年龄对诊断性乳腺超声中BI-RADS分类3-5类病变PPV的影响

Does patient age affect the PPV of ACR BI-RADS ultrasound categories 3 to 5 in the diagnostic setting?

目的评估年龄对2013年版乳腺影像报告及资料系统(BI-RADS)在临床诊断性乳腺超声检查中的3-5类病灶的阳性预测值(PPV)的影响。方法回顾中山大学孙逸仙纪念医院2014年6月至2016年6月因临床症状行乳腺超声检查的成年女性病例,筛选最终分类为3～5类且接受活检有最终病理诊断的来自4428例患者的4428个病灶进行分析。所有病例按患者年龄分为三组(年轻组<35岁,中年组35～50岁及年长组>50岁),计算各BI-RADS分类中三个年龄组的年龄相关PPV并进行比较分析。结果在3类及4类的三个亚类中,PPV均随着年龄增长而逐渐升高。在3类、4A及4B类中,年长组的年龄相关PPV接近或超出相应类别参考范围上界。结论2013版超声BI-RADS分类在乳腺疾病诊断的应用中,3类及4类病灶的PPV与年龄有着显著相关性。在临床应用中,当对年长病人给予最终BI-RADS分类时,应小心谨慎,以防低估。

Objective To calculate the positive predictive value(PPV)of the Ultrasound section of the American College of Radiology Breast Imaging Reporting and Data System(ACR BI-RADS US)Atlas Categories 3 to 5 in different age groups and to determine whether patient age influences the PPV of each category in the diagnosis of breast lesions.Methods Using our database from June 2014 to June 2016,we identified 4428 ACR BI-RADS US categories 3 and 5 lesions with a known pathological diagnosis in 4428 women.The patients were classified into three age groups(<35,35~50,and>50 years).The age-related PPVs of each category in the three age groups were calculated based on the pathological diagnoses and compared using the chi-squared test.Results PPV gradually increased with increasing age in patients with category 3 and 4 lesions.PPVs in the oldest group with categories 3 to 4B lesions were close to or exceeded the reference values.Conclusion PPV and age were significantly associated in patients with category 3 and 4 lesions according to the newest edition of ACR BI-RADS US in the diagnostic setting.Closer attention should be given to older patients when assigning a final assessment category.