Fallenberg Eva M, Schmitzberger Florian F, Amer Heba, Ingold-Heppner Barbara, Balleyguier Corinne, Diekmann Felix, Engelken Florian, Mann Ritse M, Renz Diane M, Bick Ulrich, Hamm Bernd, Dromain Clarisse
Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Institut of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Eur Radiol. 2017 Jul;27(7):2752-2764. doi: 10.1007/s00330-016-4650-6. Epub 2016 Nov 28.
To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) to digital mammography (MG) and magnetic resonance imaging (MRI) in a prospective two-centre, multi-reader study.
One hundred seventy-eight women (mean age 53 years) with invasive breast cancer and/or DCIS were included after ethics board approval. MG, CESM and CESM + MG were evaluated by three blinded radiologists based on amended ACR BI-RADS criteria. MRI was assessed by another group of three readers. Receiver-operating characteristic (ROC) curves were compared. Size measurements for the 70 lesions detected by all readers in each modality were correlated with pathology.
Reading results for 604 lesions were available (273 malignant, 4 high-risk, 327 benign). The area under the ROC curve was significantly larger for CESM alone (0.84) and CESM + MG (0.83) compared to MG (0.76) (largest advantage in dense breasts) while it was not significantly different from MRI (0.85). Pearson correlation coefficients for size comparison were 0.61 for MG, 0.69 for CESM, 0.70 for CESM + MG and 0.79 for MRI.
This study showed that CESM, alone and in combination with MG, is as accurate as MRI but is superior to MG for lesion detection. Patients with dense breasts benefitted most from CESM with the smallest additional dose compared to MG.
• CESM has comparable diagnostic performance (ROC-AUC) to MRI for breast cancer diagnostics. • CESM in combination with MG does not improve diagnostic performance. • CESM has lower sensitivity but higher specificity than MRI. • Sensitivity differences are more pronounced in dense and not significant in non-dense breasts. • CESM and MRI are significantly superior to MG, particularly in dense breasts.
在一项前瞻性双中心、多阅片者研究中，比较对比增强光谱乳腺摄影（CESM）与数字乳腺摄影（MG）及磁共振成像（MRI）的诊断性能。
经伦理委员会批准后，纳入178例患有浸润性乳腺癌和/或导管原位癌的女性（平均年龄53岁）。三名盲法放射科医生根据修订后的美国放射学会（ACR）乳腺影像报告和数据系统（BI-RADS）标准对MG、CESM和CESM + MG进行评估。另一组三名阅片者对MRI进行评估。比较受试者操作特征（ROC）曲线。对各检查方法中所有阅片者均检测到的70个病灶进行大小测量，并与病理结果进行相关性分析。
共获得604个病灶的阅片结果（273个恶性、4个高危、327个良性）。与MG（0.76）相比，单独使用CESM（0.84）和CESM + MG（0.83）的ROC曲线下面积显著更大（在致密型乳腺中优势最大），而与MRI（0.85）无显著差异。MG的大小比较Pearson相关系数为0.61，CESM为0.69，CESM + MG为0.70，MRI为0.79。
本研究表明，单独使用CESM以及CESM与MG联合使用时，在病灶检测方面与MRI准确性相当，但优于MG。与MG相比，致密型乳腺患者从CESM中获益最大，且额外剂量最小。
• CESM在乳腺癌诊断方面具有与MRI相当的诊断性能（ROC-AUC）。• CESM与MG联合使用并不能提高诊断性能。• CESM的敏感性低于MRI，但特异性高于MRI。• 敏感性差异在致密型乳腺中更明显，在非致密型乳腺中不显著。• CESM和MRI显著优于MG，尤其是在致密型乳腺中。
