Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Clin Imaging. 2020 Oct;66:87-92. doi: 10.1016/j.clinimag.2020.05.012. Epub 2020 May 16.
To compare the characteristics, outcomes, and performance metrics in women undergoing initial breast MRI screening versus subsequent screening.
A retrospective database search identified screening MRIs performed at an academic practice from 2013 to 2015. MRIs were divided into two groups: (1) initial screens and (2) subsequent screens (interpreted with at least one prior MRI for comparison). Benignity was confirmed with pathology or >1-year follow-up. Malignancy was confirmed by pathology. Performance metrics were calculated. Comparisons were made using Binomial and Fisher's exact tests.
We observed a higher rate of abnormal interpretations (52% vs. 19%; p < 0.001) and rate of biopsy (49% vs. 15%; p < 0.001) in the initial versus subsequent screen group. The positive predictive value of biopsy was slightly lower at initial versus subsequent screen (17% vs. 19%, p = 0.99). However, the cancer detection rate was higher at initial than at subsequent screen (85 vs. 29/1000, p = 0.08). Sensitivity was higher at initial (100%) versus subsequent (88%) screen. However, the specificity at initial screen was low (55%) compared to subsequent screen (83%).
The higher rate of abnormal interpretations in the initial versus subsequent screen group in part reflects a prevalence screening. Although we observed more abnormal interpretations in the initial screen, this was likely justified by the significantly higher cancer detection. This evidence may be used to counsel patients and referring providers on the expected higher likelihood of recall from an initial screening MRI balanced with higher detection of malignancies. Findings also highlight the importance of having comparison MRIs to decrease false positives.
比较女性首次行乳腺 MRI 筛查与后续筛查的特征、结果和性能指标。
回顾性数据库检索了 2013 年至 2015 年在一家学术机构进行的筛查性 MRI。将 MRI 分为两组：（1）初始筛查，（2）后续筛查（至少有一次先前的 MRI 进行比较）。良性通过病理或 >1 年的随访确认。恶性通过病理证实。计算性能指标。使用二项式和 Fisher 精确检验进行比较。
我们观察到初始筛查组异常解读率（52%比 19%；p<0.001）和活检率（49%比 15%；p<0.001）均高于后续筛查组。初始筛查与后续筛查的活检阳性预测值略低（17%比 19%，p=0.99）。然而，初始筛查的癌症检出率高于后续筛查（85 比 29/1000，p=0.08）。初始筛查的敏感性高于后续筛查（100%比 88%）。然而，初始筛查的特异性较低（55%比后续筛查 83%）。
初始筛查组异常解读率高于后续筛查组，部分原因是患病率筛查。尽管我们在初始筛查中观察到更多的异常解读，但这可能是由于显著更高的癌症检出率所致。这一证据可以用于向患者和转诊医生解释初始筛查 MRI 更有可能召回，同时平衡更高的恶性肿瘤检出率。这些发现还强调了拥有比较性 MRI 的重要性，以减少假阳性。
