Grubstein Ahuva, Rapson Yael, Gadiel Itai, Cohen Maya
Department of Imaging, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel; affiliated to Sacker School of Medicine, Tel Aviv University.
J Clin Ultrasound. 2017 Jun;45(5):245-251. doi: 10.1002/jcu.22474. Epub 2017 Mar 13.
To assess the reasons for false-negative readings of automated breast ultrasound (ABUS) studies.
Between 2012 and 2015, 1,890 ABUS studies were performed at our tertiary medical center. Those for which false-negative results were documented in the initial ABUS report against the corresponding hand-held ultrasound (HHUS) scan were reviewed by three specialized breast radiologists. Key images of specific lesions were marked on the ABUS and HHUS scans and compared for quality (equal, better with HHUS, better with ABUS). Readers were also asked to identify the reasons for the differences in image quality between the scans: poor visibility, lesion location, or fibroglandular tissue shadowing.
Twenty-two ABUS studies met the study criteria. Two of the three readers found that most lesions were better demonstrated with HHUS. Overall agreement among the readers was moderate (kappa 0.36, SD 0.15, p = 0.002). Highest agreement was found for better image quality for HHUS than ABUS (kappa 0.4, SD 1.3, p = 0.0007). Of the four biopsy-proven carcinomas, three were found by all three readers to be better depicted with HHUS; two were located peripherally and were not seen by ABUS. For all readers, the most common reason for false-negative readings was poor visibility, followed by peripheral lesion location and shadowing obscuring the lesion.
Several factors may make reading ABUS images difficult. Resolution can be diminished by imperfect transducer-breast contact, and fibrotic breasts can cause artifacts such as marked shadowing. Peripheral lesions may be missed because of blind spots. Reader training and experience may play an important role in managing these issues. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:245-251, 2017.
评估自动乳腺超声（ABUS）检查出现假阴性结果的原因。
2012年至2015年期间，在我们的三级医疗中心进行了1890例ABUS检查。对那些在初始ABUS报告中记录为针对相应手持超声（HHUS）扫描的假阴性结果进行了三位专业乳腺放射科医生的复查。在ABUS和HHUS扫描上标记特定病变的关键图像，并比较其质量（相等、HHUS更好、ABUS更好）。还要求阅片者确定扫描之间图像质量差异的原因：能见度差、病变位置或纤维腺组织阴影。
22例ABUS检查符合研究标准。三位阅片者中有两位发现大多数病变在HHUS上显示得更好。阅片者之间的总体一致性为中等（kappa值0.36，标准差0.15，p = 0.002）。发现HHUS图像质量优于ABUS的一致性最高（kappa值0.4，标准差1.3，p = 0.0007）。在经活检证实的4例癌中，三位阅片者均发现其中3例在HHUS上显示得更好；2例位于周边，ABUS未显示。对于所有阅片者，假阴性结果的最常见原因是能见度差，其次是周边病变位置和阴影遮挡病变。
有几个因素可能使ABUS图像的判读变得困难。换能器与乳腺接触不完美会降低分辨率，纤维化乳腺会导致伪像，如明显的阴影。周边病变可能因盲点而漏诊。阅片者的培训和经验可能在处理这些问题中发挥重要作用。©2016威利期刊公司。《临床超声杂志》45:245 - 251，2017年。
