各国における乳癌検診の現状（７）日本版ＢＩ‐ＲＡＤＳとオリジナルＢＩ‐ＲＡＤＳの相違点と問題点

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  • Problems Arising from Differences between Japanese and American (Original) BI-RADS

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The Breast Imaging-Reporting and Data System (BI-RADS) has been developed in order to improve the quality of breast cancer screening by standardizing the terms for mammography reading and their interpretation, and by standardizing methods of reporting the results obtained and of accumulation and analysis of data. The original BI-RADS devised in the USA defines 7-step final assessment categories from 0 to 6 and each category clearly indicates subsequent management ; category 1 is defined as no abnormal findings, category 2 benign findings, category 3 probably benign findings and a 6-month interval follow-up is suggested, and categories 4 and 5, suspicious abnormality and highly suggestive of malignancy, respectively, both requiring needle biopsy or appropriate action. The Japanese BI-RADS does not clearly define the necessary subsequent management for each category. The Japanese system differs distinctly from the original one in category 3, i.e. the Japanese category 3 requires recall. A further obvious difference between the two systems is that the Japanese system does not have the category 0 of the American system, which requires additional imaging evaluation including an enlarged, spot mammogram or echogram, and final assessment is determined from the results of these examinations. Because of the lack of category 0 in the Japanese BI-RADS, the Japanese category 3 includes mammograms of the American category 0, which probably includes benign findings or even near suspicious abnormality that requires recall. This creates a confusing situation at screening and recall institutions. Because of absence of category 0 in the Japanese system, the recall rate (RR) and positive predicitive value (PPV) as indicators of reading quality control and reading ability may be calculated incorrectly.<BR>As breast cancer screening with mammography has just recently started in Japan, the current Japanese assessment categories should be normalized to the original system, otherwise they will not yield correct data that are suitable for international discussion.

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