Positive Predictive Values for Sonographic BI-RADS Assessment Categories by Different Age Groups

Purpose: To investigate positive predictive values (PPVs) of BI-RADS (Breast Imaging Reporting and Data System classification on US in women under age 50 and more than age 50. Materials and Methods: Between May 2009 and October 2009, We reviewed 392 pathologically proven BIRADS category 3, 4, and 5 lesions of 370 patients retrospectively based on BI-RADS US lexicon. Including number of women were 121 patents of aged ≥ 50 (mean age 58.8, range 50~89) and 249 patients of aged < 50 (mean age 38.3, age range 18~49) PPVs for each categories were evaluated in different age groups. By generalized estimating equation. Results: There were 88 benign lesions and 304 malignant lesions. The overall PPV of category 4 and combined category 3, 4, and 5 in women under aged 50 and below was 11.6% and 17.3% versus 25.6% and 33.3% in women aged 50 and above. There was significant positive association between the age-related PPVs and increased age in category 4 and category 3, 4 and 5 (p < 0.001). Conclusion: PPVs of BI-RADS classification on US were significant difference in different age groups. Therefore, more attention should be paid to special age groups that we found sonographic categorizationope

Sonographic and Pathologic Characteristics of Breast Cancers Detected Only by Ultrasound

Purpose: To evaluate the sonographic and pathologic characteristics of breast cancers detected only by ultrasound. Materials and Methods: From March 2009 to January 2010, 13 patients who diagnosed breast cancer by ultrasound (US) with negative mammographic results were included this study. The patients’ age distribution ranged from 45 to 69 years (mean age: 53.2 years). We reviewed the patients’ clinical, imaging and pathologic data. We analyzed sonographic finding of the breast masses, according to ACR BI-RADS - US lexicon classification. Results: 12 patients have grade 3 and 4 dense breasts on mammography and one patient have grade 2 breast density. Breast cancers seen only by US measured 4-12 mm (mean: 8.4 mm). 11 masses were assessed BIRADS category 4a and 2 masses were category 4c. The final surgical pathologic diagnosis were 7 invasive ductal carcinomas, 5 ductal carcinoma in situ and 1 invasive lobular carcinoma. The final pathologic stage were 5 stage 0, 7 stage I, 1 stage IIA. Conclusion: Breast cancers detected only by ultrasound tend to be small masses less than 1 cm without calcification. Patients usually underwent breast conserving surgery and be diagnosed node-negative invasive cancers.ope

Comparison of Cancer Yields and Diagnostic Performance of Screening Mammography vs. Supplemental Screening Ultrasound in 4394 Women with Average Risk for Breast Cancer

PURPOSE: The effectiveness of supplemental screening ultrasound (US) was investigated in women ≥ 40 years at average risk for breast cancer regardless of breast parenchymal density. A total of 4394 women at average risk and having previously undergone screening mammography were classified as the mammography group.  MATERIALS AND METHODS: Of 4394 women, 2005 underwent screening US after a final assessment of category 1 or 2 on screening mammography, and were categorized as the US group. Category 0, 4, and 5 on mammography and 3, 4, and 5 on US were defined as positive. The cancer yields per 1000 women and diagnostic performance of two groups were compared. RESULTS: The total cancer and invasive cancer yields for the mammography group were 3.0 (95 % confidence interval 1.6, 5.1) and 2.0 (95 % CI, 0.9, 3.9) per 1000 women, higher than the US values of 2.0 (0.5, 5.1) and 1.0 (0.1, 3.6), not statistically significant. The specificity, accuracy, and positive predictive value (PPV) for mammography were 88.90 % (87.93, 89.81), 88.85 % (87.88, 89.76), and 2.61 % (1.39, 4.41), significantly higher than the US values of 69.07 % (66.99, 71.09), 69.13 % (67.05, 71.15), and 0.64 % (0.18, 1.64). The short-term follow-up rate of mammography was 5.51 % (4.85, 6.22), significantly lower than the rate of 26.58 (24.66, 28.58) for US.  CONCLUSION: Supplemental screening US in mammographically negative breasts can find additional carcinomas in women at average risk but is not as effective as screening mammography because of the lower cancer yield, invasive cancer yield, specificity, accuracy, PPV and a high short-term follow-up rate.ope

Is Mammography Superior to Breast Ultrasound? Some remarks to: Moon HJ, Jung I, Park J, et al. Ultraschall in Med 2015; 36: 255-263

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Interobserver variability and diagnostic performance in US assessment of thyroid nodule according to size

PURPOSE: To evaluate the interobserver variability for US assessments of thyroid nodules and analyze the diagnostic performances of US assessments in thyroid nodules according to nodule size. MATERIALS AND METHODS: This was an IRB-approved retrospective study with waiver of informed consent. A total of 400 surgically-confirmed thyroid nodules were included. Nodules were divided into 4 groups by size; group 1 (nodule size < 5 mm), group 2 (5 mm ≤ nodule size < 10 mm), group 3 (10 mm ≤ nodule size < 20 mm), and group 4 (nodule size ≥ 20 mm). Three experienced (7 - 10 years) radiologists retrospectively reviewed the US images. Agreement of each US descriptor and final US assessment, and diagnostic performances were calculated in each group and compared. RESULTS: Composition represented substantial or good agreement (k = 0.719 - 0.89). Margin showed the lowest agreement (k = 0.322 - 0.365). Individual kappa values for final assessment according to nodule size were as follows: group 1 (k = 0.674), group 2 (k = 0.596), group 3 (k = 0.674), and group 4 (k = 0.673). Specificity, PPV, and accuracy were significantly different among the groups with different size (p value < 0.05) and lowest in group 1. NPV, specificity, PPV and accuracy except PPV of observer 3 increased with nodule size (p < 0.05). CONCLUSION: Interobserver agreements were relatively good (k = 0.637) in final US assessment regardless of nodule size in experienced radiologists. High false-positive rate was observed in US assessment in nodules less than 5 mm in maximum diameter.ope