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OBJECTIVE To evaluate the feasibility of the Breast Imaging Reporting and Data System (BI-RADS) in the categorization of nonpalpable breast lesions (NPBLs) and to determine its value in aiding decision-making for biopsy in a Chinese population.METHODS One hundred and seventy-four nonpalpable breast lesions in 155 female patients examined by mammography were retrospectively categorized according to the BI-RAD System, 4th edition, which was established by the American College of Radiology (ACR). All the lesions were diagnosed by a histopathological analysis after mammographically guided wire-localization biopsy.RESULTS The 174 localizations yielded 125 (71.8%) benign lesions and 49 (28.2%) cancers, including 14 (28.6%) ductal carcinomas in situ and 35 (71.4%) invasive cancers. The overall positive predictive value (PPV)for cancer was 28.2% (49/174). After categorization according to the BI-RAD System, there were 12 category 2, 59 category 3, 83 category 4 and 20 category 5 lesions. The PPV for cancer for each category were 0% (0of 12 lesions) in category 2, 3.4% (2 of 59 lesions) in category 3, 37.3%(31 of 83 lesions) in category 4 and 80.0% (16 of 20 lesions) in category 5.CONCLUSION It is concluded that BI-RADS is valuable for the categorization of nonpalpable breast lesions in our Chinese popuiation. This system greatly improved the diagnostic specificity of nonpalpable breast lesions and was feasible in aiding decision-making for biopsy. It is suggested that nonpalpable breast lesions in categories BI-RADS 4 and 5should receive a biopsy because these lesions have a moderate and high positive predictive value for cancer.