Thomassin-Naggara Isabelle, Perrot Nicolas, Dechoux Sophie, Ribeiro Carine, Chopier Jocelyne, de Bazelaire Cedric
Sorbonne Universités, UPMC Univ Paris 06, IUC, 75005 Paris, France; INSERM, UMR970, Equipe 2, Imagerie de l'angiogenèse, 75005 Paris, France; AP-HP, Hôpital Tenon, Department of Radiology, 4 rue de la Chine, 75020 Paris, France.
AP-HP, Hôpital Tenon, Department of Radiology, 4 rue de la Chine, 75020 Paris, France; Centre Pyramides, Paris, France.
Eur J Radiol. 2015 Feb;84(2):235-41. doi: 10.1016/j.ejrad.2014.10.022. Epub 2014 Nov 15.
To retrospectively evaluate the added value of one-view breast tomosynthesis in adjunct with mammography to characterize breast lesions.
Our institutional ethics committees approved the study and granted a waiver of informed consent. One hundred fifty-five women (mean age, 51.3 years, range: 24-92 years) who systematically underwent mammography and breast tomosynthesis with subsequent percutaneous biopsy were analyzed. Four radiologists (two seniors, R1 and R2, and two juniors, R3 and R4 with 30, 10, 3 and 1 years of experience in breast imaging, respectively) independently reviewed exams in two steps: mammography alone and tomosynthesis in adjunct with mammography. The lesions in the cohort included 39.3% (61/155) cancers, 2.5% (4/155) high-risk lesions and 58.1% (90/155) benign lesions. A receiver operating characteristic (ROC) curve analysis was performed to compare the results of the two readings.
There was almost perfect agreement irrespective of reader experience for the reading of the mammography in adjunct with tomosynthesis, whereas agreement was poor between junior and senior readers for the reading of mammography alone. Area under the ROC (Az) values for the tomosynthesis in adjunct with mammography were significantly better than Az values for mammography alone for all readers except the most experienced, for whom only a tendency was noted. The proportion of cancers undiagnosed by mammography alone that were well diagnosed by tomosynthesis in adjunct with mammography was 6.5% (4/61), 13.1% (8/61), 27.8% (17/61) and 26.2% (16/61) for Readers 1, 2, 3 and 4, respectively. The proportion of false positive cases induced by the addition of breast tomosynthesis to mammography was 2.1% (2/94), 2.1% (2/94), 9.5% (9/94) and 12.7% (12/94) for Readers 1, 2, 3 and 4, respectively.
Adding breast tomosynthesis to mammography improved sensitivity and negative predictive value for all readers except for the most experienced one, in whom only a tendency for improvement was noted.
回顾性评估单视图乳腺断层合成联合乳腺X线摄影在乳腺病变特征描述方面的附加价值。
我们机构的伦理委员会批准了本研究并豁免了知情同意书。对155名女性（平均年龄51.3岁，范围：24 - 92岁）进行了分析，这些女性均接受了乳腺X线摄影和乳腺断层合成检查，随后进行了经皮活检。四位放射科医生（两位资深医生，R1和R2，以及两位初级医生，R3和R4，分别具有30年、10年、3年和1年的乳腺影像诊断经验）分两步独立阅片：先单独阅乳腺X线摄影片，再阅乳腺断层合成联合乳腺X线摄影片。队列中的病变包括39.3%（61/155）的癌症、2.5%（4/155）的高危病变和58.1%（90/155）的良性病变。进行了受试者操作特征（ROC）曲线分析以比较两次阅片的结果。
无论阅片者经验如何，乳腺断层合成联合乳腺X线摄影的阅片结果几乎完全一致，而单独阅乳腺X线摄影片时，初级和资深阅片者之间的一致性较差。除经验最丰富的阅片者外，所有阅片者的乳腺断层合成联合乳腺X线摄影的ROC曲线下面积（Az）值均显著优于单独乳腺X线摄影的Az值，对于经验最丰富的阅片者，仅观察到有改善的趋势。单独乳腺X线摄影未诊断出但乳腺断层合成联合乳腺X线摄影能很好诊断出的癌症比例，阅片者1、2、3和4分别为6.5%（4/61）、13.1%（8/61）、27.8%（17/61）和26.2%（16/61）。乳腺断层合成联合乳腺X线摄影增加后导致的假阳性病例比例，阅片者1、2、3和4分别为2.1%（2/94）、2.1%（2/94）、9.5%（9/94）和12.7%（12/94）。
除经验最丰富的阅片者外，乳腺断层合成联合乳腺X线摄影对所有阅片者均提高了敏感性和阴性预测值，对于经验最丰富的阅片者仅观察到有改善的趋势。
