Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Eur J Nucl Med Mol Imaging. 2012 Jun;39(6):971-82. doi: 10.1007/s00259-011-2054-z.
To determine interobserver agreement and diagnostic accuracy using a lexicon for standardized interpretation of molecular breast imaging (MBI) studies by breast radiologists.
An MBI lexicon was developed, including descriptors of lesion type, background uptake, and associated findings by a consensus of experts. In an institutional review board-exempted protocol, six breast imaging radiologist observers without prior MBI experience attended a 2-h MBI interpretation training session, including definitions of lexicon terminology, case examples, and ten unknown cases with expert feedback. Following training, each radiologist observer interpreted an independent set of MBI images of 50 breasts, including 20 (40%) with malignancies with a median invasive tumor size of 1.7 cm (range 1.0 to 6.3 cm). The findings were described using the lexicon and each breast was given a final assessment of 1 to 5, paralleling BI-RADS assessment categories. Sensitivity, specificity, positive and negative predictive values were determined with core or surgical pathology results or 1-year imaging follow-up as the reference standard. Interobserver agreement for lesion-type classification, lesion and background uptake intensity, and final assessments were determined using Cohen's kappa.
For the six observers, median sensitivity was 1.0 (range 0.90-1.0), specificity 0.88 (range 0.83-0.97), and AUC 0.94 (range 0.93-0.98). Fair interobserver agreement was shown for background uptake (κ = 0.31). Agreement was substantial for lesion type (κ = 0.79) and non-mass distribution (κ = 0.63), and near-perfect for final assessment (κ = 0.84).
Dedicated breast imaging radiologists, newly trained to interpret MBI with the proposed lexicon, achieved high agreement and diagnostic accuracy.
通过乳腺影像学专家达成共识，为分子乳腺影像（MBI）研究的标准化解读制定词汇表，以此确定观察者间的一致性和诊断准确性。
我们制定了一个 MBI 词汇表，其中包括病变类型、背景摄取以及相关发现的描述符。在一项机构审查委员会豁免的协议中，六名没有 MBI 经验的乳腺成像放射科医生观察者参加了为期 2 小时的 MBI 解读培训课程，内容包括词汇表术语的定义、案例示例以及十个带有专家反馈的未知病例。培训后，每位放射科医生观察者独立解读了 50 例乳腺 MBI 图像，其中 20 例（40%）为恶性肿瘤，浸润性肿瘤大小中位数为 1.7cm（范围 1.0 至 6.3cm）。使用词汇表描述发现，对每个乳房进行 1 至 5 的最终评估，与 BI-RADS 评估类别平行。以核心或手术病理结果或 1 年影像学随访作为参考标准，确定敏感性、特异性、阳性和阴性预测值。使用 Cohen's kappa 确定病变类型分类、病变和背景摄取强度以及最终评估的观察者间一致性。
对于六位观察者，中位数敏感性为 1.0（范围 0.90-1.0），特异性为 0.88（范围 0.83-0.97），AUC 为 0.94（范围 0.93-0.98）。背景摄取的观察者间一致性中等（κ=0.31）。病变类型（κ=0.79）和非肿块分布（κ=0.63）的一致性较高，最终评估（κ=0.84）的一致性近乎完美。
经过专门培训，使用提出的词汇表解读 MBI 的乳腺影像学放射科医生达成了高度的一致性和诊断准确性。
