The diagnostic performances of BI-RADS descriptors, BI-RADS categories, and the scoring system were evaluated and compared between our reviewers' assessments and the 5th edition of BI-RADS or a prior study using the area under the receiver operating characteristic curve (AUROC) ( 3, 4, 5). Positive predictive value (PPV) of BI-RADS descriptors and BI-RADS categories were analyzed using generalized estimating equations with post-hoc analysis. In addition, BI-RADS categories were reassigned according to the recommendations of the 5th edition of BI-RADS and a previous study ( 3, 4).įor the validation dataset, mammograms were obtained with two digital mammography units (Senographe DS, GE Healthcare, Chicago, IL, USA Siemens Mammomat Novation DR, Siemens, Munich, Germany) and all images were reviewed at a dedicated review workstation (SenoAdvantage, GE Healthcare) by two breast specialists with 5 and 9 years of experience, respectively, in interpreting digital mammography. Radiologists were asked to assign the single most appropriate descriptor and a BI-RADS final assessment category of 3, 4A, 4B, 4C, or 5 for each lesion according to the 5th edition of BI-RADS, as categories 0, 1, 2, and 6 were not included ( 4). All images were reviewed at a dedicated review workstation (Lorad Selenia Softcopy Workstation, Hologic) by two breast specialists with 6 and 17 years, respectively, of experience in interpreting digital mammography. Standard mediolateral oblique and craniocaudal mammograms or magnified views of microcalcifications were obtained with a full-field digital mammography unit (Lorad Selenia, Hologic, Marlborough, MA, USA). Mammography Examination and Interpretation The validation set for testing the developed scoring system consisted of 100 surgically excised microcalcifications in 100 women (mean age, 54.5 ± 9.5 years range, 29–77 years) at Chonbuk National University Hospital from August 2013 to August 2018 under the same inclusion criteria. Thus, a total of 194 microcalcifications in 183 women (mean age, 49.8 ± 8.5 years range, 34–75 years) were included and used to develop a scoring system for stratifying malignancy risk in this study. Fourteen cases did not have preoperative mammograms and were therefore excluded. This retrospective study was approved by the Institutional Review Boards of Gangnam Severance Hospital and Chonbuk National University Hospital, and the requirement for written informed consent from participants was waived.īetween August 2015 and July 2017, 208 consecutive surgical excisions were performed after needle localization under mammographic guidance for microcalcifications assigned as BI-RADS category 4 or 5 at Gangnam Severance Hospital. The purpose of the present study was to develop a scoring system stratifying the malignancy risk of mammographic microcalcification in the 5th edition of BI-RADS. Therefore, further evaluation is needed that embraces the use of categories 3 and 5 with category 4 subdivision and punctate calcification, and a nomogram such as a scoring system could be developed to stratify malignancy risk according to the BI-RADS lexicon. In addition, punctate calcification, although described in the section on round calcification as typically benign, may warrant a probably benign assessment (category 3) if found as an isolated group or imaging-guided biopsy if appearing as linear or segmental, but no data are present ( 4). Previous studies investigated the categorization of calcifications by combining morphology and distribution but focused on the integration of category 4A into the category 4 subdivision and did not investigate the use of categories 3 or 5 ( 2, 3). For BI-RADS final assessment, the 5th edition suggests the use of category 2 (typically benign), category 3 (solitary grouped punctate), category 4B (amorphous, coarse heterogeneous, fine pleomorphic), and category 4C (fine linear or linear branching) for calcifications, but categories 4A and 5 are not specified despite common use in daily practice ( 2). In the 5th edition, the lexicon for mammographic calcification morphology has been consolidated into two categories, typically benign and suspicious, after combining the “intermediate concern” and “higher probability” categories of the 4th edition ( 1). Since the Breast Imaging Reporting and Data System (BI-RADS) was first developed to provide a lexicon of breast imaging findings, assessment, and management recommendations to facilitate communication between radiologists and referring physicians, it has been revised several times.

Bi rads category 02 benign finding 2a