Solid breast mass characterisation: use of the sonographic BI-RADS classification

PurposeThe aim of this study was to assess the reliability of the sonographic Breast Imaging Reporting and Data System (BI-RADS) classification in differentiating benign from malignant breast masses.Materials and methodsA total of 292 female patients with breast masses undergoing biopsy between November 2004 and March 2006 in our department were included in this study. All lesions were classified according to the sonographic BI-RADS lexicon. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the sonographic BI-RADS lexicon and PPV and NPV for each lesion category and each sonographic descriptor were calculated. The χ2 test and the Fischer exact test were used to evaluate our results.ResultsUnivariate analysis showed a significant difference between malignant and benign groups with regard to morphology (p<0.001), horizontal-vertical diameter ratio<1 (p<0.002), orientation (p<0.001), noncircumscribed margins (p<0.001), echogenic halo (p<0.001), hypoechoic pattern (p=0.035), shadowing (p<0.001) and surrounding tissue alterations (p=0.001). The cumulative risk for malignancy was 64 and 10 times higher, respectively, in categories 5 and 4 than in category 3.ConclusionsThe sonographic BI-RADS lexicon is an important system for describing and classifying breast lesions.RiassuntoObiettivoValutare l’attendibilità della classificazione BI-RADS nella caratterizzazione ecografica delle lesioni solide della mammella.Materiali e metodiSono state studiate 292 pazienti con nodulo mammario sottoposto a biopsia nel nostro Dipartimento dal novembre 2004 al marzo 2006. Ogni lesione è stata studiata ecograficamente e classificata secondo i criteri BI-RADS. Sono stati calcolati specificità, sensibilità, accuratezza, valore predittivo positivo e negativo (VPP e VPN) del sistema BI-RADS, VPP e VPN per ogni classe e per ogni descrittore ecografico. Sono stati adottati il test del χ2 e il test esatto di Fischer per valutare la significatività dei nostri risultati.RisultatiDall’analisi univariata sono emerse differenze statisticamente significative tra il gruppo lesioni maligne e quello lesioni benigne rispetto alle seguenti variabili: forma (p<0,001), rapporto dei diametri inferiori a 1 (p<0,002), orientamento (p<0,001), margini non circoscritti (p<0,001), alone iperecogeno (p<0,001), ipoecogenecità (p=0,035), sbarramento (p<0,001), presenza di alterazioni del parenchima circostante (p=0,001). Dall’analisi multivariata è risultato che il rischio di avere una lesione maligna è in classe V e IV, rispettivamente 64 e 10 volte maggiore rispetto alla classe III.ConclusioniIl nostro studio conferma che la classificazione ecografica BI-RADS costituisce un accurato sistema per la descrizione e il management delle lesioni mammarie.

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