Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Eur Radiol. 2011 Jul;21(7):1353-63. doi: 10.1007/s00330-011-2060-3. Epub 2011 Jan 28.
To prospectively assess the reliability of US-guided diffuse optical tomography (US-DOT) using interobserver agreement for the diagnosis of breast lesions with individual real-time imaging and to assess the interobserver agreement of conventional sonography (US) combined with US-DOT for differentiation between benignity and malignancy breast lesions.
An Institutional Review Board approved this study, and all subjects provided written informed consent. 122 breast lesions in 111 patients evaluated with US-guided core biopsy were included. Assessments with US and US-DOT for cases subjected to biopsy were obtained by two radiologists using individual real-time imaging prior to biopsy and were prospectively recorded by each performer. With DOT, the total haemoglobin concentration (THC) for each breast lesion was measured. Histopathological results from US-guided biopsies were used as a reference standard. To assess measurement interobserver agreement, the intraclass correlation coefficient (ICC) and the Bland-Altman plot were used for THC in US-DOT and the kappa values and ROC analysis were used to evaluate the diagnostic performances of the US BI-RADS final assessment in US and combined US and US-DOT.
Of 122 US-guided core biopsied lesions, 83 (68.0%) were diagnosed as benign, and 39 (32.0%) as malignant. Excellent correlation was seen in the THC in US-DOT (ICC score 0.796; 95% confidence interval, 0.708-0.857). The interobserver agreement in BI-RADS final assessment with US and US-DOT (almost perfect; κ = 0.8618) was improved compared with that of US (substantial agreement, κ = 0.6574). However, the overall areas under the ROC curve did not show significant differences between US and combined US and US-DOT, 0.8894 and 0.8975, respectively (P = 0.981).
The reliability of THC in US-DOT showed excellent correlation in overall real-time performance. Although the inter-observer agreement for BI-RADS final assessment of US was improved by using US-DOT, the performances of radiologists with respect to the characterization of breast masses as benign or malignant were not significantly improved with US-DOT.
前瞻性评估使用观察者间一致性的超声引导漫射光学断层成像（US-DOT）在实时成像个体化的情况下对乳腺病变诊断的可靠性，并评估常规超声（US）与 US-DOT 结合对良恶性乳腺病变进行鉴别诊断的观察者间一致性。
本研究经机构审查委员会批准，所有患者均签署书面知情同意书。共纳入 111 例患者的 122 个经超声引导核心活检的乳腺病变。对活检病例进行超声和 US-DOT 检查，两位放射科医生在活检前使用实时成像进行评估，并由每位医生进行前瞻性记录。在 DOT 中，测量每个乳腺病变的总血红蛋白浓度（THC）。US 引导下活检的组织病理学结果作为参考标准。为了评估测量的观察者间一致性，采用组内相关系数（ICC）和 Bland-Altman 图评估 US-DOT 中的 THC，采用kappa 值和 ROC 分析评估 US 和联合 US-DOT 的 US BI-RADS 最终评估的诊断性能。
122 个经超声引导核心活检的病变中，83 个（68.0%）诊断为良性，39 个（32.0%）为恶性。US-DOT 中的 THC 相关性极好（ICC 评分 0.796；95%置信区间，0.708-0.857）。与 US 相比，US 和 US-DOT 的 BI-RADS 最终评估的观察者间一致性（极好；κ=0.8618）得到改善（高度一致，κ=0.6574）。然而，ROC 曲线下的总面积在 US 与联合 US 和 US-DOT 之间没有显示出显著差异，分别为 0.8894 和 0.8975（P=0.981）。
US-DOT 中 THC 的可靠性在整体实时性能方面显示出极好的相关性。尽管使用 US-DOT 提高了 US 对 BI-RADS 最终评估的观察者间一致性，但放射科医生对乳腺肿块为良性或恶性的特征描述的性能并没有因 US-DOT 而得到显著提高。
