Shao Zhenzhen, Liu Peifang, Zhang Shuping, Lu Hong
Department of Breast Imaging, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
Gland Surg. 2021 Sep;10(9):2705-2714. doi: 10.21037/gs-21-463.
To compare the diagnostic accuracy of an abbreviated protocol (AP) with or without quantitative apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) and a full diagnostic protocol (FDP) in terms of the Breast Imaging Reporting and Data System (BI-RADS) classification of breast magnetic resonance imaging (MRI).
Our study sample consisted of 436 patients undergoing breast MRI from January to October 2015 in a clinical setting. The three reviews included a pre-contrast and the first single post-contrast T1-weighted (T1W) sequences (AP1), AP1 combined with quantitative DWI (AP2), and the FDP, the AP1 of which were assessed independently by a junior and senior radiologist. Agreement on the evaluation of the BI-RADS classifications (between the junior and senior radiologists, between AP1 and FDP, and between AP2 and FDP) was assessed using the kappa test statistic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared between AP1 and FDP plus between AP2 and FDP. Diagnostic parameters of these reviews were examined using the McNemar test.
The study included 436 patients, with 251 breast cancers, 99 benign lesions, and 86 patients with benign or no lesions and followed up for at least 24 months. The agreement of the BI-RADS classifications between the junior and senior radiologists was very good (kappa =0.847). The agreement between AP2 and FDP (kappa =0.931) was higher than the agreement between AP1 and FDP (kappa =0.872) on evaluating the BI-RADS benign and malignant classifications. The sensitivity/specificity/PPV/NPV was 95.6%/83.8%/88.9%/93.4% for AP1, 98.0%/83.8%/89.1%/96.9% for AP2, 98.8%/83.8%/89.2%/98.1% for FDP, respectively.
The addition of quantitative DWI to the abbreviated MRI protocol based on the pre-and first post-contrast sequence improved diagnostic performance for characterizing breast lesions. Quantitative DWI may be a useful adjunct to dynamic contrast enhancement (DCE) of breast MRI.
根据乳腺影像报告和数据系统（BI-RADS）对乳腺磁共振成像（MRI）进行分类，比较在扩散加权成像（DWI）上使用或不使用定量表观扩散系数（ADC）值的简化方案（AP）与完整诊断方案（FDP）的诊断准确性。
我们的研究样本包括2015年1月至10月在临床环境中接受乳腺MRI检查的436例患者。三次评估包括造影前和首次造影后单次T1加权（T1W）序列（AP1）、AP1结合定量DWI（AP2）以及FDP，其中AP1由一名初级放射科医生和一名高级放射科医生独立评估。使用kappa检验统计量评估BI-RADS分类评估的一致性（初级和高级放射科医生之间、AP1和FDP之间以及AP2和FDP之间）。比较AP1和FDP之间以及AP2和FDP之间的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。使用McNemar检验检查这些评估的诊断参数。
该研究纳入436例患者，其中251例为乳腺癌，99例为良性病变，86例为良性或无病变患者并进行了至少24个月的随访。初级和高级放射科医生之间BI-RADS分类的一致性非常好（kappa =0.847）。在评估BI-RADS良性和恶性分类方面，AP2和FDP之间的一致性（kappa =0.931）高于AP1和FDP之间的一致性（kappa =0.872）。AP1的敏感性/特异性/PPV/NPV分别为95.6%/83.8%/88.9%/93.4%，AP2为98.0%/83.8%/89.1%/96.9%，FDP为98.8%/83.8%/89.2%/98.1%。
在基于造影前和首次造影后序列的简化MRI方案中加入定量DWI可提高乳腺病变特征性诊断性能。定量DWI可能是乳腺MRI动态对比增强（DCE）的有用辅助手段。
