Analysis of breast imaging reporting and data system (BI-RADS classification) caused by differences in the confusion

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In recent years, the major hospitals and even some grass-roots hospitals to carry out a variety of imaging imaging of breast diseases, most

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In recent years, the major hospitals and even some grass-roots hospitals to carry out a variety of imaging imaging of breast diseases, most of the use of high frequency color Doppler ultrasound and molybdenum target, nuclear magnetic resonance has gradually become a routine means of inspection. Breast imaging reporting and data system (BI-RADS). It was a good thing, easy to unify. However, due to the differences in the various hospital equipment, with the level of different levels of examination, so there are different breast imaging report differences. But recently produced more and more examples of differences, different reports also allow clinicians and patients more and more confused, confused.

Here are a few examples:

1 patients with fan XX, female, aged 45, report of the external medicine mammography, right breast irregular high density shadow, BI-RADS grade 4, nor is it 4a, or 4b, or 4c. Molybdenum target is not given to the patient, because the molybdenum target can not be more than pat, my hospital to the patient to do a B ultrasound, showing a low left ventricular echo position, BI-RADS 3. Hand detection can not touch the mass, and finally had to do nuclear magnetic resonance examination, but only for the right breast benign nodules. Check the difference to let the patient know.

2 patients with Zhu XX, female, aged 53 years old, the left side of the hospital B ultrasound breast mass, rich blood supply, accompanied by calcification, BI-RADS grade 5, in our hospital after the manual examination, a mass of hard, poor activity, but also suspected malignant may. However, the molybdenum target examination showed that the pattern of calcification of popcorn, belong to benign calcification, BI-RADS Level 3, the results also confirmed that fibroma with calcification.

3 patients with Wang XX, female, aged 42 years, external hospital MRI, right breast mass on the inside, the report shows that the level of BI-RADS 4a, causing the patient's concerns, to the hospital to do B ultrasound, showing the right lateral hyperplasia of breast nodules, BI-RADS level 3. Molybdenum targets can not see what. Results I took the patient to the MRI room to analyze the film, and found that the enhancement of the time signal curve is benign, which may be related to the change of the incision scar after ten years ago. For such patients, surgery is not appropriate, the need for close follow-up.

4 patients with Yang XX, female, 33 years old, three years after breast augmentation, recently left breast nodules, compared the size of hard, such as rice, the patient is very afraid. B ultrasound findings left breast mass BI-RADS 4A level. Because the radiologist is not willing to do worry about Mo scar, crush the prosthesis. Nuclear magnetic resonance imaging was performed to show the chronic inflammatory necrosis of the tissue. Surgical pathology was confirmed.

5 patients with XX, female, 46 years old, right breast invasive lobular carcinoma after surgery for three years. Found on the left breast, only the size of soybean. B-mode ultrasonography, mammography and MRI showed no signs of malignancy. Reports are BI-RADS 2. Because invasive lobular carcinoma is characterized by bilateral growth, multifocal and multicentric, the left side of the nodule must be taken into account. Results the tumor was confirmed by surgery, and the axillary lymph node metastasis was 4+/18.

A similar situation was proposed, too numerous to mention, I hope you look after pay attention, learn from the experience and lessons, then you can walk less detours, not excessive treatment, and will not delay the patient's condition.

This reminds me of the story on the basis of one-sided viewpoint. Of course, this metaphor is not necessarily appropriate, each image has its limitations, and check the doctor can not be a comprehensive understanding of the patient's condition. The advantage of B ultrasound is that it can be dynamic and repeated examination, it can distinguish between the mass is cystic or cystic, we can measure the tumor blood flow index. But it has no effect on calcification. The molybdenum target is very clear to the small calcification, but also shows the distortion and asymmetry of the gland. But its drawback is that there is a small amount of radioactive rays, it is best to be done once every six months. Nuclear magnetic resonance enhanced scanning can not only make the lesions more clearly, but also can be used to evaluate the benign and malignant lesions. At the same time, MRI is considered to be the best imaging method to evaluate the breast implant and the disease, and there is no radioactivity. However, it is difficult to operate and is expensive.

The clinical surgeon of breast surgery must be combined with ultrasound and radiologists, if for patients with masses of touch is not clear, must be in before operation with the patient came to the B ultrasonic room examination, positioning. The same is true of the calcified lesions, must be to the radiology department to see the biopsy needle positioning film. Although it is hard to do some, but the operation, the heart to be more practical. To be able to see a variety of mass image on the screen, can also increase their perceptual knowledge mass image, is also an endless enjoyment.

Clinicians must have the ability of comprehensive analysis, with years of clinical experience to judge, to have business research on the patient's heart and a strong sense of responsibility, in order to make the correct diagnosis, reduce the patient's pain, get the best results. So when the patient is confused, do not panic, to find an experienced specialist consultation. "Do diagnosis treatment right the first time and". How important it is to diagnose and treat for the first time!

 

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