Retrospective analysis and clinical significance of the fifth edition of the BI-RADS ultrasound lexicon in the diagnosis of breast cancer

Abstract:

Objective：To explore the application of the ultrasonographic descriptors in the fifth edition（2013 update） of the Breast Imaging Reporting and Data System（BI-RADS） ultrasound（US） lexicon combined with relevant clinical data in the diagnosis of breast cancer，and to evaluate the diagnostic value of the new edition of the BI-RADS US lexicon for breast cancer. Methods：The ultrasono－grams of 2 860 masses were retrospectively reviewed by three independent sonographers with reference to the collected clinical data，and the masses were classified into different categories according to the new edition of the BI-RADS US lexicon. The diagnostic efficacy of the new edition of BI-RADS-US classification was calculated using the receiver operating characteristic（ROC） curve with pathological results as the gold standard，and the recorded ultrasonographic descriptors and collected clinical data were first analyzed by univariate analysis，and the indicators of statistical significance were further analyzed by multivariate logistic regression analysis. Results：According to the new edition of BI-RADS-US for the diagnosis of breast cancer，the malignancy rate was 0.66% in BI-RADS category 2，0.99% in BI-RADS category 3，9.57% in BI-RADS category 4a，32.31% in BI-RADS category 4b，88.36% in BI-RADS category 4c，and 94.19% in BI-RADS category 5. With BI-RADS category 4a as the cut-off point，the new edition of BI-RADS-US for the diagnosis of breast cancer had a sensitivity of 88.55%，a specificity of 92.17%，an accuracy of 91.75%，an AUC of 0.948，and a Youden index of 0.81. Conclusions：The new edition of BI-RADS-US has a high accuracy in the diagnosis and risk stratification of breast cancer. With BI-RADS category 4a as the cut-off point，the new edition of BI-RADS-US has high diagnostic efficacy for breast cancer. The shape，margin，calcification，and blood flow of the mass are important ultrasonographic variables，which clinicians can use for clinical diagnosis and precise treatment with refer－ence to patients’ age and axillary lymph node metastasis.