Lobbes Marc B I, Lalji Ulrich, Houwers Janneke, Nijssen Estelle C, Nelemans Patty J, van Roozendaal Lori, Smidt Marjolein L, Heuts Esther, Wildberger Joachim E
Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands,
Eur Radiol. 2014 Jul;24(7):1668-76. doi: 10.1007/s00330-014-3154-5. Epub 2014 Apr 3.
Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.
During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities.
Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0% (+3.1%), specificity to 87.7% (+45.7%), PPV to 76.2% (+36.5%) and NPV to 100.0% (+2.9%) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p < 0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p < 0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed.
CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening.
• CESM is feasible in the workflow of referrals from routine breast screening. • CESM is superior to mammography, even in low disease prevalence populations. • CESM has an extremely high negative predictive value for breast cancer. • CESM is comparable to MRI in assessment of breast cancer extent. • CESM is comparable to histopathology in assessment of breast cancer extent.
可行性研究表明，对比增强光谱乳腺摄影（CESM）可提高乳腺摄影的诊断准确性。我们研究了来自乳腺癌筛查项目的患者中CESM的诊断准确性，这些患者的疾病患病率低于先前发表的关于CESM的论文中的患病率。
在6个月期间，所有转诊至我院的女性均符合CESM检查条件。两名对最终诊断不知情的放射科医生对传统乳腺摄影和CESM进行了BI-RADS分类。使用McNemar检验计算乳腺摄影和CESM之间差异的统计学显著性。为两种成像方式构建了受试者操作特征（ROC）曲线。
在116名符合条件的女性中，113名接受了CESM检查。与乳腺摄影相比，CESM将敏感性提高到100.0%（提高了3.1%），特异性提高到87.7%（提高了45.7%），阳性预测值提高到76.2%（提高了36.5%），阴性预测值提高到100.0%（提高了2.9%）。传统乳腺摄影和CESM之间的差异具有统计学显著性（p < 0.0001）。在ROC曲线中也观察到了类似趋势。对于传统乳腺摄影，AUC为0.779。使用CESM时，AUC提高到0.976（p < 0.0001）。此外，观察到使用CESM、乳腺MRI和组织病理学测量的肿瘤直径之间具有良好的一致性。
即使在患病率较低的患者群体中，如来自乳腺癌筛查的转诊患者，CESM也能提高传统乳腺摄影的诊断性能。
• CESM在常规乳腺筛查转诊的工作流程中是可行的。• 即使在疾病患病率较低的人群中，CESM也优于乳腺摄影。• CESM对乳腺癌具有极高的阴性预测值。• 在评估乳腺癌范围方面，CESM与MRI相当。• 在评估乳腺癌范围方面，CESM与组织病理学相当。
