乳腺影像报告数据系统（）.docx

乳腺影像报告数据系统（BI-RADS）简介 1992年，美国放射学院（American College of Radiology）出版了指导性的文件：乳腺影像报告数据系统（Breast Imaging Reporting And Data System，BI-RADS）， 其后经3次修订，至2003年不仅指导乳腺X线诊断（第4版），而且，也增加了超声和MRI诊断。对乳腺作为一个整体器官的所有影像学正常与异常情况的诊断报告进行规范，使用统一的专业术语、标准的诊断归类及检查程序，使放射科医生的诊断有章可循，同时，也加强了放射科和临床其他有关科室的协调与默契，使临床治疗医师一看放射科医师的报告即知道下一步该做什么。注意Category 一词不应翻译成“级”，应翻译成“类”。BI-RADS评价被分成了不定类别（Assessment is Incomplete）（0类，Category 0）和最终类别（Assessment is Complete Final Categories）（1-6类，Categorie 1, 2, 3, 4, 5 and 6）。不定类别需要进一步的影像学检查，如加摄其他X线投照体位、对比旧片、作超声或MRI（注意：并未推荐红外热图或CT）。当附加的影像学检查执行后，最终类别的评价就应完成，并且应整合这些影像学检查的内容，得出综合的诊断评价分类。 乳腺X线摄影质量规范（Mammography Quality Standards Act，MQSA）要求对乳腺X线检查提供单一的分析报告。医院或临床医师希望分别提供每一个乳腺的BI-RADS分类，这在报告书的诊断结果栏目或诊断描述栏目中提到。并提供单一总的诊断报告，将BI-RADS分类表述在整个报告的末尾处。当然，总的最终报告应该基于最令人忧心的事情的存在。例如，假如一个乳腺记为可能良性的发现，而对侧乳腺疑有恶性病变，则总的诊断报告应该记录为“BI-RADS 4类（可疑恶性病变）”。相似地，如果一侧乳腺需要立即进行附加的评价（譬如，病人当时不能等待超声检查），其对侧乳腺可能有良性的发现，这个总的分类应为“BI-RADS 0类，不定型”。临床扪及病变而影像阴性是很多医院疑惑不解的问题。诊断报告应该做出什么样的最终评价基于影像发现。当影像发现的解释受到临床发现的影响时，最终的评价应该结合两方面进行通盘考虑。临床发现应细致描述到报告中。0类（Category 0）：Need Additional Imaging uation and/or Prior Mammograms for Comparison.在乳腺常规X线摄影之后使用0类。限时进一步的诊断评价（如加摄投照体位或行超声检查）或召回旧片分析是需要的。对照旧片可以降低病人回访的必要。然而，对照并非总是必须（Frankel SD，1995；Thurfjell MG，2000）。在缺乏任何发现的情况下，先前的照片仅仅约3.2%（35/1093）是有帮助的（Bassett LW，1994）。只有乳腺X线摄影确定有某些改变需要旧片比较才将其定为0类。这常常包括可能代表正常变异的局限性非对称性改变或者X线片显示边缘清楚的肿块，它们可能已经在先前的图像上存在。如果，没有旧片比较，那就应该进一步检查（如加拍X线片和/或行超声检查）。在我国，一些妇女乳房脂肪较少，实质丰富，乳腺组织缺乏自然对比，也需要采用其他影像学方法（如超声、MRI）进一步检查，也可将其评价为0类。1类（Category 1）：Negative.乳腺摄影显示乳腺结构清楚而没有病变显示。注意，在我国常常使用的所谓的乳腺囊性增生症、小叶增生、腺病（统称为纤维囊性改变或结构不良）根据BI-RADS的描述均归于此类。如果临床扪及肿块，并有局限性不对称性改变，尽管最后诊断为硬化性腺病，亦不能归入此类，可能归入3类或4A类。乳内淋巴结、腋前份淋巴结显示低密度的淋巴结门（侧面观）或者中央低密度（淋巴结门的轴向观）均视为正常淋巴结，属1类。2类（Category 2）：Benign Finding.肯定的乳腺良性肿块（如纤维腺瘤、纤维脂肪腺瘤、脂肪瘤、单纯囊肿、积乳囊肿、积油囊肿）、肯定的良性钙化（如环状钙化、边界清楚的短条状钙化、粗的斑点状钙化、稀疏的大小较单一的圆点状钙化、新月形的沉积性钙化等）均属此类。但是，肿块边缘清楚并不是排除恶性病变的必然条件，对于年龄超过35岁的妇女，应该注意扪诊，并召回旧片进行比较，或者随访观察其变化，因此，可能分别被评价为0类或3类。3类（Category 3）：Probably Benign Finding Initial Short-Interval Follow-Up Suggested. Initial short-term follow up (usually 6-month) examination.3类（可能良性）被保留，其发现几乎为肯定良性。必须强调的是，此类并非是不确定的类型，但是对于乳腺X线摄影来说，它的恶性几率小于2%（亦即几乎都是良性的）。其表现被逐渐认识，均是基于对照既往普查结果或者没有既往普查资料对照的图像。用对乳腺加拍其他方位的投照和/或超声的评估需要定为3类（可能良性）。此类型的病变包括在常规的X线片上不能扪及的边界清楚的肿块（除非是囊肿、乳内淋巴结或者其他良性病变）、在点压片上部分较薄的局限性非对称性改变、细点状成簇钙化。在常规乳腺X线摄影发现后6月采用单侧摄片短期随访。如果病变没有变化，建议再在6月后双乳随访（即在最初发现后12月随访）。如果第二次双乳随访未观察到其他可疑之处，则报告为3类，建议进行典型的12月后双乳随访（即首次检查后24月随访）。如果接下来的随访（第24月随访）仍然没有发现改变，最后的评估可能就是2类（良性），当然也可能结合临床慎重考虑为3类（可能良性）。根据文献（Sickles EA，1995）在2-3年稳定后，最终的诊断可能改变为2类（良性），但还是需要随访，必要时还进行放大摄影。也许，经验较少的医生会坚持认为有一个较小的局限性非对称性改变，从而将其界定为3类。经验丰富的医生通过6、12、24月的随访可能认定这个改变是正常变异，为此确定为1类（阴性）。由于临床医生或病人恐惧肿瘤而不愿意随访等原因，3类可能被立即活检，在这些病例中，最终的诊断评估分类应该基于恶性的危险性，而不是基于所提供的处理。超声评判为可能良性的病变包括不能扪及的复杂囊肿。有人报告不能与复杂囊肿区别的不能扪及的卵圆形低回声结节的恶性率小于2%。没有分散实体成分的成簇分布的微囊同样可能被评定为3类。恰当的3类评定需要审核医生的实践能力。评定在这类的病例的恶性率应该小于2%。对于超声，恶性率也应小于2%，但这还没有看到广泛的文章确认。对于MRI，归于此类型的病例仅进行了短期随访，其恶性率尚需要进一步的研究。4类（Category 4）：Suspicious Abnormality Biopsy Should Be Considered.4类用来表示需要做从复杂囊肿抽吸到多形性钙化的活检的介入放射程序。许多单位将4类再细分类，以说明介入处理和恶性危险度的不同。这使用受试者工作特性曲线（receiver-operating characteristic curve, ROC curve）分析，接受更大的临床检验，以帮助临床医师和放射科医生。4类分为三个亚类便于帮助达到上述目的。4A类：Finding needing intervention with a low suspicion for malignancy.4A类用来表述需要介入处理但恶性度较低的病变。其病理报告不期待是恶性的，在良性的活检或细胞学检查结果后常规随访6月是合适的。此类包括一些可扪及的、部分边缘清楚的实体性肿块，如超声提示纤维腺瘤、可扪及的复杂性囊肿或可疑脓肿。4B类：Lesions with an intermediate suspicion of malignancy.4B类包括中等拟似恶性的病变（intermediate suspicion of malignancy）。放射诊断和病理结果的相关性接近一致。在此情形下，良性随访取决于这种一致性。部分边界清楚，部分边界模糊的肿块可能是纤维腺瘤或脂肪坏死是可被接受的，但是，乳突状瘤则需要切除活检。4C类：Findings of moderate concern, but not classic for malignancy.4C类病变表示中等稍强拟似恶性的病变（moderate concern），尚不具备象5类那样的典型恶性特点。此类中包括例如边界不清、不规则形的实体性肿块或者新出现的微细的多形性成簇钙化。此类病理结果往往是恶性的。4类的这些更细分类应该鼓励病理学家着手对在4C类中报告为良性的病变进行进一步的分析，应该让临床医师明白对诊断为4类但活检报告为良性的病例进行随访复查的必要性。5类（Category 5）：Highly Suggestive of Malignancy Appropriate Action Should Be Taken.5类用来表述几乎肯定是乳腺癌的病变。在BI-RADS早期版本中，当穿刺活检获得组织学或细胞学诊断尚不普及时，5类预示病变最终要被处理而没有先前的组织标本。现在，此类发现的标本必须保留以发现典型的乳腺癌，具有95%的恶性可能性。带毛刺不规则形密度增高的肿块、段或线样分布的细条状钙化，或者不规则形带毛刺的肿块且其伴随不规则形和多形性钙化是归于5类。规范的活检而没有发现典型恶性的病变归于4类。6类（Category 6）：Known Biopsy-Proven Malignancy Appropriate Action Should Be Taken.6类是新增加的类型，用来描述已被活检证实为乳腺癌但先前仅仅进行了有限的治疗（如外科切除、放疗、化疗或乳腺切除术）的病例。不象BI-RADS 4类、5类，6类不需介入处理以确定病变是否为恶性。在先前的标本中发现第二个诊断并显示为恶性，或者检测先于手术前进行的新辅助化疗的效果就可以评定为6类。 BI-RADS超声分类标准BI-RADS超声分类意义及相应处理措施推荐乳腺包块超声诊断报告内容及报告模板样式报告内容规范术语报告结论病变描述内容和规范用语-形状病变描述内容和规范用语-形状病变描述内容和规范用语-形状病变描述内容和规范用语-形状肿块的边缘肿块的边缘肿块的边缘 3内部回声内部回声2内部回声分布形态后方表现后方表现 2钙化1钙化2钙化3钙化4钙化5纵横比导管扩张导管扩张2导管乳头状瘤导管扩张4Characterization ofSolid Breast MassesJ Ultrasound Med 2006;乳腺实性肿块的特点-乳腺图像报告和数据系统的应用翻译：felicia1222Objective. The purpose of this study was to determine the reliability of sonographic American Collegeof Radiology Breast Imaging Reporting And Data System (BI-RADS) classification in differentiatingbenign from malignant breast masses. Methods. One hundred seventy-eight breast masses studiedby sonography with a known diagnosis were reviewed. All lesions were classified according to thesonographic BI-RADS lexicon. Pathologic results were compared with sonographic features. Sensitivity,specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) for thesonographic BI-RADS lexicon were calculated. Results. Twenty-six cases were assigned to class 3, 73to class 4, and 79 to class 5. Pathologic results revealed 105 malignant and 73 benign lesions. Thesonographic BI-RADS lexicon showed 71.3% accuracy, 98.1% sensitivity, 32.9% specificity, 67.8%PPV, and 92.3% NPV. The NPV for class 3 was 92.3%. The PPVs for classes 4 and 5 were 46.6% and87.3%. Typical signs of malignancy were irregular shape, antiparallel orientation, noncircumscribedmargin, echogenic halo, and decreased sound transmission. Typical signs of benignity were oval shapeand circumscribed margin. Conclusions. The sonographic BI-RADS lexicon is an important system fordescribing and classifying breast lesions. Key words: breast masses; diagnosis; sonography.目的：评价美国BI-RADS系统对鉴别乳腺良恶性肿瘤的价值。方法：回顾性分析178个有确切病理的乳腺实性肿块。根据BI-RADS对所有的肿块进行分级诊断，然后将病理结果与超声描述进行对照分析。计算敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（NPV）。结果：26个肿块被评为3级，73个肿块被评为4级，79个肿块评为5级。病理结果显示良性73个而恶性105个。 BI-RADS分级的诊断准确性为71.3%，敏感度98.1%，特异度32.9%，PPV 67.8%，NPV为92.3%。3级的NPV为92.3%，4级和5级的PPV为46.6%和87.3%. 典型的恶性指标包括形态不规则，非平行性生长，无清晰边界，低回声，后方衰减。典型的良性特征是卵圆状外形，边界清晰。结论：BI-RADS对鉴别乳腺良恶性肿瘤具有重要价值关键词： 乳腺肿瘤，诊断，超声 。In addition to mammography, sonography hasbecome a standard breast-imaging procedure duringthe last 15 years because of rapid technologicaladvances such as the use of all-digital high-frequencytransducers of up to 13 MHz, color and power Dopplerimaging, and harmonic imaging.16 Although breastsonography has historically been used for differentiatingfluid from solid lesions, there has been growing interestin using sonography to differentiate benign from malignantsolid masses7,8 and to avoid biopsies because of itsability to accurately identify the lesion characteristicssuggestive of malignancy.912 The sensitivity of breastsonography has been found to be superior to mammography5,6,12especially in premenopausal breasts,1315 andrecently, screening sonography has also been advocatedfor dense breasts.13,15,16 Today, sonography plays animportant role in guiding interventional proceduressuch as needle aspiration, core needle biopsy, and prebiopsyneedle localization.17,18由于高频超声、彩色多普勒、频谱多普勒等数字化先进技术的应用以及超声在过去15年的飞速发展，超声已经成为除了放射线以外的另一种常用的乳腺成像方法。虽然以往的超声仅被用来区分囊性和实性，如今的超声因其能够比较准确的判断肿瘤的恶性特征而在鉴别良恶性肿瘤以及避免不必要的穿刺方面崭露头角。部分研究认为乳腺超声的诊断敏感性优于钼靶放射线成像，尤其是对绝经期前的乳腺以及近来推崇的致密型乳腺。今天，乳腺超声在引导介入性操作比如细针穿刺活检，细针穿刺定位的等方面也发挥着重要的作用。 A lexicon of sonographic descriptors of breastmasses with attendant assessment categories(Breast Imaging Reporting and Data SystemBI-RADS) has been developed by the AmericanCollege of Radiology (ACR; Reston, VA) to enhancethe clinical efficacy of breast sonographyand to standardize terms for lesion characterizationand reporting. The sonographic BI-RADSlexicon includes sonographic descriptors forshape, orientation, margins, lesion boundary,echo pattern, posterior acoustic features, andsurrounding tissue alterations. On the basis ofthese descriptors, each lesion was assigned to afinal assessment category.为了提高临床诊断效率，规范乳腺肿块的超声描述和报告，ACR协会提出了一个包含乳腺超声描述和评价的规范系统BR-RADS。该系统包含了对乳腺肿块形状、方向、边缘、边界、回声、后方回声特点以及周围组织等方面的描述。并根据这些描述将每个肿块进行了分类评价。 The purpose of this study was to determine the reliability of the sonographic BI-RADS lexicon in differentiating benign from malignant breast masses. Cytologic or histologic results were used as the standard criterion. The objectives of our study were the following end points: (1) primary end point, diagnostic accuracy of sonographic BI-RADS classification in distinguishing benign from malignant masses; and (2) secondary end points, diagnostic sensitivity, specificity, prevalence, error ratio, positive predictive value (PPV) and negative predictive value (NPV) of sonographic BI-RADS classification. Positive and negative predictive values of each class of suggestive sonographic descriptors were also evaluated.本文旨在以病理结果或组织学检查为进标准，评价BI-RADS系统在鉴别乳腺良恶性肿块的可信度。本文的目的有一下两点：1）初级目标：BI-RADS系统在评价乳腺良恶性肿瘤中的准确度2）次级目标：计算该标准中各个级别对诊断乳腺肿瘤良、恶性的敏感度、特异度、流行度、误诊率、阳性预测值、阴性预测值。同时还评价了每一个超声指标诊断乳腺良性和恶性的阳性预测值和阴性预测值。Materials and Methods Breast masses with known diagnosis studied by sonography in our department from October 2002 to October 2004 were retrospectively reviewed. All patients who in the period of reference consecutively underwent sonographically guided fine-needle aspiration cytologic examination (FNAC) of a breast lesion entered the study. The indication for FNAC was based on a preliminary breast examination performed by us or elsewhere in accord with the attending physician. 材料和方法：回顾性分析我院2002年10月-2004年10月有明确病理诊断的乳腺肿块。为保险期间，所有入组病理均进行了超声引导下细针穿刺活检（FNAC）。细针穿刺活检的适应症选择是根据我们的预实验或其他辅助检查结果。 Sonography was performed with a high-resolution (10- to 13-MHz) linear array transducer and a Siemens Antares sonography unit (Siemens Medical Solutions, Sweden). The scanning protocol included both transverse and longitudinal real-time imaging.采用Siemens Antares超声诊断仪，配有高频线阵探头（10-13MHZ）。检查方法包括纵切扫查和横切扫查。 Initially all lesions underwent FNAC. The FNAC results were accepted for a definitive diagnosis only if they led to a specific benign or malignant diagnosis. The FNAC results were considered not definitive if imaging and cytologic findings were discordant, if insufficient sampling was indicated, and if the sample consisted of normal breast epithelial cells. As a specific negative result, we considered cytologic matter with no atypical characteristics and compatible with complicated cysts, fibroadenoma, galactocele, liponecrosis, inflammations such as granulomas, and fibrocystic modifications such as apocrine metaplasia. As a positive result, we considered the presence of atypical cytologic characteristics. In cases in which results of fine-needle aspiration were positive for malignancy or not definitive, surgical excision and subsequent histologic examination were performed, as in our usual protocol. In cases in which results of fine-needle aspiration were negative for malignancy, the lesion was scheduled for follow-up every 6 months首先所有病例均进行FNAC检查，只有当FNAC检查结果诊断为确定的良性或恶性时方被接受。有下列情况时认为诊断结果不确切，包括活检结果与超声图像有较大差异，取样不足，样本检查显示为正常的乳腺上皮细胞。典型的阴性结果包括无不典型增生上皮的混合性囊肿，纤维腺瘤，乳房囊肿，脂肪坏死，慢性炎性肉芽肿，浆细胞的纤维囊性变。典型的阳性结果包括细胞的不典型增生。当细针穿刺活检的结果提示为恶性或者结果不确切时，患者常规进行肿物切除病理活检。当FNAC结果显示为确切的良性时，对患者进行为期6个月的随访观察。 Only sonographic examinations performed in the study period by 2 radiologists experienced in breast imaging (P.B. and M.C.) were selected to prevent reading bias. The radiologists retrospectively reviewed the hard copy sonographic images of all cases without considering the clinical history or pathologic results. All lesions were classified according to the sonographic BI-RADS lexicon (Table 1),19 and final decisions were made with consensus agreement among observers请两位有经验的超声医师（P.B和M.C）阅读乳腺超声检查的图像拷贝。两位超声医师均不知晓患者的临床情况和病理检查结果。根据BI-RADS系统对所有肿块进行分类，并根据观察者讨论达成的一致意见给患者做出诊疗建议。 表一 ACR推出的BI-RADS诊断系统的最终分级诊断资料不完全0级 需要进一步的图像资料资料完全（最终分级）1级 阴性2级 良性表现3级 可能良性，需要进行短期的随访4级 可能恶性，建议进行活检5级 高度可能恶性 需要进行适当的干预治疗6级 已知恶性：活检证实After careful description of the lesions according to BI-RADS criteria, all lesions with the following combination of benign signs were assigned to class 3: round or oval shape, parallel orientation, circumscribed margins, well-defined interface, enhancement or absence of posterior acoustic alterations, and absence of alterations in the adjacent tissue independent of the echoic structure. Lesions having indistinct margins or posterior acoustic shadowing as the only sign of suspicion were also placed in class 3. 根据细致的超声描述，满足以下条件的肿块被分类为3级：圆形或卵圆形，平行于皮肤生长，边界清晰截然，后方增强或无衰减，周围组织回声无明显变化。如果肿块单纯具备肿块边界不清晰或者后方回声衰减也被归为第三级。 All lesions showing an association of at least 3 of the following signs were assigned to BI-RADS class 5: irregular shape, antiparallel orientation, noncircumscribed margins, presence of a hyperechoic halo, presence of posterior acoustic shadowing, and presence of adjacent tissue alterations independent of the echoic structure. Class 4 included all lesions that did not satisfy the criteria for benign lesions and did not have a combination of 3 signs of malignancy and therefore were indeterminate. 满足以下至少3条者被归为第5级：比较不规则，纵向生长，边缘不清晰，明显低回声，后方声影，周围组织回声改变。4级诊断为可疑，包含了所有不满足良性条件也不足以归类为5级的肿块 Patient age and site and size of each lesion were also considered. Cytologic or histologic examinations were compared with sonographic features. A definitive diagnosis of atypical hyperplasia was considered malignant, whereas a definitive diagnosis of usual hyperplasia was considered benign. 我们同时考虑了患者的年龄和肿物的大小、位置。并将肿块的病理检查结果与超声结果进行了对照。明确的不典型增生被认为是恶性，而典型的常规乳腺增生被认为是良性。 The diagnostic sensitivity, specificity, accuracy, prevalence, error ratio, PPV, and NPV of the sonographic BI-RADS lexicon were calculated, including class 3 in the benign group and unifying classes 4 (probably malignant) and 5 (malignant) in the malignant group. The PPV and NPV for each class and sonographic descriptor were also calculated. The PPV and NPV for each sonographic descriptor were obtained as follows: PPV for sonographic descriptor = number of cancers per sonographic feature; and NPV for sonographic descriptor = number of benign lesions per sonographic feature. 计算3级（良性）、4级（不确定）和5级（恶性）的诊断敏感度、特异度、准确度、普遍度、误诊率、PPV、NPV。PPV和NPV的计算公式如下：超声描述的PPV=符合该超声描述的恶性肿瘤数；超声描述的NPV=符合该超声描述的良性肿瘤数； ResultsOne hundred seventy-eight breast masses in 164 female patients were included in our study. All lesions were studied with sonographically guided FNAC, and 148 of 178 underwent subsequent surgical resection. Patients in BI-RADS classes 3 and 4 (18 and 12, respectively) who had FNAC that documented only a specific benign lesion underwent sonography every 6 months (mean follow-up, 24.6 months; range, 1236 months). In particular, 24 patients reached a 2-year follow-up; 5 reached an 18-month follow-up; and 1 reached a 1-year follow-up. The mean age of the patients SD was 54.19 12.41 years (range, 2590 years). The mean size of the lesions was 15.21 13.18 mm (range, 490 mm). No prevalence of side or quadrant was observed. 结果：共164个患者的178枚肿块进入研究。所有的肿块进行了FNAC检查。其中148枚进行了后续的外科手术治疗。有良性诊断的18枚3级肿瘤以及12枚4级肿瘤每6个月进行一次超声检查随访（共随访12-36个月，平均随访24.6个月，）。具体的说24位患者随访了2年，5位随访了18个月，1位随访了1年。患者的平均年龄为54.1912.41岁（范围25-90岁）。肿块的大小平均为15.2113.18mm（范围4-90mm）。大小以及位置没有明显的流行学特点。 On the basis of sonographic BI-RADS categorization, our cases were classified as follows: 26 class 3, 73 class 4, and 79 class 5. No case was assigned to class 0, 1, 2, or 6. Cytologic and histologic results revealed 105 malignant lesions and 73 benign lesions. The total benign-malignant ratio was 0.69. The NPV for class 3 was 92.3%; the PPVs for classes 4 and 5 were 46.6% and 87.3%, respectively (Table 2). 根据BI-RADS系统，我们的肿块分类如下：26枚分为3级，73枚分类为4级，79枚分类为5级。没有分类为0、1、2、6级的肿块。组织学检查结果显示良性肿块73例，恶性肿块105例。良恶比例为0.69:1。3级的NPV为92.3%，4级和5级的PPV分别为46.6%和87.3%。 Table 2. Distribution of Benign and Malignant Lesions for Each BI-RADS Class 表二 每个BI-RADS分级的良恶性肿瘤构成比 3级 4级 5级 总计良性 24 (92.3) 39 (63.4) 10 (12.7) 73 恶性 2 (7.7) 34 (46.6) 69 (87.3) 105 总计 26 73 79 178Definitive diagnoses of all cases in relation to sonographic BI-RADS categorization are shown in Table 3. The prevalence of cancer in our study population was 58.98%. The sonographic BI-RADS system showed 71.3% accuracy, 98.1% sensitivity, 32.9% specificity, and a 28.6% error ratio. The PPV and NPV were 67.8% and 92.3%, respectively (Table 4). 所有入选肿块的确切诊断见表3.在本组病理中，乳腺癌的流行度为58.9%。BI-RADS诊断的准确度为71.3%，敏感度为98.1%，特异度为32.9%，误诊率为38.6%，PPV和NPV 为67.8%和92.3%。 Table 3. Definitive Diagnosis in Relation to Sonographic BI-RADS Categorization 表三 入选肿块的病理诊断以及分级情况病理诊断 3级 4级 5级 总计混合性囊肿纤维腺瘤混合性纤维腺瘤乳房囊肿脂肪坏死硬化病变炎性改变纤维囊性变乳头状瘤管状腺瘤典型上皮增生不典型增生导管原位癌纤维腺瘤癌变叶状肿瘤粘液癌导管癌小叶癌管状腺癌小叶/管状癌乳头状癌囊内癌转移癌总计其中括号中的数字为囊性肿块的个数，而其他的均为组织学检查的个数。Table 4. Distribution of False- and True-Positive and -Negative Results Based on Pathologic Diagnosis and Diagnostic Discrimination Indicators D+ indicates disease-positive; D, disease-negative; FN, false-negative; FP, false-positive; T+, test-positive (lesions assigned to classes 4 and 5); T test-negative (lesions assigned to class 3); TN, true-negative; and TP, true-positive.表四 诊断及描述的真/假阳性值的分布D+ 阳性 D- 阴性 FN 假阴性； FP 假阳性；T+ 诊断阳性（分级为4级和5级）；T- 诊断为阴性（分级为3级） ； TN 真阴性 TP 真阳性Table 4. Distribution of False- and True-Positive and -Negative Res