Singer Adam Daniel, Wong Phil, Umpierrez Monica, Reimer Nickolas, Gonzalez Felix, Reiter David, Cardona Kenneth
Department of Radiology and Imaging Sciences, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA.
Department of Orthopedic Surgery, Emory University Hospital, Atlanta, GA, USA.
Skeletal Radiol. 2020 Dec;49(12):2039-2049. doi: 10.1007/s00256-020-03520-x. Epub 2020 Jun 29.
This study aims to determine the accuracy of a novel ultrasonography (US) scanning and reporting protocol to detect recurrences. The secondary aim is to compare US and MRI accuracy and agreement.
In this IRB-approved prospective study, consecutive patients presenting for MRI surveillance after resection were enrolled and underwent same-day US. Blinded to clinical information and the MRI, the US scanner characterized lesions using a proposed novel lexicon. Outcome was defined either by histology or a subsequent MRI scan confirming the presence or absence of recurrence. Fisher's exact test and Kappa test were performed to assess of the significance and agreement between US, MRI, and outcome.
A total of 68 US scans were performed on 55 patients. The overall accuracy to diagnose recurrence was the same for US and MRI (92.6%) while US was less sensitive (75.0% vs. 91.7%) but more specific (97.6% vs. 92.9%) than MRI. The two lesions missed by US but not MRI were an entirely intraosseous metastasis and a subcentimeter skin nodule. There was strong agreement between US and MRI with outcome (k = 0.787 and 0.801, respectively).
These pilot data suggest the accuracy of this novel US local recurrence surveillance method is comparable to MRI. A multi-institutional prospective trial would increase power and determine reproducibility.
本研究旨在确定一种用于检测复发的新型超声（US）扫描及报告方案的准确性。次要目的是比较超声和磁共振成像（MRI）的准确性及一致性。
在这项经机构审查委员会（IRB）批准的前瞻性研究中，纳入了在切除术后接受MRI监测的连续患者，并在同一天进行了超声检查。超声检查人员在不了解临床信息和MRI结果的情况下，使用一种新提出的术语对病变进行特征描述。结局通过组织学检查或后续MRI扫描来确定是否存在复发。采用Fisher精确检验和Kappa检验来评估超声、MRI与结局之间的显著性和一致性。
共对55例患者进行了68次超声扫描。超声和MRI诊断复发的总体准确率相同（92.6%），但超声的敏感性较低（75.0%对91.7%），而特异性较高（97.6%对92.9%）。超声漏诊但MRI未漏诊的两个病变分别是一个完全位于骨内的转移灶和一个直径小于1厘米的皮肤结节。超声和MRI与结局之间有很强的一致性（kappa值分别为0.787和0.801）。
这些初步数据表明，这种新型超声局部复发监测方法的准确性与MRI相当。多机构前瞻性试验将增强检验效能并确定其可重复性。
