Positive Predictive Value of Sonographic BI-RADS Final Assessment Categories for Breast Lesions
Main Article Content
Abstract
Introduction: We want to evaluate the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of BI-RADS ultrasound, as well as PPV and NPV of BI-RADS ultrasound lexicon. Methods: A total of 517 ultra- sound-guided breast biopsy cases were performed within three years. A total of 324 cases remained after 193 cases were excluded from this study. The sensitivity, specificity, accuracy, PPV and NPV of overall BI-RADS and PPV for each BI-RADS categories were calculated from the data when compared with histopathological examination (HPE) finding. One observer evaluated four criteria of BI-RADS ultrasound lexicon; margin, echogenicity, posterior artefact and internal echo from static sonographic images to determine the PPV and NPV of sonographic BI-RADS lexicon based on HPE correlation. Results: There were 236 (72.8%) benign and 88 (27.1%) malignant lesions. The overall BI-RADS has a sensitivity of 93.18%, specificity of 66.95%, accuracy of 74.07% with PPV and NPV of 51.25% and 96.34% respectively. The PPV of each BI-RADS categories were; BI-RADS 2 (9.09%), BI-RADS 3 (3.27%), BI-RADS 4 (39.02%) and BI-RADS 5 (91.89%). The highest predictive value for malignancy was irregular margin (52.3%) and for benign was well-defined margin (89.7%). Criteria for margin and posterior artefact had a significant association with HPE (p<0.0001) in differentiating between malignant and benign breast lesions in breast ultrasound. Conclusion: Overlapping benign and malignant sonographic breast lesion descriptors tend to influence radiologist’s decision to overcall final BI-RADS categories. The margin and posterior artefact are the important criteria in BI-RADS lexicon in differentiating benign and malignant breast lesion.
Downloads
Article Details
References
D’ Orsi CJ, Sickles EA, Mendelson EB and Morris EA. ACR BI-RADS ® Atlas, Breast Imaging Reporting and Data System, Reston, VA, American College of Radiology 2013.
Constantini M, Lombardi R and Franceschini G. Characterization of Solid Breast Masses, Use of Sonographic Breast Imaging Reporting and Data System Lexicon. Journal Ultrasound Med 2006; 25: 649–659.
Heinig J, Witteler R, Schmitz R, Kiesel L and J. Steinhard J. Accuracy of classification of breast ultrasound findings based on criteria used for BI- RADS. Ultrasound Obstetric Gynaecologist 2008 ; 32 : 573–578.
Zengin B, Elverici E, Barca N, Cavusoglu M, Duran S, Ozsoy A and Aktas Hafize. Positive Predictive Values of Sonographic BI-RADS Final Assessment Categories for Breast Lesion. The Journal of Breast Health 2013 ; 9 : 125–129.
Park CS, Lee JH, Yim HW, Kang BJ, Kim HS, Jung JI, Jung NY and Kim SH. Observer agreement Using the ACR Breast Imaging Reporting and Data System (BI-RADS) Ultrasound First Edition (2003). Korean Journal Radiology 2007; 8: 397–402.
Lee HJ, Kim EK, Kim MJ, Youk JH, Lee JY, Kang DR and Oh KK. Observer variability of Breast Imaging Reporting and Data System ( BI-RADS ) for breast ultrasound. European Journal of Radiology 2008 ; 65: 293–298.
Nascimento JHR, Silva VD, Maciel AC. Accuracy of sonographic findings in breast cancer : correlation between BI-RADS ® categories and histological findings. Radiology Bras. 2009; 42: 235–240.
Okeji MC, Agwu KK, Agwuna KK, and Nwachukwu IC. Sonographic Features and Its Accuracy in Differentiating between Benign and Malignant Breast Lesions in Nigerian Women. World Journal of Medical Sciences 2015 ; 12: 370–374.
Hille H, Vetter M and Hackeloer BJ. The Accuracy of BI-RADS Classification of Breast Ultrasound as a First-Line Imaging Method. Ultraschall in Med 2012 ; 33 : 160-163.
Badan GM, Junior DR, Ferreira CAP, Ferreira FAT, Fleury EFC, Amaral Campos MSD, Oliveira Seleti R and Cruz Junior H. Positive predictive values of Breast Imaging Reporting and Data System ( BI- RADS ®) categories 3 , 4 and 5 in breast lesions submitted to percutaneous biopsy. Radiology Bras. 2013; 46: 209–213.
Kim EK, Ko KH, Oh KK, Kwak JY, You JK, Kim MJ and Park BW. Clinical Application of the BI- RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008 ; 190: 1209–1215.
Kim SJ, Chang JM, Cho N, Chung SY, Han WS and Moon WK. Outcome of breast lesions detected at screening ultrasonography. European Journal of Radiology 2012; 81: 3229–3233.
Raza S, Chikarmane S.A, Neilsen S.S, Zorn L.M, Birdwell R.L. BI-RADS 3,4 and 5 Lesions: Value of US in Management - Follow up and Outcome. RSNA 2008; 248: 773-781.
Graf O, Helbich T.H, Hopf G, Graf C and Sickles E.A. Probably Benign Breast Masses at US: Is Follow up an Acceptable Alternative to Biopsy?. RSNA 2007; 244: 87-93.
Radhakrishna S, Gayathri A and Chegu D. Needle core biopsy for breast lesions : An audit of 467 needle core biopsies. Indian Journal of Medical and Paediatric Oncology 2013; 34: 252-256.
Eda E, Ayse N.B, Hafize A, Arzu O, Betul Z, Mehtap C and Levent A. Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Turkish Society of Radiology 2015; 21: 189-194.
Zou XB,Wang JW, Lan XW, Lin QG, Han F, Liu LZ and Li AH. Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions. Elsevier 2016: 2065–2071.
Lazarus E, Mainiero MB, Schepps B, Koelliker S and Livingston LS. BI-RADS Lexicon for USG and Mammography: Interobserver Variability and Positive Predictive Value. RSNA 2006; 239: 385-391.