BI-RADS 3 category, a pain in the neck for the radiologist which technique detects more cases?
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1 BI-RADS 3 category, a pain in the neck for the radiologist which technique detects more cases? Poster No.: B-0966 Congress: ECR 2013 Type: Scientific Paper Authors: J. Etxano Cantera, I. Simon-Yarza, G. Viteri, M. Páramo, A. Elizalde, L. J. Pina Insausti; Pamplona/ES Keywords: Breast, Ultrasound, Mammography, Technology assessment DOI: /ecr2013/B-0966 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 33
2 Purpose The Breast Imaging Report and Data System (BI-RADS) final assessment categories are widespread used and have become essential for all breast imaging reports (1). Perhaps, the most controversial is the BI-RADS category 3 (BR3), defined as "probably benign". A lesion categorized as BR3, should have a likelihood of malignancy lower than 2%. In other words, most BR3 lesions are completely benign. The reason why this category exists, is because a malignant lesion can show benign features Fig. 1 on page 2.Typical mammographic lesions included in this category are: well-circumscribed and noncalcified solitary mass Fig. 2 on page 3, punctate or oval clustered microcalcifications Fig. 3 on page 4 and asymmetric breast tissue Fig. 4 on page 5 (2-5). On ultrasound BR3 includes masses showing circumscribed margins, parallel orientation and oval shape Fig. 5 on page 6 (6). Finally, MRI BR3 comprises lesions showing mild to moderate progressive contrast enhancement and lacking spiculation or microlobulation (7) Fig. 6 on page 7. US is a well known complemmentary technique, especially useful for dense breast, where the sensitivity of mammography can drop dramatically. Recently, Digital Breast Tomosynthesis (DBT) has been incorporated to the radiologist s tools to improve the accuracy of digital mammography. However, it is important to evaluate both US and DBT in the detection of BR3 lesions, because a high detection rate of these lesions can produce anxiety and increase the workload, and not all patients can accomplish with periodic follow-up. The PURPOSE of our study was to compare the rates of BI-RADS 3 lesions detected by digital mammography, Ultrasound and Digital Breast Tomosynthesis Images for this section: Page 2 of 33
3 Fig. 1: Invasive ductal carcinoma showing as a well-delimited mass Page 3 of 33
4 Fig. 2: Well-delimited oval mass, a typical finding classified as BR3. The lesion was solid on US. A core-needle biopsy was performed as an alternative to short-term followup.fibroadenoma. Page 4 of 33
5 Fig. 3: Punctate and round calcifications. Typically these calcifications are benign and were stable. Page 5 of 33
6 Fig. 4: Focal asymmetry seen in the left breast. Pathology: invasive lobular carcinoma Page 6 of 33
7 Fig. 5: All of these solid massess fullfil the criteria of probably benign masses on US: oval morphology, well-delimited margins and parallel orientation. Page 7 of 33
8 Fig. 6: Different MRI findings that can be classified as BR3 include foci and well delimited nodules with internal non-enhancing septa Page 8 of 33
9 Methods and Materials This study was approved by the Ethic Committee at our institution. From October 2011 to August 2012, 2256 patients underwent DM Fig. 7 on page 9, US Fig. 8 on page 9 and DBT Fig. 9 on page 10, all of them showing ACR density patterns 2, 3 & 4 Fig. 10 on page 11. For each imaging modality, all the patients were classified according the BI-RADS categories 0-6 Fig. 11 on page 12. We compared the rate of BI-RADS 3 lesions detected on each technique, using a Pearson Chi-square test (SPSS 15.0) Fig. 12 on page 13. Images for this section: Fig. 7 Page 9 of 33
10 Fig. 8 Page 10 of 33
11 Fig. 9 Page 11 of 33
12 Fig. 10 Page 12 of 33
13 Fig. 11 Page 13 of 33
14 Fig. 12 Page 14 of 33
15 Results DM detected 227 patients with BI-RADS 3 lesions (10.06 %) US detected 471 patients with BI-RADS 3 lesions (20.88 %) DBT detected 270 patients with BI-RADS 3 lesions (11.97%) There were statistically significant differences among the three techniques Fig. 13 on page 15, Fig. 14 on page 16, but the difference was smaller between MD and DBT (p=0.04). Out of the 227 patients with BI-RADS 3 lesions detected on DM, DBT upgraded 8 cases and downgraded 23 cases, while US upgraded 18 cases and downgraded 41 cases Fig. 15 on page 17. Four cancers were diagnosed. One of them was a BI-RADS 3 lesion in all of the imaging techniques Fig. 16 on page 18 Fig. 17 on page 19 Fig. 18 on page 20. Three cancers were diagnosed because the lesions were upgraded after US or DBT Fig. 19 on page 21, Fig. 20 on page 22, Fig. 21 on page 23, Fig. 22 on page 24,Fig. 23 on page 25,Fig. 24 on page 26, Fig. 25 on page 27. Typically US detected BI-RADS 3 lesions in patients with normal DM or DBT Fig. 26 on page 28,Fig. 27 on page 29, Fig. 28 on page 30. Images for this section: Page 15 of 33
16 Fig. 13 Page 16 of 33
17 Fig. 14 Page 17 of 33
18 Fig. 15 Page 18 of 33
19 Fig. 16 Page 19 of 33
20 Fig. 17 Page 20 of 33
21 Fig. 18 Page 21 of 33
22 Fig. 19 Page 22 of 33
23 Fig. 20 Page 23 of 33
24 Fig. 21 Page 24 of 33
25 Fig. 22 Page 25 of 33
26 Fig. 23 Page 26 of 33
27 Fig. 24 Page 27 of 33
28 Fig. 25 Page 28 of 33
29 Fig. 26 Page 29 of 33
30 Fig. 27 Page 30 of 33
31 Fig. 28 Page 31 of 33
32 Conclusion Our results indicate that both US and DBT detected more patients with additional BIRADS 3 lesions than DM alone. However, US detected twice as many patients with BIRADS 3 lesions as DM. DBT detected more BI-RADS 3 cases than DM, but the difference was smaller (11.97 % vs %; p=0.04) References 1-American College of Radiology. Illustrated breast imaging reporting data system (BIrd RADS), 3 ed. Reston, VA: American College of Radiology, Sickles EA.Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 1991; 179: Adler DD, Helvie MA, Ikeda DM. Nonpalpable probably benign breast lesions: followup strategies after initial detection on mammography. AJR Am J Roentgenol.1990; 155: Vizcaino I, Gadea L, Andreo L et al. Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology.2001;219: Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S, Leborgne F. Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 2002;179: Raza S, Goldkamp AL, Chikarmane SA, Birdwell RL. US of breat massess categorized as BI-RADS 3,4, and 5: Pictorial review of factors influencing clinical management. Radiographics. 2010;30: Personal Information Page 32 of 33
33 Fig. 29 References: Radiology, Clínica Universidad de Navarra - Pamplona/ES Page 33 of 33
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