Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations

Urban, Linei Augusta Brolini Delle; Chala, Luciano Fernandes; Paula, Ivie Braga de; Bauab, Selma di Pace; Schaefer, Marcela Brisighelli; Oliveira, Ana Lúcia Kefalás; Shimizu, Carlos; Oliveira, Tatiane Mendes Gonçalves de; Moraes, Paula de Camargo; Miranda, Beatriz Medicis Maranhão; Aduan, Flávia Engel; Rego, Salete de Jesus Fonseca; Canella, Ellyete de Oliveira; Couto, Henrique Lima; Badan, Gustavo Machado; Francisco, José Luis Esteves; Moraes, Thaís Paiva; Jakubiak, Rosangela Requi; Peixoto, João Emílio

doi:10.1590/0100-3984.2023.0064-en

Cited by 3 publications

(1 citation statement)

References 65 publications

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“…Over time, ultrasound and magnetic resonance imaging (MRI) became more widely available and developed into valuable complements to mammography. MRI soon came to be recognized as a screening method for high-risk women (those with a lifetime risk of 20–25% or greater), adopted by most international medical societies, with ever increasing recommendations due to its unparalleled sensitivity and potential to better characterize breast malignancies ( 4 , 5 , 6 , 7 ) . It has been a part of the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) since its fourth edition ( 8 , 9 ) .…”

Section: Introductionmentioning

confidence: 99%

Are we ready to stratify BI-RADS 4 lesions observed on magnetic resonance imaging? A real-world noninferiority/equivalence analysis

Almeida,

Bitencourt,

Gomes

et al. 2023

Radiol Bras

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Objective: To demonstrate that positive predictive values (PPVs) for suspicious (category 4) magnetic resonance imaging (MRI) findings that have been stratified are equivalent to those stipulated in the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography and ultrasound. Materials and Methods: This retrospective analysis of electronic medical records generated between January 4, 2016 and December 29, 2021 provided 365 patients in which 419 suspicious (BI-RADS category 4) findings were subcategorized as BI-RADS 4A, 4B or 4C. Malignant and nonmalignant outcomes were determined by pathologic analyses, follow-up, or both. For each subcategory, the level 2 PPV (PPV2) was calculated and tested for equivalence/noninferiority against the established benchmarks. Results: Of the 419 findings evaluated, 168 (40.1%) were categorized as malignant and 251 (59.9%) were categorized as nonmalignant. The PPV2 for subcategory 4A was 14.2% (95% CI: 9.3–20.4%), whereas it was 41.2% (95% CI: 32.8–49.9%) for subcategory 4B and 77.2% (95% CI: 68.4–84.5%) for subcategory 4C. Multivariate analysis showed a significantly different cancer yield for each subcategory (p < 0.001). Conclusion: We found that stratification of suspicious findings by MRI criteria is feasible, and malignancy probabilities for sub-categories 4B and 4C are equivalent to the values established for the other imaging methods in the BI-RADS. Nevertheless, low suspicion (4A) findings might show slightly higher malignancy rates.

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