利用ROC曲线预测乳腺钼靶摄影与乳腺闪烁造影联合检查在疑似原发性乳腺癌中的应用价值。

Prediction of the usefulness of combined mammography and scintimammography in suspected primary breast cancer using ROC curves.

作者信息

Buscombe J R, Cwikla J B, Holloway B, Hilson A J

机构信息

Department of Nuclear Medicine, Royal Free Hospital, London, United Kingdom.

出版信息

J Nucl Med. 2001 Jan;42(1):3-8.

PMID:11197976

Abstract

UNLABELLED

The aim of this study was to compare the accuracy of 99mTc-methoxyisobutylisonitrile scintimammography (SMM) and conventional mammography in patients presenting with suspected primary breast cancer. Receiver-operating-characteristic (ROC) curve analysis was applied to determine if a combination of x-ray mammography (XMM) and SMM was more accurate than a single test alone.

METHODS

The results of SMM, XMM, and a combination of both studies performed over a 3-y period on 374 suspicious lesions in 353 patients with no previous history of breast cancer were reviewed. Each scan report was reviewed and graded as follows: grade 1, definitely normal or benign; grade 2, probably normal or benign; grade 3, equivocal; grade 4, probably cancer; and grade 5, definitely cancer. The results were verified by pathologic examination of biopsy material obtained from each suspicious mass. ROC curves were generated from these results.

RESULTS

There were 204 malignant breast tumors and 170 nonmalignant breast lesions. SMM diagnosed correctly 181 breast cancers and was true-negative in 122 benign breast lesions: sensitivity, 89%; specificity, 71%; positive predictive value (PPV), 79%; and negative predictive value (NPV), 84%. XMM diagnosed correctly 143 malignant tumors and was true-negative in 117 nonmalignant lesions. The sensitivity, specificity, PPV, and NPV for XMM were 70%, 69%, 73%, and 66%, respectively. Using a combination of the two tests, the combined sensitivity was 93%, specificity was 72%, PPV was 80%, and NPV was 90%. Using the index of the area under the ROC curve obtained by the rating method showed that the combination of XMM and SMM was significantly more accurate than either of the individual tests if performed alone (P < 0.05).

CONCLUSION

This study shows that the combination of XMM and SMM produces more accurate results than either modality alone. Therefore, if there is doubt about the accuracy of XMM, SMM should be used as the second-line test in breast imaging.

摘要

未标注

本研究的目的是比较99mTc-甲氧基异丁基异腈闪烁乳腺造影（SMM）和传统乳腺X线摄影对疑似原发性乳腺癌患者的诊断准确性。应用接受者操作特征（ROC）曲线分析来确定乳腺X线摄影（XMM）和SMM联合检查是否比单一检查更准确。

方法

回顾了353例无乳腺癌病史患者在3年期间对374个可疑病变进行的SMM、XMM以及两者联合检查的结果。每份扫描报告经审核后分为以下等级：1级，肯定正常或良性；2级，可能正常或良性；3级，不明确；4级，可能为癌症；5级，肯定为癌症。结果通过对每个可疑肿块获取的活检材料进行病理检查来验证。根据这些结果绘制ROC曲线。

结果

有204例乳腺恶性肿瘤和170例乳腺非恶性病变。SMM正确诊断出181例乳腺癌，在122例良性乳腺病变中为真阴性：敏感性为89%；特异性为71%；阳性预测值（PPV）为79%；阴性预测值（NPV）为84%。XMM正确诊断出143例恶性肿瘤，在117例非恶性病变中为真阴性。XMM的敏感性、特异性、PPV和NPV分别为70%、69%、73%和66%。使用两种检查联合，联合敏感性为93%，特异性为72%，PPV为80%，NPV为90%。通过评分法获得的ROC曲线下面积指数显示，如果单独进行，XMM和SMM联合检查比任何一种单独检查都显著更准确（P<0.05）。