Rationale and Objectives
Dedicated breast computed tomography (DBCT) is an emerging and promising modality for breast lesions. The objective of this study was to evaluate the potential use of applying the BI-RADS Mammography Atlas 5th Edition for reporting and assessing breast lesions on DBCT. Currently, no atlas exists for DBCT.
Materials and Methods
Four radiologists trained in breast imaging were recruited in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. The enrolled radiologists, who were blinded to mammographic and histopathologic findings, individually reviewed 30 randomized DBCT cases that contained marked lesions. Thirty-four lesions were included in this study: 24 (70.6%) masses, 7 (20.6%) calcifications, and 3 (8.8%) architectural distortions. Eight (23.5%) lesions were malignant and 26 (76.5%) were benign. The reader was asked to specify according to the BI-RADS Mammography Atlas for each marked DBCT lesion: primary findings, features, breast density, and final assessment. We calculated readers’ diagnostic performances for differentiating between benign and malignant lesions and interobserver variability for reporting and assessing lesions using a generalized estimating equation and the Fleiss kappa (κ) statistic.
Results
The estimated overall sensitivity of the readers was 0.969, and the specificity was 0.529. There were no significant differences in the sensitivity and the specificity between lesion types. For reporting the presence of a primary finding, the overall substantial agreement (κ = 0.70) was seen. In assigning the breast density and the final assessment, the overall agreement was moderate (κ = 0.53) and fair (κ = 0.30).
Conclusion
The use of the BI-RADS Mammography Atlas 5th Edition for DBCT showed high performance and good agreement among readers.
Introduction
Breast Imaging Reporting and Data System (BI-RADS), established by the American College of Radiology, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice and reporting , and the BI-RADS lexicon has provided a valuable and reliable guide for reporting breast lesions on mammography, ultrasound, and magnetic resonance imaging (MRI), and has been familiar to most radiologists specializing in breast imaging. The descriptors in the BI-RADS lexicon have been selected on the basis of their ability to discriminate between benignity and malignancy as clear and standardized terms . BI-RADS has also recommended that a final impression be summarized by choosing only one among several standardized final assessment categories at the end of a report, each of which included a matched, standardized management recommendation . The BI-RADS atlas is intended to be a “living” document that changes as new data are acquired and more sophisticated patterns of breast care emerge . With continued evolvement of lesion characterization and assessment for malignancy, the BI-RADS Mammography Atlas is now in its fifth edition .
In addition to the updates in mammography, the fifth edition contains standardized breast lesion lexicons and assessment language for breast ultrasound and MRI. With advancements in breast imaging technologies, such as dedicated computed tomography of the breast, the BI-RADS Mammography Atlas can serve as the standard terminology upon which lexicons in other areas of radiology and research can be modeled.
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Materials and Methods
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Readers
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Data Description
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TABLE 1
Cross-Tabulation of Lesion Type and Pathology
Type Mass Calcification AD Total Pathology Benign, n (%) 19 (56) 5 (15) 2 (6) 26 (76) Malignant, n (%) 5 (15) 2 (6) 1 (3) 8 (24) Total, N (%) 24 (71) 7 (21) 3 (9) 34 (100)
AD, architectural distortion.
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Image Interpretation
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TABLE 2
BI-RADS Atlas 5th Edition
Description Characteristic Masses Shape Oval Round Irregular Margin Circumscribed Obscured Microlobulated Indistinct Spiculated Density High density Equal density Low density Fat-containing Calcifications Typically benign Skin Vascular Coarse or “popcorn-like” Large rodlike Round Dystrophic Milk of calcium Suture Suspicious morphology Amorphous Coarse heterogenous Fine pleomorphic Fine linear or fine-linear branching Distribution Diffuse Regional Grouped Linear Segmental Architectural distortion Yes No Asymmetry Asymmetry Global asymmetry Focal asymmetry Developing asymmetry
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Data Analysis and Statistics
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Results
Performances
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TABLE 3
Sensitivities and Specificities of Readers for Different Lesion Types
Mass and AD Calcification Overall Sensitivity Specificity Sensitivity Specificity Sensitivity Specificity Reader 1 1.000 0.762 1.000 0.200 1.000 0.654 Reader 2 1.000 0.762 1.000 0.600 1.000 0.731 Reader 3 0.833 0.476 1.000 0.400 0.875 0.462 Reader 4 1.000 0.286 1.000 0.200 1.000 0.269
AD, architectural distortion.
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Interobserver Variability
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TABLE 4
Interobserver Variability in Description of Mammographic Lesions
BI-RADS Descriptor Kappa Value Presence of primary finding Overall 0.70 Mass and architectural distortion 0.78 Calcification 0.52 Breast density Overall 0.53 Final assessment Overall 0.30 Mass and architectural distortion 0.22 Calcification 0.56
BI-RADS, Breast Imaging Reporting and Data System.
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Discussion
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