Giger Maryellen L, Inciardi Marc F, Edwards Alexandra, Papaioannou John, Drukker Karen, Jiang Yulei, Brem Rachel, Brown Jeremy Bancroft
1 Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637.
2 University of Kansas Medical Center, Kansas City, KS.
AJR Am J Roentgenol. 2016 Jun;206(6):1341-50. doi: 10.2214/AJR.15.15367. Epub 2016 Apr 4.
The objective of our study was to assess and compare, in a reader study, radiologists' performance in the detection of breast cancer using full-field digital mammography (FFDM) alone and using FFDM with 3D automated breast ultrasound (ABUS).
In this multireader, multicase, sequential-design reader study, 17 Mammography Quality Standards Act-qualified radiologists interpreted a cancer-enriched set of FFDM and ABUS examinations. All imaging studies were of asymptomatic women with BI-RADS C or D breast density. Readers first interpreted FFDM alone and subsequently interpreted FFDM combined with ABUS. The analysis included 185 cases: 133 noncancers and 52 biopsy-proven cancers. Of the 52 cancer cases, the screening FFDM images were interpreted as showing BI-RADS 1 or 2 findings in 31 cases and BI-RADS 0 findings in 21 cases. For the cases interpreted as BI-RADS 0, a forced BI-RADS score was also given. Reader performance was compared in terms of AUC under the ROC curve, sensitivity, and specificity.
The AUC was 0.72 for FFDM alone and 0.82 for FFDM combined with ABUS, yielding a statistically significant 14% relative improvement in AUC (i.e., change in AUC = 0.10 [95% CI, 0.07-0.14]; p < 0.001). When a cutpoint of BI-RADS 3 was used, the sensitivity across all readers was 57.5% for FFDM alone and 74.1% for FFDM with ABUS, yielding a statistically significant increase in sensitivity (p < 0.001) (relative increase = 29%). Overall specificity was 78.1% for FFDM alone and 76.1% for FFDM with ABUS (p = 0.496). For only the mammography-negative cancers, the average AUC was 0.60 for FFDM alone and 0.75 for FFDM with ABUS, yielding a statistically significant 25% relative improvement in AUC with the addition of ABUS (p < 0.001).
Combining mammography with ABUS, compared with mammography alone, significantly improved readers' detection of breast cancers in women with dense breast tissue without substantially affecting specificity.
我们研究的目的是在一项阅片者研究中评估并比较放射科医生分别使用全视野数字乳腺摄影（FFDM）以及联合使用FFDM与三维自动乳腺超声（ABUS）检测乳腺癌的表现。
在这项多阅片者、多病例、序贯设计的阅片者研究中，17名符合《乳腺摄影质量标准法案》要求的放射科医生解读了一组富含癌症病例的FFDM和ABUS检查影像。所有影像学检查对象均为无症状且乳腺影像报告和数据系统（BI-RADS）分类为C或D类乳腺密度的女性。阅片者首先单独解读FFDM影像，随后解读FFDM与ABUS联合的影像。分析包括185个病例：133个非癌症病例和52个经活检证实的癌症病例。在52个癌症病例中，筛查FFDM影像被解读为BI-RADS 1或2类表现的有31例，被解读为BI-RADS 0类表现的有21例。对于被解读为BI-RADS 0类的病例，还给出了强制BI-RADS评分。根据受试者工作特征（ROC）曲线下的曲线下面积（AUC）、灵敏度和特异度对阅片者的表现进行比较。
单独使用FFDM时AUC为0.72，联合使用FFDM与ABUS时AUC为0.82，AUC相对提高了14%，具有统计学意义（即AUC变化=0.10 [95% CI，0.07 - 0.14]；p < 0.001）。当使用BI-RADS 3作为切点时，所有阅片者单独使用FFDM时的灵敏度为57.5%，联合使用FFDM与ABUS时为74.1%，灵敏度有统计学意义的提高（p < 0.001）（相对提高=29%）。总体特异度单独使用FFDM时为78.1%，联合使用FFDM与ABUS时为76.1%（p = 0.496）。对于仅乳腺摄影表现为阴性的癌症，单独使用FFDM时平均AUC为0.60，联合使用FFDM与ABUS时为0.75，联合使用ABUS后AUC相对提高了25%，具有统计学意义（p < 0.001）。
与单独使用乳腺摄影相比，乳腺摄影联合ABUS可显著提高阅片者对乳腺组织致密女性乳腺癌的检测能力，且基本不影响特异度。
