News | Breast Biopsy Systems | May 08, 2018

New Analytics Approach Offers Potential of Reducing Unnecessary Breast Biopsies

Study defines advanced statistical methods that can be used with diagnostic imaging output to downgrade breast mass risk classification

New Analytics Approach Offers Potential of Reducing Unnecessary Breast Biopsies

May 8, 2018 — The American Journal of Roentgenology recently published findings on statistical methods for downgrading the risk classification of breast masses to reduce the need for unnecessary breast biopsies. Clinicians from Seno Medical and medical center collaborators from The University of Texas co-authored the report.1  

"The perceived risk of missing a breast cancer diagnosis with breast imaging studies is much higher than the risk of a false-positive diagnosis, leading to breast imagers recommending a breast biopsy whenever the risk of cancer is greater than 2 percent. Sometimes ancillary diagnostic breast imaging studies are performed to reduce risk to less than 2 percent, but it is difficult to know exactly how much risks are reduced even after a negative ancillary diagnostic imaging examination," said Thomas Stavros, M.D., chief medical officer of Seno Medical and a co-author of the report. "However, the use of the Negative Likelihood Ratio (NLR) along with BI-RADS [Breast Imaging-Reporting and Data System] 4 subcategories can help to reduce the number of false-positives without experiencing excessive negative results that would lead to cancer going undiagnosed."

The report explores the use of a statistical calculation known as the Negative Likelihood Ratio (NLR). It shows how NLR can be calculated from a diagnostic test's sensitivity and specificity and also show the NLRs of some currently available diagnostic imaging modalities. It outlines how the BI-RADS 4A sub-category has low enough and narrow enough range of pre-test probabilities (see Table 1) to allow downgrading to a post-test probability of 2 percent or less after a negative diagnostic imaging test with an adequately low NLR.

 

FINAL ASSESSMENT CATEGORIES

Category

Management

Likelihood of cancer

0

Need Additional Imaging or Prior Examinations

Recall for Additional Imaging and/or Await Prior Examinations

n/a

1

Negative

Routine Screening

Essentially 0%

2

Benign

Routing Screening

Essentially 0%

3

Probably Benign

Short Interval Follow-up (6 month) or Continued

>0% but < 2%

4

Suspicious

Tissue Diagnosis

  • 4a. low suspicion for malignancy (>2% to < 10%)
  • 4b. moderate suspicion for malignancy (>10% to < 50%)
  • 4c. high suspicion for malignancy (>50% to <95%)

5

Highly Suggestive of Malignancy

Tissue Diagnosis

>95%

6

Known Biopsy-Proven

Surgical Excision when Clinically Appropriate

n/a

Table 1. BI-RADS Categories

Source: http://www.radiologyassistant.nl/data/bin/a53b4293920e94_TAB-Birads

"Reducing the number of unnecessary breast biopsies is an essential advancement toward improving women's healthcare and protecting breast health," said Pam Otto, M.D., Department of Radiology, The University of Texas Health Science Center at San Antonio and co-author. "I would encourage breast imagers to consider using BI-RADS 4 subcategories and NLR as important tools for helping them minimize false positive studies with minimum adverse effect on sensitivity, optimizing their patients' breast health. The availability of web-based programs for automating the NLR calculations should help to facilitate routine use of this important statistical tool."

For more information: www.ajronline.org

References

1. Yang WT, Parikh JR, Stavros AT, Otto P and Maislin G. Exploring the Negative Likelihood Ratio and How It Can Be Used to Minimize False-Positives in Breast Imaging. AJR 2018;210:301-306.

 

 

Related Content

Medical researchers at Flinders University have established a new link between high body mass index (BMI) and breast cancer survival rates — with clinical data revealing worse outcomes for early breast cancer (EBC) patients and improved survival rates in advanced breast cancer (ABC).

Getty Images

News | Women's Health | May 13, 2021
May 13, 2021 — Medical researchers at Flinders University
News | Artificial Intelligence | May 11, 2021
May 11, 2021 — Whiterabbit, an AI technology company focused on early...
A 37-year-old woman developed a new, palpable left supraclavicular lymphadenopathy lump five days after her first dose of the Moderna COVID-19 vaccine in the left arm. On the day of vaccination, the patient was asymptomatic. This is an example of how the vaccine can mimic cancer and swollen lymph nodes. Image used with permission of RSNA.

A 37-year-old woman developed a new, palpable left supraclavicular lymphadenopathy lump five days after her first dose of the Moderna COVID-19 vaccine in the left arm. On the day of vaccination, the patient was asymptomatic. This is an example of how the vaccine can mimic cancer and swollen lymph nodes. Read more about this case study. Image used with permission of RSNA.

Feature | Coronavirus (COVID-19) | May 03, 2021 | By Dave Fornell, Editor
While the mass COVID-19 vaccinat
A 63-year-old multiple #myeloma patient, with skeletal pain. New #FDG avid axillary #lymphadenopathy 62 days (9 weeks) after second #mRNA #vaccination dose. Image used with permission of the Radiological Society of North America (#RSNA)

A 63-year-old multiple myeloma patient, with skeletal pain. New FDG avid axillary lymphadenopathy 62 days (9 weeks) after second mRNA vaccination dose. Image used with permission of the Radiological Society of North America (RSNA)

Feature | Coronavirus (COVID-19) | April 29, 2021 | By Melinda Taschetta-Millane