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The Risk Factor of Malignancy in ACR BI-RADS 4 Mammography Lesion Which was Invisible in Breast Ultrasound
乳房攝影診斷為ACR BI-RADS 4且超音波不可見的乳房腫瘤其為惡性之風險因子
摘要
美國放射線醫學會發展出的乳房影像報告及數據系統目前廣泛應用於乳癌篩檢；我們從2006年10月至2008年10月共收集2例女性病患，她們接受乳房攝影檢查時經由美國放射線醫學會乳房影像報告及數據系統評定為第4級之乳房病灶而乳房超音波卻無法發現病灶。其中26位病患接受乳房攝影定位手術切除病灶，一位病患未接受手術而以乳房核磁共振照影檢查結果評定為有異常但為良性之第2級；在26位接受手術切除乳房病灶的病患中，共有7位發現為惡性腫瘤包括6位診斷為原位癌及1位診斷為侵襲性管腺癌，其餘19位病患診斷為良性；因為並非所有病患均為惡性腫瘤，因此本研究之目的在尋找這群病患中何者可能為惡性腫瘤之危險因子進而探討可否避免不必要的手術。我們探討的危險因子變項有停經狀態（停經前與停經後）、有否哺乳、有否補充女性荷爾蒙、乳癌家族史、生育子女數、第一胎活產之年齡、停經之年齡。將病患區分為惡性腫瘤病患與良性腫瘤病患兩群來比較，停經後狀態是惡性腫瘤之危險因子。
並列摘要
The ACR-BI-RADS is commonly used to assess breast lesion during breast cancer screening by mammography as recommended by the American College of Radiology. From October 2006 through October 2008, our group have identified 27 cases of breast lesion by mammographic screening. Although all these cases were reported as ACR-BI-RADS 4. Yet breast ultrasound revealed negative results. Among theses 27 cases, 26 had received wired localization of the lesion under mammography and surgery to remove the lesion. One patient selected breast MRI and was reported as ACR BI-RADS 2. For patients who had surgery, only seven patients were identified as malignancy (six ductal carcinoma in situ and one infiltrating ductal carcinoma). The rest 19 patients were reported as benign lesion. The aim of this study is therefore to identify the risk factor of malignancy based on the variables gathered from these patients so that the unnecessary breast biopsy can be obviated in the future. Fisher exact test for testing the difference rate between the benign and the malignancy groups on these variables including menopause (pre-or post) status, breast feeding, hormone replacement, family history of breast cancer, number of child birth, age of first child birth, age of menarche. Out of these variables, we found that only post-menopause status was significant linked to the occurrence of malignancy and hence to be a genuine risk factor for malignancy.