乳腺影像报告和数据系统在国人女性乳腺癌筛查中的应用价值

Value of breast imaging reporting and data system in Chinese breast cancer screening

目的 探讨乳腺影像报告和数据系统（BI-RADS）评估分类在国人女性乳腺癌筛查中的应用价值.方法 搜集2009年8月至12月参加乳腺癌筛查项目中行乳腺X线摄影的3483名妇女资料,参照BI-RADS标准对乳腺评估分类,对于疾病的诊断最终以组织病理结果为金标准,计算BI-RADS评估分类的准确度、敏感度、特异度及BI-RADS各类的阳性预测值（PPV）和阴性预测值（NPV）.结果 3483名受检妇女乳腺组成中脂肪型、散在腺体型、不均匀致密型和高度致密型分别有267、1245、1890和81名.进行BI-RADS评估分类,0～5类分别为273（7.8%）、1011（29.0%）、1741（50.0%）、383（11.0%）、59（1.7%）和16（0.5%）名.71例受检者的77个乳腺病变经病理证实,包括恶性病变29例,良性病变48例.BI-RADS评估分类的准确度为63.6%（49/77）,敏感度为93.1%（27/29）,特异度为45.8%（22/48）,BI-RADS总体PPV为50.9%（27/53）,0类、4类和5类的PPV分别为25.0%（1/4）、36.4%（12/33）和87.5%（14/16）,2类、3类的NPV分别为90.9%（10/11）和100.0%（12/12）.结论 乳腺X线摄影应用BI-RADS评估分类可以有效地预测乳腺恶性病变,在国人女性乳腺癌筛查应用中有一定价值.

Abstract：Objective To study the value of breast imaging reporting and data system （BI-RADS）in Chinese breast cancer screening. Methods A total number of 3483 women participated in breast cancer screening with mammography in Hexi district in Tianjin from August to December 2009, which was organized by ministry of public health. BI-RADS assessment categories and recommendations were compared with histological findings. The precision, sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） were calculated. Results Among 3483 screening mammography cases, 267 were almost entirely fat breast, 1245 were scauered fibroglandular, 1890 were dense and 81 extremely dense.There were 1011 patients（29.0%） with category 1, 1741 （50.0%） with category 2, 383 （11.0%） with category 3, 59 patients（1. 7%） with category 4 and 16 （0. 5%） with category 5 according to BI-RADS assessment categories. Totally, 71 women with 77 lesions were confirmed by histological examinations. There were 29 malignant and 48 benign lesions. The diagnostic precision, sensitivity, specificity of BI-RADS were 63. 6% （49/77） , 93. 1% （27/29） and 45.8% （22/48） . The general PPV of BI-RADS was 50. 9%（27/53）. The PPV of categories 0, 4, 5 were 25.0% （1/4）, 36. 4% （12/33） and 87. 5% （14/16）. The NPV of categories 2 and3 were90.9% （10/11）, 100.0% （12/12）. Conclusions B1-RADS is of much value in assessing the breast malignancy. It is applicable in Chinese breast cancer screening.