OBJECTIVE: The present study was aimed at evaluating BI-RADS® 3, 4 and 5 categories as positive predictive value for malignancy of non-palpable breast lesions, correlating mammographic and histopathological findings. MATERIALS AND METHODS: In the period from July/2005 to March/2008, 371 patients with mammograms classified as BI-RADS categories 3, 4 and 5 were referred to a center of reference in cancer treatment in Terezina, PI, Brazil, for histopathological investigation and had their mammograms reviewed. Among these 371 patients, 265 were submitted to core-biopsy and 106 to preoperative needle localization. RESULTS: Mammograms were classified as follows: 11.32% category 3, 76.28% category 4 and 12.4% category 5. The histopathological studies demonstrated 24% of results positive for malignancy. Positive predictive values for categories 3, 4 and 5 were, respectively, 7.14%, 16.96% and 82.61%. Positive predictive values were separately calculated for core-biopsies (7.14%, 15.76%, and 76.47%) and pre-surgical needle localization (7.14%, 20%, 100%). CONCLUSION: Malignant findings were underestimated, and benign findings were overestimated by mammographic reports, thus resulting in some unnecessary invasive procedures.

Keywords: BI-RADS, Mammography, Cancer, Breast

OBJECTIVE: To evaluate the positive predictive value for BI-RADS (Breast Imaging Reporting and Data System) categories 3, 4 and 5, correlating mammographic and histological diagnosis in non-palpable breast lesions. MATERIALS AND METHODS: Analytical-descriptive study of 169 women submitted to stereotactic localization for surgical biopsy of non-palpable breast lesions. Mammographic and histological findings were correlated, analyzing the predictive positive value for each category. RESULTS: Forty-two (24.8%) cases were diagnosed with breast cancer - only one in category 3, 19 in category 4, and 22 in category 5. The positive predictive value for categories 3, 4A, 4B, 4C and 5 were, respectively, 3.4%, 10.3%, 11.3%, 36% and 91.7%. Microcalcifications were the most frequent finding related to malignancy, present in 61.5% of these cases. CONCLUSION: The present study has demonstrated that BI-RADS allows a safe prediction of high suspicion of malignancy in lesions category 5 and low suspicion for category 3. As regards the category 4, the positive predictive value has shown a progressive increase in subcategories A, B and C, demonstrating that this subclassification represents an invaluable contribution for a more detailed and accurate assessment of lesions suspicious for malignancy.

Keywords: Breast cancer, Mammography, BI-RADS, Histological diagnosis

OBJECTIVE: The present study was aimed at evaluating the BI-RADS® classification accuracy in mammography. Additionally, the frequency of different findings was described and the interobserver agreement was evaluated. MATERIALS AND METHODS: Mammographic images of 115 patients were independently and blindly reviewed by two specialists in compliance with BI-RADS recommendations, and later compared with histological data. The BI-RADS accuracy in mammography was evaluated. The interobserver agreement was analyzed with the Cohen's kappa (κ) test, and the differences between groups were evaluated with the chi-squared test. RESULTS: The present study demonstrated that the mammographic accuracy ranged from 75% to 62% in the differentiation between benign and malignant lesions with the utilization of the BI-RADS classification. Statistically significant interobserver agreement was observed in the description of masses margins (κ= 0.66). A low agreement rate was identified in the description of masses borders (shape) (κ= 0.40) and calcifications, both in relation to their distribution (κ= 0.24) and morphology (κ= 0.36). CONCLUSION: The present study demonstrated the BI-RADS accuracy in the differentiation between benign and malignant lesions. The interobserver agreement was poor in the analysis of calcifications morphology and distribution, but a progressive increase in the positive predictive values was observed in the subcategory 4.

Keywords: Breast cancer, Mammography, Histopathology, Accuracy, BI-RADS, Ultrasonography

OBJECTIVE: To investigate the utilization of text mining technique for evaluating the informational quality of electronic mammographic reports considering adherence to the BI-RADS® lexicon as a quality parameter. MATERIALS AND METHODS: A total of 22,247 mammography reports of the period between January, 2000 and June, 2006 were collected from the radiology information database of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, SP, Brazil. Two experiments were undertaken - experiment 1 to evaluate the accuracy in the adoption of the lexicon terms (text mining method specificity), and experiment 2 to identify all and any attempt to utilize or refer to the lexicon (text mining method sensitivity). RESULTS: Experiment 1: variation between 11% and 61% in reports including lexicon terms in their conclusion, randomly distributed over time since 2001. Experiment 2: variation between 44% and 100% in reports that somehow refer to the lexicon in their conclusion. CONCLUSION: Results indicate a good potential for text mining tool application for assessing the quality of information included in electronic mammography reports.

Keywords: Mammography, BI-RADS, Information theory, Medical information technology

OBJECTIVE: The main purpose of the present study is to evaluate the accuracy of ultrasonography (BI-RADS) in the diagnosis of breast cancer whereas the additional specific objectives are to describe the frequency of different sonographic findings and evaluating interobserver agreement. MATERIALS AND METHODS: Images of 110 patients who had been referred for biopsy with previous diagnosis of breast nodules were independently reviewed by two specialists according to the BI-RADS classification. Histological findings were utilized as a gold-standard. The accuracy of findings was determined. The chi-squared test for categorical variables was utilized in the analysis of the differences resulting from the groups comparison, and the interobserver agreement was calculated with kappa () statistics. RESULTS: Among 110 breast masses evaluated by ultrasonography, 76 (69%) were benign and 34 (30.9%) were malignant. According to the radiologists, the sensitivity ranged from 70.5% to 82.3%, negative predictive value, from 81.1% to 87.5%, positive predictive value, from 42.1% to 45.1%, specificity from 56.58% to 55.2%, and accuracy from 60.9% to 63.6%. The global interobserver agreement was considered as moderate ( = 0.50). CONCLUSION: The fourth edition of BI-RADS provides radiologists with an accurate clinical decision support system for the diagnosis and management of breast disease.

Keywords: Breast cancer, Ultrasonography, BI-RADS, Anatomopathological, Accuracy

OBJECTIVE: To evaluate the predictive value of BI-RADS™ categories 3, 4 and 5 in non-palpable breast masses assessed by mammography, ultrasound and magnetic resonance imaging MATERIALS AND METHODS: Twenty-nine patients with BI-RADS categories 3, 4 and 5 nonpalpable breast masses identified by mammograms were submitted to complementary ultrasound and magnetic resonance imaging studies, besides excisional biopsy. In total, 30 biopsies were performed. The lesions as well as their respective BI-RADS classification into 3, 4 and 5 were correlated with the histopathological results. The predictive values calculation was made by means of specific mathematical equations. RESULTS: Negative predictive values for category 3 were: mammography, 69.23%; ultrasound, 70.58%; and magnetic resonance imaging, 100%. Positive predictive values for category 4 were: mammography, 63.63%; ultrasound, 50%; and magnetic resonance imaging, 30.76%. For category 5, positive predictive values were: mammography and ultrasound, 100%; and magnetic resonance imaging, 92.85%. CONCLUSION: For category 3, the negative predictive value of magnetic resonance imaging was high, and for categories 4 and 5, the positive predictive values of the three modalities were moderate.

Keywords: BI-RADS, Breast cancer, Mammography, Predictive value

OBJECTIVE: To review the literature about the positive predictive value of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5. MATERIALS AND METHODS: A research was performed in the online Medline database, entering the terms "predictive value" and "BI-RADS". Eleven studies were included in this review. RESULTS: The positive predictive values ranged respectively between 0% and 8%, 4% and 62%, and 54% and 100% for BI-RADS® categories 3, 4 and 5. Three studies have also evaluated morphological criteria with higher positive predictive value in mammography, mass with spiculated margins being the finding with highest positive predictive value for malignancy. CONCLUSION: A high variability was found in the reviewed literature among positive predictive values of BI-RADS® categories 3, 4 and 5, although methodological differences have been identified, limiting the comparative analysis.

Keywords: Mammography, BI-RADS®, Breast cancer

The author presents a critical analysis of the recently published BI-RADS TM system. The first recommendation is to always determine if BI-RADS TM is being used for mammography, ultrasound or magnetic resonance by using the term BI-RADS TM-US or a similar term. The advantages of using the BI-RADS TM-US including reproducibility, standardization, auditing, basis of echogenicity are also considered. In addition, some drawbacks of the system are identified: the omission of statistically significant proven descriptors such as marked hypoechogenicity and number of lobulations, the use of non-recognized descriptors such as the Cooper ligament, and the lack of data on the positive predictive value of some very common breast lesions such as hypoechoic nodules. Finally, a suggestion is presented: to classify the descriptors according to its importance as predictors in order to determine the positive predictive value of the lesions.

Keywords: BI-RADS™, Mammography, Breast cancer

OBJECTIVE: To present an audit model for mammography results used on the examinations performed at "Centro de Diagnóstico Mamário da Santa Casa da Misericórdia do Rio de Janeiro", Rio de Janeiro, Brazil. MATERIALS AND METHODS: Between May 1997 and September 1998, 2,000 mammography examinations were performed, 1,570 in asymptomatic women, which results were assessed in this audit. RESULTS: The mammography examinations of the asymptomatic women were classified as follow: category 1 - 1,362 cases; category 2 - 9 cases; category 3 - 95 cases; category 4 - 24 cases; category 5 - 6 cases; category 0 - 74 cases. Out of 199 abnormal examinations (categories 0, 3, 4 and 5), 107 (54%) were followed-up and 92 (46%) were lost to follow-up. The 107 cases included in the study were classified as follows: category 3 - 48 cases; category 4 - 18 cases; category 5 - 4 cases; category 0 - 37 cases. No cases of cancer were detected among the 48 cases in category 3; two cases of cancer were seen among the 18 cases in category 4; all four cases in category 5 were cancer; one case of cancer was seen among the 37 cases in category 0. The audit values obtained were the following: positive predictive value (based on the exam with abnormal result) - 11%; positive predictive value (when there was indication for biopsy) - 31%. The rate of cancer detection in 1,570 women was of seven cases; the sensitivity was 100%; the specificity was 96%; and the recall rate was 4.7%. CONCLUSION: All these results reproduce data from the literature.

Keywords: Audit, Mammography, BI-RADS

The Breast Imaging Reporting and Data System (BI-RADS™) of the American College of Radiology is a system designed to standardize mammography reports, to reduce breast imaging misinterpretations and to facilitate monitoring of the outcome. OBJECTIVE: To identify the compliance of women and physicians with BI-RADS recommendations in Goiânia, GO, Brazil. MATERIALS AND METHODS: 3,000 women submitted to mammography examinations in a private clinic in Goiânia (January to December, 2002) were evaluated. The mammograms were reported according to BI-RADS classification. Women classified as categories 0, 3, 4 and 5 were followed up by telephone. RESULTS: Women who refused to follow the recommendation: category 0 (11.5%), 3 (13.8%), 4 (28%), 5 (0%). Physician failure to advise the patient to follow the recommendation: category 0 (18.2%), 3 (17%), 4 (20%). Women who complied with BI-RADS recommendation: category 0 (1.8%), 3 (5.7%), 4 (40%), 5 (100%). Contact lost during the follow-up: category 0 (68.5%), 3 (39%), 4 (12%). CONCLUSION: The level of compliance with BI-RADS recommendations was low in categories 0 and 3, and moderate in category 4. About 30% of women classified as category 0 did not undergo additional imaging evaluations either because of their refusal or lack of adequate physician advice.

Keywords: Mammography, Screening, BI-RADS

In a retrospective study, from August 1999 until June 2002, 6,999 consecutive mammograms were analyzed using Breast Imaging Reporting and Data System (BI-RADS™) guidelines, with the purpose of a regional analysis of mammographic findings in the categories 4 and 5 BI-RADS, which were all recommended to histopathologic study, evaluating the sensibility of this method in these categories, as an indicator of malignancy. The analysis revealed 43.65% (n = 3,055) of negative findings, 47.36% (n = 3,315) of benign lesions, 7.47% (n = 523) of probably benign lesions, 0.87% (n = 61) of suspicious lesions, and 0.64% (n = 45) of highly suspicious lesions. All the patients fitted in the categories 4 (61 patients) and 5 (45 patients) were referred for biopsy. The histopathologic analysis showed 27 patients in category 4 (44.26%) and 27 patients in category 5 (60%): 55.55% (n = 15) of category 4 patients showed malignant lesions; 96.29% (n = 26) of category 5 patients showed malignant lesions. The study demonstrates the high positive predictive value for malignancy in BI-RADS category 5 and the real need for follow-up investigation in BI-RADS category 4.

Keywords: BI-RADS, Mammography

We used the American College of Radiology BI-RADS™ (Breast Imaging Reporting and Data System) guidelines to perform a regional retrospective analysis of 4,968 mammograms. The frequency of each mammography finding was determined in order to categorize the mammograms into different groups. The analysis of the 4,968 mammograms revealed 44.4% (n = 2,208) of negative findings, 46.3% (n = 2,305) of benign lesions, 7.5% (n = 374) of probably benign lesions, 0.98% (n = 49) of suspicious lesions and 0.72% (n = 36) of highly suspicious lesions. This study also demonstrates the importance of using BI-RADS™ as a standardized report system for mammogram analysis, particularly as a predictor of malignancy and guideline for patient management.

Keywords: BI-RADS, Mammography

Objective: To assess the performance of morphometric parameters calculated from breast lesion contours at ultrasonography, in the quantification of morphological features and in the distinction among BI-RADS categories 2, 3, 4 and 5. Materials and Methods: The present casuistry included 40 cases, with orthogonal imaging of patients submitted to surgery. Based on the lesions segmentation, the following five morphometric parameters were calculated: area ratio, overlap ratio, normalized residual value, circularity and depth-to-width ratio. Linear discriminant analysis was applied to select the best parameters, and ROC curve was utilized as figure of merit. Results: Overlap ratio was able to statistically distinguish breast lesions classified as BI-RADS 3 from others classified as BI-RADS 4 (α = 5%; p = 0.015). Additionally, such parameter presented the best performance in the differentiation between malignant and benign breast lesions. Conclusion: These results indicate that morphometric analysis of breast lesions at ultrasonography seems to be helpful in distinguishing patients who should undergo biopsy from those to be followed-up only with imaging methods.

Keywords: Breast ultrasonography; BI-RADS; Computer-assisted image processing; Computer-assisted image interpretation.

OBJECTIVE: To evaluate the BI-RADS as a predictive factor of suspicion for malignancy in breast lesions by correlating radiological with histological results and calculating the positive predictive value for categories 3, 4 and 5 in a breast cancer reference center in the city of São Paulo. MATERIALS AND METHODS: Retrospective, analytical and cross-sectional study including 725 patients with mammographic and/or sonographic findings classified as BI-RADS categories 3, 4 and 5 who were referred to the authors' institution to undergo percutaneous biopsy. The tests results were reviewed and the positive predictive value was calculated by means of a specific mathematical equation. RESULTS: Positive predictive values found for categories 3, 4 and 5 were respectively the following: 0.74%, 33.08% and 92.95%, for cases submitted to ultrasound-guided biopsy, and 0.00%, 14.90% and 100% for cases submitted to stereotactic biopsy. CONCLUSION: The present study demonstrated high suspicion for malignancy in lesions classified as category 5 and low risk for category 3. As regards category 4, the need for systematic biopsies was observed.

Keywords: Breast cancer; BI-RADS; Percutaneous biopsy; Positive predictive value; Histological diagnosis.

OBJECTIVE: Undertaking of a complete audit of the service of mammography, as recommended by BI-RADS^®, in a private reference institution for breast cancer diagnosis in the city of São Paulo, SP, Brazil, and comparison of results with those recommended by the literature. MATERIALS AND METHODS: Retrospective, analytical and cross-sectional study including 8,000 patients submitted to mammography in the period between April 2010 and March 2011, whose results were subjected to an internal audit. The patients were followed-up until December 2012. RESULTS: The radiological classification of 7,249 screening mammograms, according to BI-RADS, was the following: category 0 (1.43%), 1 (7.82%), 2 (80.76%), 3 (8.35%), 4 (1.46%), 5 (0.15%) and 6 (0.03%). The breast cancer detection ratio was 4.8 cases per 1,000 mammograms. Ductal carcinoma in situ was found in 22.8% of cases. Positive predictive values for categories 3, 4 and 5 were 1.3%, 41.3% and 100%, respectively. In the present study, the sensitivity of the method was 97.1% and specificity, 97.4%. CONCLUSION: The complete internal audit of a service of mammography is essential to evaluate the quality of such service, which reflects on an early breast cancer detection and reduction of mortality rates.

Keywords: Breast cancer; Mammographic screening; BI-RADS; Audit of mammography service; Percutaneous biopsy; Positive predictive value.