The Accuracy of BI-RADS Classification of Breast Ultrasound as a First-Line Imaging Method

Zusammenfassung

Ziel: Das Ziel dieser Untersuchung ist die Bestimmung der Treffsicherheit bei der sonografischen Zuordnung von Herdbefunden BI-RADS 3 – 5 im Rahmen primär ausgeführter Brustultraschalluntersuchungen. Material und Methoden: Es handelt sich um eine nicht selektierte, konsekutiv untersuchte Klientel von symptomatischen und asymptomatischen Patientinnen. Von 5077 durchgeführten Untersuchungen konnten 835 Fälle BI-RADS 3 – 5 evaluiert werden. Ergebnisse: Der PPV für das Mammakarzinom bei BI-RADS 3 – 5 betrug jeweils 0,03; 0,48; 0,97. Wenn die Kategorien BI-RADS 4 und 5 als suspekt zusammengefasst werden und BI-RADS 3 als wahrscheinlich benigne gewertet wird, so ergab sich eine prospektiv vergebene Ratio von 1:1,8 (benigne zu maligne Befunde). Sensitivität, Spezifität und Genauigkeit der sonografischen Klassifikation von Herdbefunden BI-RADS 3 – 5 betrugen 0,92; 0,85; 0,87. Schlussfolgerung: Die erhobenen Daten belegen die Fähigkeit der Mammasonografie zu einer ausreichend zuverlässigen Unterscheidung benigner von malignen Herdbefunden nach den Vorgaben der BI-RADS-Klassifikation. Die primär ausgeführte Mammasonografie führt somit nicht zu einer erheblichen Zunahme der Indikationsstellung medizinisch unnötiger Biopsien.

Abstract

Purpose: The aim was to evaluate the accuracy of BI-RADS categories 3 – 5 in breast ultrasound (US) as the first-line imaging method. Materials and Methods: 5077 examinations of a consecutive, unselected and mixed collective of symptomatic and asymptomatic patients were performed. Of these examinations, 835 cases of BIRADS 3 – 5 could be analyzed. Results: The PPV with respect to a malignant lesion for BI-RADS 3, 4, 5 was 0.03, 0.48, and 0.97, respectively. When BI-RADS 4 and 5 cases are considered to be suspicious, the ratio of benign to malignant findings corresponds to 1:1.8. Analyzing BIRADS 3 – 5 lesions, the sensitivity, specificity and accuracy are 0.92, 0.85, and 0.87, respectively. Conclusion: The data support the feasibility of US for discriminating malignant from benign findings corresponding to the ACR BI-RADS classification without excessively increasing the number of unnecessary biopsies.

Key words

breast ultrasound - breast carcinoma - screening - BI-RADS

References

• 1 Madjar H, Ohlinger R, Mundinger A et al. BI-RADS-analogue DEGUM criteria for findings in breast ultrasound – Consensus of the DEGUM committee on breast ultrasound.  Ultraschall in Med. 2006;  27 374-312
• 2 Buchberger W, Niehoff A, Obrist P et al. Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography.  Semin Utrasound CT MR. 2000;  21 325-336
• 3 Kolb T M, Lichy J, Jeffrey H et al. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: An analysis of 27 825 patient evaluations.  Radiology. 2002;  225 165-175
• 4 Chrystal P, Strano S D, Shcharanski S et al. Using sonography to screen women with mammographically dense breasts.  AJR. 2003;  181 177-182
• 5 Leconte I, Feger C, Galant C et al. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density.  AJR. 2003;  180 1675-1679
• 6 Corsetti V, Houssami N, Ferrari A et al. Breast screening with ultrasound in women with mammography-negative dense breasts: Evidence on incremental cancer detection and false positives, and associated cost.  Eur J Cancer. 2008;  44 539-544
• 7 Houssami N, Irwig L, Simpson J M et al. Sydney breast imaging accuracy study: Comparative sensitivity and specificity of mammography and sonography in young women with symptoms.  AJR. 2003;  180 935-940
• 8 Schulz K D, Albert U S (eds).. Level-3-Guideline for early detection of breast carcinoma (Stufe-3-Leitlinie, Brustkrebsfrüherkennung). München: Zuckschwert; 2008
• 9 Kopans D B. Effectiveness of US breast cancer screening remains to be demonstrated (letter).  Radiology. 2003;  227 606
• 10 Gordon P B. Ultrasound for breast cancer screening and staging.  Radiol Clin North Am. 2002;  40 403-441
• 11 Nothacker M, Duda V, Hahn M et al. Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review.  BMC cancer. 2009;  9 335
• 12 Ohta T, Okamotot K, Kanemaki Y et al. Use of ultrasonography as an alternative modality for first-line examination in detecting breast cancer in selected patients.  Clin Breast Cancer. 2007;  7 624-626
• 13 Berg W A, Blume J D, Cormack J B et al. Combined screening with ultrasound and mammography vs. mammography alone in women at elevated risk of breast cancer.  JAMA. 2008;  299 2151-2163
• 14 Benson S R, Blue J, Judd K et al. Ultrasound is now better than mammography in detection of invasive breast cancer.  Am J Surg. 2004;  188 381-385
• 15 Berg W A, Gutierrez L, NessAiver M S et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.  Radiology. 2004;  233 830-849
• 16 Chan S W, Cheung P S, Chan S et al. Benefit of ultrasonography in the detection of clinically and mammographically occult breast cancer.  World J Surg. 2008;  32 2593-2598
• 17 Madjar H, Becker S, Doubeck T et al. Impact of breast ultrasound screening in gynecological practice.  Ultraschall in Med. 2010;  31 289-295
• 18 Lenz S. Breast ultrasound in office gynecology – ten years of experience.  Ultraschall in Med. 2011;  32 S3-S7
• 19 BMU .RS II, 1 – 1602 / 14.6./ 09.11.2009. 
• 20 American College of Radiology (ACR) .ACR-BI-RADS® – Breast Imaging Reporting and Data System (BI-RADS™). Breast Imaging Atlas. 3rd ed. Reston (VA): ©America College of Radiology; 2003
• 21 Moy L, Slanetz P J, Moore R et al. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review.  Radiology. 2002;  225 176-181
• 22 Heinig J, Witter R, Schmitz L et al. Accuracy of classification o breast ultrasound findings based on criteria used for BI-RADS.  Ultrasound Obstet Gynecol. 2008;  32 573-578
• 23 Fu C Y, Hsu H H, u J C et al. Influence of age on PPV of sonographic BI-RADS categories 3, 4, and 5.  Ultraschall in Med. 2011;  32 S8-S13
• 24 Eusoma guidelines for quality assurance in breast cancer screening and diagnosis. 4th edition. 2006
• 25 Graf O, Helbich T H, Hopf G et al. Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy?.  Radiology. 2007;  244 87-93