Harvard Medical School, Boston, Massachusetts, USA.
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Can Assoc Radiol J. 2019 Aug;70(3):282-291. doi: 10.1016/j.carj.2019.03.005. Epub 2019 Jul 9.
Our purpose was twofold. First, we sought to determine whether 2 orthogonal oriented views of excised breast cancer specimens could improve surgical margin assessment compared to a single unoriented view. Second, we sought to determine whether 3D tomosynthesis could improve surgical margin assessment compared to 2D mammography alone.
Forty-one consecutive specimens were prospectively imaged using 4 protocols: single view unoriented 2D image acquired on a specimen unit (1VSU), 2 orthogonal oriented 2D images acquired on the specimen unit (2VSU), 2 orthogonal oriented 2D images acquired on a mammogram unit (2V2DMU), and 2 orthogonal oriented 3D images acquired on the mammogram unit (2V3DMU). Three breast imagers randomly assessed surgical margin of the 41 specimens with each protocol. Surgical margin per histopathology was considered the gold standard.
The average area under the curve (AUC) was 0.60 for 1VSU, 0.66 for 2VSU, 0.68 for 2V2DMU, and 0.60 for 2V3DMU. Comparing AUCs for 2VSU vs 1VSU by reader showed improved diagnostic accuracy using 2VSU; however, this difference was only statistically significant for reader 3 (0.73 vs 0.63, P = .0455). Comparing AUCs for 2V3DMU vs 2V2DMU by reader showed mixed results, with reader 1 demonstrating increased accuracy (0.72 vs 0.68, P = .5984), while readers 2 and 3 demonstrated decreased accuracy (0.50 vs 0.62, P = .1089 and 0.58 vs 0.75, P = .0269).
2VSU showed improved accuracy in surgical margin prediction compared to 1VSU, although this was not statistically significant for all readers. 3D tomosynthesis did not improve surgical margin assessment.
我们的目的有两个。首先，我们试图确定与单一切面相比，两个正交定向的切除乳腺癌标本视图是否可以改善手术切缘评估。其次，我们试图确定与二维乳腺 X 线摄影相比，三维断层合成是否可以改善手术切缘评估。
连续 41 个标本采用 4 种方案进行前瞻性成像：在标本单位上获取的单一切面非定向二维图像（1VSU）、在标本单位上获取的两个正交定向二维图像（2VSU）、在乳腺摄影单位上获取的两个正交定向二维图像（2V2DMU）和在乳腺摄影单位上获取的两个正交定向三维图像（2V3DMU）。三位乳腺成像者随机使用每种方案评估 41 个标本的手术切缘。根据组织病理学，手术切缘被认为是金标准。
1VSU 的平均曲线下面积（AUC）为 0.60，2VSU 为 0.66，2V2DMU 为 0.68，2V3DMU 为 0.60。通过阅读器比较 2VSU 与 1VSU 的 AUC，使用 2VSU 提高了诊断准确性；然而，只有读者 3 的差异具有统计学意义（0.73 对 0.63，P=0.0455）。通过读者比较 2V3DMU 与 2V2DMU 的 AUC，结果不一，读者 1 显示出更高的准确性（0.72 对 0.68，P=0.5984），而读者 2 和 3 显示出较低的准确性（0.50 对 0.62，P=0.1089 和 0.58 对 0.75，P=0.0269）。
与 1VSU 相比，2VSU 显示出在手术切缘预测方面的准确性提高，尽管并非所有读者的差异均具有统计学意义。三维断层合成术并未改善手术切缘评估。
