Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seongsanno, Seodaemun-gu, Shinchondong, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2011 Mar;196(3):730-6. doi: 10.2214/AJR.10.4654.
The purpose of this article is to evaluate the interobserver variability of elastography on real-time ultrasound and how it influences the agreement of final assessment on ultrasound.
From April to May 2009, 65 breast lesions of 53 patients (mean age, 42.6 years; range, 18-72 years) who underwent ultrasound-guided core biopsy were included in this study. Ultrasound and elastography images of the lesion subjected to biopsy were obtained and prospectively analyzed by three radiologists with individual real-time image scanning prior to biopsy. Each radiologist recorded final ultrasound BI-RADS assessments using ultrasound and combined ultrasound and elastography and the fat-to-lesion ratio and elasticity score. The histopathologic results obtained from ultrasound-guided core biopsy or excision were used as the reference standard. Diagnostic performances and interobserver agreement were analyzed.
Of the 65 lesions, 43 (66.2%) were benign, and 22 (33.8%) were malignant. Specificity (20.2-33.3%), positive predictive value (38.7-45.1%), and accuracy (46.7-55.4%) were significantly improved in combined ultrasound and elastography (p < 0.001). Area under the curve (AUC) values for all three performers did not show significant differences in ultrasound (AUC, 0.959) and combined ultrasound and elastography (AUC, 0.957) (p = 0.92). Interobserver agreement was not improved with combined ultrasound and elastography (κ = 0.25) in comparison to ultrasound only (κ = 0.37). Interobserver agreement of real-time elastography was fair in both fat-to-lesion ratio (intraclass correlation coefficient score, 0.25) and elasticity score (κ = 0.28). Moderate agreement (κ = 0.46) was seen with static elastography.
Elastography improves the specificity, positive predictive value, and accuracy of ultrasound. However, significant interobserver variability exists, with real-time elastographic performance showing fair agreement.
本文旨在评估实时超声弹性成像的观察者间变异性及其对超声最终评估一致性的影响。
2009 年 4 月至 5 月，我们对 53 例（年龄 18-72 岁，平均 42.6 岁）患者的 65 个经超声引导活检的乳腺病变进行了前瞻性研究。对所有病变均进行超声和实时弹性成像检查，由 3 名放射科医师独立对病灶进行实时图像扫描后进行分析。每位医师均采用超声和联合超声及弹性成像技术记录最终 BI-RADS 评估，并记录病灶脂肪与病变比值和弹性评分。以超声引导下的核心活检或切除的组织病理学结果为参考标准。分析诊断性能和观察者间一致性。
65 个病灶中，良性 43 个（66.2%），恶性 22 个（33.8%）。联合超声和弹性成像时，特异度（20.2%-33.3%）、阳性预测值（38.7%-45.1%）和准确性（46.7%-55.4%）均显著提高（p < 0.001）。3 位医师在超声（AUC 0.959）和联合超声及弹性成像（AUC 0.957）时的曲线下面积（AUC）值均无显著差异（p = 0.92）。与仅采用超声时相比（κ = 0.37），联合超声和弹性成像时观察者间一致性并无提高（κ = 0.25）。实时弹性成像的脂肪与病变比值（组内相关系数评分，0.25）和弹性评分（κ = 0.28）的观察者间一致性为中等，静态弹性成像为中度一致（κ = 0.46）。
弹性成像提高了超声的特异度、阳性预测值和准确性。然而，存在显著的观察者间变异性，实时弹性成像的性能显示出中等一致性。
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