Niell Bethany L, Gavenonis Sara C, Motazedi Tina, Chubiz Jessica Cott, Halpern Elkan P, Rafferty Elizabeth A, Lee Janie M
Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts.
Department of Radiology, Christiana Care Health System, Newark, Delaware.
J Am Coll Radiol. 2014 Sep;11(9):883-9. doi: 10.1016/j.jacr.2014.02.003. Epub 2014 Apr 29.
Breast MRI is increasingly used for both screening and diagnostic purposes. Although performance benchmarks for screening and diagnostic mammography have been published, performance benchmarks for breast MRI have yet to be established. The purpose of this study was to comprehensively evaluate breast MRI performance measures, stratified by screening and diagnostic indications, from a single academic institution.
Institutional review board approval was acquired for this HIPAA-compliant study. Informed consent was not required. Retrospective review of the institutional database identified all breast MRI examinations performed from April 1, 2007, to March 31, 2008. After application of exclusion criteria, the following performance measures for screening and diagnostic indications were calculated: cancer detection rate, positive predictive value (PPV), and abnormal interpretation rates.
The study included 2,444 examinations, 1,313 for screening and 1,131 for diagnostic indications. The cancer detection rates were 14 per 1,000 screening breast MRI examinations and 47 per 1,000 diagnostic examinations (P < .00001). The abnormal interpretation rate was 12% (152 of 1,313) for screening and 17% (194 of 1,131) for diagnostic indications (P = .00008). The PPVs of MRI were lower for screening [PPV1 (abnormal findings) = 12%, PPV2 (biopsy recommended) = 24%, PPV3 (biopsy performed) = 27%] compared with diagnostic indications (PPV1 (abnormal findings) = 28%, PPV2 (biopsy recommended) = 36%, PPV3 (biopsy performed) = 38%].
Breast MRI performance measures differ significantly between screening and diagnostic MRI indications. Medical audits for breast MRI should calculate performance measures for screening and diagnostic breast MRI separately, as recommended for mammography.
乳腺磁共振成像（MRI）越来越多地用于筛查和诊断。尽管已公布了筛查和诊断性乳腺钼靶的性能基准，但乳腺MRI的性能基准尚未确立。本研究的目的是从单一学术机构全面评估按筛查和诊断指征分层的乳腺MRI性能指标。
本符合健康保险流通与责任法案（HIPAA）的研究获得了机构审查委员会的批准。无需知情同意。对机构数据库进行回顾性审查，确定了2007年4月1日至2008年3月31日期间进行的所有乳腺MRI检查。应用排除标准后，计算了以下筛查和诊断指征的性能指标：癌症检出率、阳性预测值（PPV）和异常解读率。
该研究包括2444例检查，其中1313例用于筛查，1131例用于诊断指征。每1000例筛查乳腺MRI检查的癌症检出率为14例，每1000例诊断性检查为47例（P <.00001）。筛查的异常解读率为12%（1313例中的152例），诊断指征的异常解读率为17%（1131例中的194例）（P =.00008）。与诊断指征相比，MRI筛查的PPV较低[PPV1（异常发现）= 12%，PPV2（建议活检）= 24%，PPV3（进行活检）= 27%]（PPV1（异常发现）= 28%，PPV2（建议活检）= 36%，PPV3（进行活检）= 38%]。
乳腺MRI筛查和诊断指征的性能指标存在显著差异。乳腺MRI的医学审计应像乳腺钼靶检查那样，分别计算筛查和诊断性乳腺MRI的性能指标。
