasound was diagnosed by sub classification standard.Medcalc12.7 statistical software was used for statistical analysis.At the same time,ROC curves of Mr sub classification and ultrasonic sub classification were drawn and compared.The area under ROC curve was compared by Z-test.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of the two diagnostic methods were calculated with pathological results as the gold standard.Kappa was used to analyze the consistency between the two diagnostic methods and pathological results.To draw the histogram of four types of ultrasound lesions,magnetic resonance sub classification lesions and pathological benign and malignant lesions,and analyze the consistency between the two diagnostic methods and pathological results.Results:1.Comparison of two diagnostic methods:The area under ROC curve of Mr sub classification and ultrasonic sub classification is 0.949 and 0.889 respectively.The AUC of Mr sub classification is higher than that of ultrasonic sub classification(Z=4.928,P<0.0001).The sensitivity of Mr sub classification and ultrasonic sub classification were 98.34%and 91.16%respectively,and the specificity of Mr sub classification and ultrasonic sub classification were 85.19%and 65.61%respectively,indicating that the sensitivity and specificity of Mr sub classification were higher than that of ultrasonic sub classification.The kappa value of Mr sub classification is 0.833,and that of ultrasonic sub classification is 0.829.Therefore,the consistency between Mr sub classification and pathological results is higher than that between ultrasonic sub classification and pathological results.2.Four types of ultrasound lesions were compared with Mr sub classification and pathology:There were 297 cases of 4 types of lesions,including 84 cases of ultrasound 4a,13 cases of malignant lesions,42 cases(59%)of benign lesions,and 43 cases(58%)of benign lesions Among the 4C lesions,there were 100 malignant lesions,51(51%)lesions were classified as 5,and 6 benign lesions were classified as 4.It can be seen that most of the magnetic resonance sub classifications of the four types of ultrasound lesions are degraded,most of the magnetic resonance sub classifications of the malignant lesions are upgraded,the sub classifications of the four types of ultrasound lesions are not consistent with the pathological results,and the sub classifications of the magnetic resonance are more consistent with the pathological diagnosis,indicating that the accuracy and specificity of the sub classification of the magnetic resonance are higher.Conclusion:The sensitivity and specificity of Mr sub classification are higher than that of ultrasonic sub classification.For the breast lesions with 4 types of lesions diagnosed by ultrasound,a lot of benign lesions can be detected by MRI,avoiding puncture biopsy.Therefore,it is necessary to carry out MRI for the lesions with 4 types of lesions diagnosed by ultrasound,so as to improve the accuracy and specificity of the diagnosis of 4 types of breast lesions,so as to help the clinical formulation of a more reasonable diagnosis and treatment plan.