Predictive performance of BI-RADS magnetic resonance imaging descriptors in the context of suspicious (category 4) findings

• Published in: Radiologia brasileira 2016-06, Vol.49 (3), p.137-143
• Main Authors: de Almeida, João Ricardo Maltez, Gomes, André Boechat, Barros, Thomas Pitangueiras, Fahel, Paulo Eduardo, Rocha, Mário de Seixas
• Format: Article
• Language: English
• Subjects: Original; RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
• ISSN: 0100-3984; 1678-7099; 0100-3984; 1678-7099
• DOI: 10.1590/0100-3984.2015.0021

To determine the positive predictive value (PPV) and likelihood ratio for magnetic resonance imaging (MRI) characteristics of category 4 lesions, as described in the Breast Imaging Reporting and Data System (BI-RADS(®)) lexicon, as well as to test the predictive performance of the descriptors using multivariate analysis and the area under the curve derived from a receiver operating characteristic (ROC) curve. This was a double-blind review study of 121 suspicious findings from 98 women examined between 2009 and 2013. The terminology was based on the 2013 edition of the BI-RADS. Of the 121 suspicious findings, 53 (43.8%) were proven to be malignant lesions, with no significant difference between mass and non-mass enhancement (p = 0.846). The PPVs were highest for masses with a spiculated margin (71%) and round shape (63%), whereas segmental distribution achieved a high PPV (80%) for non-mass enhancement. Kinetic analyses performed poorly, except for type 3 curves applied to masses (PPV of 73%). Logistic regression models were significant for both patterns, although the results were better for masses, particularly when kinetic assessments were included (p = 0.015; pseudo R(2) = 0.48; area under the curve = 90%). Some BI-RADS MRI descriptors have high PPV and good predictive performance-as demonstrated by ROC curve and multivariate analysis-when applied to BI-RADS category 4 findings. This may allow future stratification of this category.