Lalji U C, Houben I P L, Prevos R, Gommers S, van Goethem M, Vanwetswinkel S, Pijnappel R, Steeman R, Frotscher C, Mok W, Nelemans P, Smidt M L, Beets-Tan R G, Wildberger J E, Lobbes M B I
Departments of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Radiology, University Hospital Antwerp, Edegem, Meirstraat 61, 2890 St., Amands, Belgium.
Eur Radiol. 2016 Dec;26(12):4371-4379. doi: 10.1007/s00330-016-4336-0. Epub 2016 Apr 20.
Contrast-enhanced spectral mammography (CESM) is a promising problem-solving tool in women referred from a breast cancer screening program. We aimed to study the validity of preliminary results of CESM using a larger panel of radiologists with different levels of CESM experience.
All women referred from the Dutch breast cancer screening program were eligible for CESM. 199 consecutive cases were viewed by ten radiologists. Four had extensive CESM experience, three had no CESM experience but were experienced breast radiologists, and three were residents. All readers provided a BI-RADS score for the low-energy CESM images first, after which the score could be adjusted when viewing the entire CESM exam. BI-RADS 1-3 were considered benign and BI-RADS 4-5 malignant. With this cutoff, we calculated sensitivity, specificity and area under the ROC curve.
CESM increased diagnostic accuracy in all readers. The performance for all readers using CESM was: sensitivity 96.9 % (+3.9 %), specificity 69.7 % (+33.8 %) and area under the ROC curve 0.833 (+0.188).
CESM is superior to conventional mammography, with excellent problem-solving capabilities in women referred from the breast cancer screening program. Previous results were confirmed even in a larger panel of readers with varying CESM experience.
• CESM is consistently superior to conventional mammography • CESM increases diagnostic accuracy regardless of a reader's experience • CESM is an excellent problem-solving tool in recalls from screening programs.
对比增强光谱乳腺摄影（CESM）是一种有前景的解决问题的工具，适用于从乳腺癌筛查项目中转介而来的女性。我们旨在使用更多具有不同CESM经验水平的放射科医生，研究CESM初步结果的有效性。
所有从荷兰乳腺癌筛查项目中转介而来的女性均符合CESM检查条件。连续199例病例由10名放射科医生阅片。其中4名有丰富的CESM经验，3名没有CESM经验但为经验丰富的乳腺放射科医生，3名是住院医师。所有阅片者首先对低能量CESM图像给出BI-RADS评分，之后在查看完整的CESM检查时可对评分进行调整。BI-RADS 1-3级被视为良性，BI-RADS 4-5级为恶性。以此为界值，我们计算了敏感度、特异度和ROC曲线下面积。
CESM提高了所有阅片者的诊断准确性。所有阅片者使用CESM的表现为：敏感度96.9%（+3.9%），特异度69.7%（+33.8%），ROC曲线下面积0.833（+0.188）。
CESM优于传统乳腺摄影，在从乳腺癌筛查项目中转介而来的女性中具有出色的解决问题的能力。即使在更多具有不同CESM经验的阅片者中，先前的结果也得到了证实。
• CESM始终优于传统乳腺摄影 • 无论阅片者的经验如何，CESM均可提高诊断准确性 • CESM是筛查项目召回病例中一种出色的解决问题的工具。
