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Grading system to categorize breast MRI using BI-RADS 5th edition: a statistical study of non-mass enhancement descriptors in terms of probability of malignancy

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To analyze the association of breast non-mass enhancement descriptors in the BI-RADS 5th edition with malignancy, and to establish a grading system and categorization of descriptors.

Materials and methods

This study was approved by our institutional review board. A total of 213 patients were enrolled. Breast MRI was performed with a 1.5-T MRI scanner using a 16-channel breast radiofrequency coil. Two radiologists determined internal enhancement and distribution of non-mass enhancement by consensus. Corresponding pathologic diagnoses were obtained by either biopsy or surgery. The probability of malignancy by descriptor was analyzed using Fisher’s exact test and multivariate logistic regression analysis. The probability of malignancy by category was analyzed using Fisher’s exact and multi-group comparison tests.

Results

One hundred seventy-eight lesions were malignant. Multivariate model analysis showed that internal enhancement (homogeneous vs others, p < 0.001, heterogeneous and clumped vs clustered ring, p = 0.003) and distribution (focal and linear vs segmental, p < 0.001) were the significant explanatory variables. The descriptors were classified into three grades of suspicion, and the categorization (3, 4A, 4B, 4C, and 5) by sum-up grades showed an incremental increase in the probability of malignancy (p < 0.0001).

Conclusion

The three-grade criteria and categorization by sum-up grades of descriptors appear valid for non-mass enhancement.

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Abbreviations

ADC:

Apparent diffusion coefficient

BI-RADS:

Breast imaging reporting and data system

CI:

Confidence interval

CNB:

Core needle biopsy

DCE:

Dynamic contrast enhancing

MIP:

Maximum intensity projection

MRI:

Magnetic resonance imaging

NME:

Non-mass enhancement

NMLE:

Non-mass-like enhancement

OR:

Odds ratio

PPV:

Positive predictive value

ST-:

Stereotactic-

US:

Ultrasound

VAB:

Vacuum-assisted biopsy

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Acknowledgements

The authors would like to thank Ueno Takahiko for his help in the statistical design of the study.

Author information

Authors and Affiliations

  1. Department of Radiology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan

    Tatsunori Asada & Takayuki Yamada

  2. Department of Radiology, Breast and Imaging Center, St. Marianna University School of Medicine, 6-7-2 Mampukuji, Asao-ku, Kawasaki, Kanagawa, 215-0004, Japan

    Yoshihide Kanemaki & Satoko Okamoto

  3. Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Keishi Fujiwara & Yasuo Nakajima

Authors
  1. Tatsunori Asada
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  2. Takayuki Yamada
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  3. Yoshihide Kanemaki
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  4. Keishi Fujiwara
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  5. Satoko Okamoto
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  6. Yasuo Nakajima
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Corresponding author

Correspondence to Tatsunori Asada.

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The authors declare no conflicts of interest.

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Asada, T., Yamada, T., Kanemaki, Y. et al. Grading system to categorize breast MRI using BI-RADS 5th edition: a statistical study of non-mass enhancement descriptors in terms of probability of malignancy. Jpn J Radiol 36, 200–208 (2018). https://doi.org/10.1007/s11604-017-0717-9

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  • DOI: https://doi.org/10.1007/s11604-017-0717-9

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