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Available from: Po-Hao Chen, Aug 16, 2014
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    ABSTRACT: The purpose of the study was to assess the positive predictive value of mammographic features and final assessment categories described in the Breast Imaging Reporting and Data System (BI-RADS) for lesions on which biopsies have been performed. We prospectively evaluated 492 impalpable mammographically detected lesions on which surgical biopsy (as opposed to percutaneous biopsy) was performed. Each lesion was classified according to BI-RADS descriptors for masses (margins and shape) and calcifications (morphology and distribution) and was categorized by the BI-RADS final assessment categories as category 3 ("probably benign"), category 4 ("suspicious abnormality"), or category 5 ("highly suggestive of malignancy"). Mammographic and pathologic findings were reviewed. Carcinoma was present in 225 (46%) of 492 lesions. For the 492 lesions subject to biopsy, BI-RADS final assessment categories were category 3 in eight lesions (2%), category 4 in 355 (72%), and category 5 in 129 (26%). The features with highest positive predictive value for carcinoma were spiculated margins (81%), irregular shape (73%), linear calcification morphology (81%), and segmental or linear calcification distribution (74% and 68%, respectively). Carcinoma was present in 105 (81%) of 129 category 5 lesions compared with 120 (34%) of 355 category 4 lesions (p < .001). The frequency of carcinoma was higher in category 5 than in category 4 lesions for all mammographic lesion types and all interpreting radiologists. The standardized terminology of the BI-RADS lexicon allows quantification of the likelihood of carcinoma in an impalpable breast lesion. The features with highest positive predictive value--spiculated margins, irregular shape, linear morphology, and segmental or linear distribution--warrant designation of a lesion as category 5.
    American Journal of Roentgenology 07/1998; 171(1):35-40. DOI:10.2214/ajr.171.1.9648759 · 2.74 Impact Factor
  • American Journal of Roentgenology 08/2001; 177(1):173-5. · 2.74 Impact Factor
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    ABSTRACT: To retrospectively evaluate whether microcalcification descriptors and the categorization of microcalcification descriptors in the Breast Imaging Reporting and Data System (BI-RADS) 4th edition help stratify the risk of malignancy, by using biopsy and clinical follow-up as reference standards. The institutional review board approved this HIPAA-compliant study and waived informed consent. The study included 115 women (age range, 26-82 years; mean age, 55.8 years +/- 10.5 [standard deviation]) who consecutively underwent image-guided biopsy of microcalcifications between November 2001 and October 2002. Screening and diagnostic mammograms (including magnification views) obtained before biopsy were analyzed in a blinded manner by a subspecialty-trained breast imager who recorded BI-RADS descriptors on a checklist. The proportion of malignant cases was used as the outcome variable to evaluate the ability of the descriptors to help capture the risk of malignancy. Fisher exact test was used to calculate the difference among the individual descriptors and descriptor categories. The positive predictive value of biopsy for malignancy was 21.7%. Each calcification morphologic descriptor was able to help stratify the probability of malignancy as follows: coarse heterogeneous, one (7%) of 14; amorphous, four (13%) of 30; fine pleomorphic, 10 (29%) of 34; and fine linear, 10 (53%) of 19. Fisher exact test results revealed a significant difference among these descriptor categories (P = .005). Significant differences among the risks suggested by microcalcification distribution descriptors (P = .004) and between that of stability descriptors (P = .001) were found. The microcalcification descriptors and categories in BI-RADS 4th edition help predict the risk of malignancy for suspicious microcalcifications.
    Radiology 03/2007; 242(2):388-95. DOI:10.1148/radiol.2422052130 · 6.21 Impact Factor