Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, SPC 5326, Ann Arbor, MI 48109, USA.
Radiology. 2012 Jan;262(1):61-8. doi: 10.1148/radiol.11101763. Epub 2011 Oct 13.
To determine if digital breast tomosynthesis (DBT) performs comparably to mammographic spot views (MSVs) in characterizing breast masses as benign or malignant.
This IRB-approved, HIPAA-compliant reader study obtained informed consent from all subjects. Four blinded Mammography Quality Standards Act-certified academic radiologists individually evaluated DBT images and MSVs of 67 masses (30 malignant, 37 benign) in 67 women (age range, 34-88 years). Images were viewed in random order at separate counterbalanced sessions and were rated for visibility (10-point scale), likelihood of malignancy (12-point scale), and Breast Imaging Reporting and Data System (BI-RADS) classification. Differences in mass visibility were analyzed by using the Wilcoxon matched-pairs signed-ranks test. Reader performance was measured by calculating the area under the receiver operating characteristic curve (A(z)) and partial area index above a sensitivity threshold of 0.90 (A(z)(0.90)) by using likelihood of malignancy ratings. Masses categorized as BI-RADS 4 or 5 were compared with histopathologic analysis to determine true-positive results for each modality.
Mean mass visibility ratings were slightly better with DBT (range, 3.2-4.4) than with MSV (range, 3.8-4.8) for all four readers, with one reader's improvement achieving statistical significance (P = .001). The A(z) ranged 0.89-0.93 for DBT and 0.88-0.93 for MSV (P ≥ .23). The A(z)((0.90)) ranged 0.36-0.52 for DBT and 0.25-0.40 for MSV (P ≥ .20). The readers characterized seven additional malignant masses as BI-RADS 4 or 5 with DBT than with MSV, at a cost of five false-positive biopsy recommendations, with a mean of 1.8 true-positive (range, 0-3) and 1.3 false-positive (range, -1 to 4) assessments per reader.
In this small study, mass characterization in terms of visibility ratings, reader performance, and BI-RADS assessment with DBT was similar to that with MSVs. Preliminary findings suggest that MSV might not be necessary for mass characterization when performing DBT.
确定数字乳腺断层摄影术（DBT）在对乳腺肿块进行良性或恶性特征描述方面是否与乳腺点片摄影术（MSV）相当。
本研究获得了机构审查委员会（IRB）批准和 HIPAA 合规性认证，所有受试者均签署了知情同意书。四位经过乳腺影像质量标准法案（Mammography Quality Standards Act）认证的盲法学术放射科医生分别评估了 67 名女性（年龄 34-88 岁）中 67 个肿块（30 个恶性，37 个良性）的 DBT 图像和 MSV。图像以随机顺序在单独的平衡会议中查看，并根据可视性（10 分制）、恶性可能性（12 分制）和乳腺影像报告和数据系统（BI-RADS）分类进行评分。使用 Wilcoxon 配对符号秩检验分析肿块可视性差异。通过使用恶性可能性评分计算接收器工作特征曲线下面积（A(z)）和高于灵敏度阈值 0.90 的部分面积指数（A(z)(0.90)）来衡量读者的性能。将 BI-RADS 4 或 5 级的肿块与组织病理学分析进行比较，以确定每种模态的真阳性结果。
所有四位读者的平均肿块可视性评分均略高于 DBT（范围，3.2-4.4），而低于 MSV（范围，3.8-4.8），其中一位读者的改善具有统计学意义（P =.001）。DBT 的 A(z)范围为 0.89-0.93，MSV 的 A(z)范围为 0.88-0.93（P ≥.23）。DBT 的 A(z)(0.90)范围为 0.36-0.52，MSV 的 A(z)(0.90)范围为 0.25-0.40（P ≥.20）。与 MSV 相比，四位读者使用 DBT 额外将七例恶性肿块归类为 BI-RADS 4 或 5 级，代价是五次假阳性活检推荐，每位读者平均有 1.8 例真阳性（范围，0-3）和 1.3 例假阳性（范围，-1 至 4）评估。
在这项小型研究中，DBT 对肿块可视性评分、读者表现和 BI-RADS 评估的特征描述与 MSV 相似。初步研究结果表明，在进行 DBT 时，MSV 可能不是肿块特征描述所必需的。
