Interobserver variability and positive predictive value for ultrasonographic BI-RADS categories requiring pathohistological evaluation.

OBJECTIVE: The objective of this study was an analysis of interobserver variability and positive predictive value (PPV) for BI-RADS categories requiring pathohistological evaluation: 4A, 4B, 4C, and 5. MATERIAL AND METHODS: Interobserver variability for each of descriptors as well as PPV for final BI-RADS categories requiring pathohistological evaluation was measured in a retrospective study which included 30 ultrasonographic reports, with pathohistological verification, randomly selected from ultrasonographic reports from Institute for Oncology and Radiology of Serbia where about 1,100 breast cancers are verified every year. Ten observers, seven gynecologists, and three radiologists, independently rated each ultrasonographic report according to the fourth edition of BI-RADS atlas. Interobserver variability was measured with k coefficient. RESULTS: There was most conformity for a category of orientation (k = 0.79). Substantial degree of conformity was also present for both boundary (k = 0.71) and shape (k = 0.65) categories. Moderate degree of conformity was achieved for posterior features (k = 0.54) and margins (k = 0.41) descriptors, while there was poor conformity in echogenicity (k = 0.38). In case of a final score, common conformity for all BI-RADS 4A, 4B, 4C, and 5 categories was (k = 0.51); it was the greatest for category 5 (k = 0.50), and it was less for categories 4C (k = 0.37), 4B (k = 0.32), and 4A (k = 0.29). CONCLUSIONS: Interobserver conformity for ultrasonographic descriptors and final evaluation of BI-RADS 4A, 4B, 4C, and 5 categories is good. PPV implies that not only division into categories 4 and 5, but also classification into categories 4 and subcategories 4A, 4B, and 4C are justified and clinically applicable.

The significance of 3D power Doppler in prenatal diagnosis and the evaluation of the anatomical structure of vein of Galen aneurysmatic malformation: case report.

Prenatal diagnosis of vein of Galen aneurysmatic malformation (VGAM) is made with the use of color Doppler, while in B-mode it is seen as a centrally placed supratentorial cystic structure. 3D-power Doppler (3D-PD) is a method that enables precise visualization of the vascular anatomy of this complex malformation. In our case, VGAM was detected in the 33rd week of gestation with power Doppler, and the use of 3D-PD enabled better visualization of the angioarchitecture and detection of feeding and drainage vessels of aneurysmatic widening. The diagnosis was confirmed postnatally with the use of MRI. A prenatal study of the angioarchitecture could have prognostic significance as well as being important in the therapeutic approach during the postnatal period.