Seely J M, Nguyen E T, Jaffey J
Department of Radiology, The Ottawa Hospital, Ottawa, ON Canada.
Acta Radiol. 2007 Oct;48(8):838-45. doi: 10.1080/02841850701468883.
While breast magnetic resonance imaging (MRI) is a highly sensitive test for detecting breast carcinoma, its specificity is lower, and several methods have been described on how to optimize specificity.
To compare the specificity and sensitivity of the BI-RADS category with the Fischer score in breast MRI for diagnosing cancer in women previously treated for breast cancer.
Women referred for evaluation of possible local recurrence or new breast cancer underwent breast MRI examination. Morphologic and kinetic enhancement characteristics were evaluated. BI-RADS category and Fischer score were assigned for each enhancing lesion and compared using a chi-square test. Sensitivity, specificity,and positive predictive values for 27 morphologic and enhancement characteristics were calculated. Pathologic diagnosis was obtained in all patients with enhancing lesions who had ultrasound or mammographic correlation. In those without correlate, 6-, 12-, and 24-month follow-up breast MRIs were obtained. Interobserver kappa correlation was determined for each variable studied.
34 benign and 32 malignant lesions were identified in 26 of 30 patients. BIRADS category yielded a specificity of 77.1% and a sensitivity of 81.8%. Fischer score had a lower specificity and sensitivity (62.9% and 72.7%, respectively) (P<0.0001). Of the 27 variables studied, >100% enhancement was more sensitive than BI-RADS for malignant lesions. Specificity was highest for rim enhancement (97.1%), but sensitivity was low (24.2%). Interobserver kappa correlation was good for all 27 characteristics(k=0.84), and highest for BI-RADS assessment (k=0.91).
BI-RADS category in breast MRI had the highest combination of specificity and sensitivity, and the highest interobserver correlation. Fischer score and other morphologic and enhancement features lack sensitivity or specificity and do not have high positive predictive values when analyzed as single independent variables.
虽然乳腺磁共振成像（MRI）是检测乳腺癌的高灵敏度检查，但其特异性较低，并且已经描述了几种优化特异性的方法。
比较乳腺MRI中BI-RADS分类与费舍尔评分在诊断既往接受过乳腺癌治疗的女性癌症中的特异性和灵敏度。
因可能存在局部复发或新发乳腺癌而接受评估的女性接受了乳腺MRI检查。评估形态学和动态增强特征。为每个强化病灶指定BI-RADS分类和费舍尔评分，并使用卡方检验进行比较。计算27种形态学和增强特征的灵敏度、特异性和阳性预测值。对所有具有超声或乳腺X线相关性的强化病灶患者进行病理诊断。对于无相关性的患者，进行6个月、12个月和24个月的随访乳腺MRI检查。对所研究的每个变量确定观察者间kappa相关性。
30例患者中的26例共发现34个良性病灶和32个恶性病灶。BI-RADS分类的特异性为77.1%，灵敏度为81.8%。费舍尔评分的特异性和灵敏度较低（分别为62.9%和72.7%）（P<0.0001）。在所研究的27个变量中，>100%增强对恶性病灶比BI-RADS更敏感。边缘强化的特异性最高（97.1%），但灵敏度较低（24.2%）。观察者间kappa相关性对所有27个特征均良好（k=0.84），对BI-RADS评估最高（k=0.91）。
乳腺MRI中的BI-RADS分类具有最高的特异性和灵敏度组合，以及最高的观察者间相关性。费舍尔评分以及其他形态学和增强特征缺乏灵敏度或特异性，作为单一独立变量分析时阳性预测值不高。
