Stanford School of Medicine, Center for Academic Medicine, Radiology + MC: 5659, 453 Quarry Road, Palo Alto, CA 94304, United States.
Texas A&M College of Medicine, Round Rock, TX, 78665, United States.
Eur J Radiol. 2021 Dec;145:110029. doi: 10.1016/j.ejrad.2021.110029. Epub 2021 Nov 13.
To assess the impact of adjunctive ultrasound guided diffuse optical tomography (US-guided DOT) on BI-RADS assessment in women undergoing US-guided breast biopsy.
This prospective study enrolled women referred for US-guided breast biopsy between 3/5/2019 and 3/19/2020. Participants underwent US-guided DOT immediately before biopsy. The US-guided DOT acquisition generated average maximum total hemoglobin (HbT) spatial maps and quantitative HbT values. Four radiologists blinded to histopathology assessed conventional imaging (CI) to assign a CI BI-RADS assessment and then integrated DOT information in assigning a CI&DOT BI-RADS assessment. HbT was compared between benign and malignant lesions using an ANOVA test and Tukey's test. Benign biopsies were tabulated, deeming BI-RADS ≥ 4A as positive. Reader agreement was assessed.
Among 61 included women (mean age 48 years), biopsy demonstrated 15 (24.6%) malignant and 46 (75.4%) benign lesions. Mean HbT was 55.3 ± 22.6 µM in benign lesions versus 85.4 ± 15.6 µM in cancers (p < .001). HbT threshold of 78.5 µM achieved sensitivity 80% (12/15) and specificity 89% (41/46) for malignancy. Across readers and patients, 197 pairs of CI BI-RADS and CI&DOT BI-RADS assessments were assigned. Adjunctive US-guided DOT achieved a net decrease in 23.5% (31/132) of suspicious (CI BI-RADS ≥ 4A) assessments of benign lesions (34 correct downgrades and 3 incorrect upgrades). 38.3% (31/81) of 4A assessments were appropriately downgraded. No cancer was downgraded to a non-actionable assessment. Interreader agreement analysis demonstrated kappa = 0.48-0.53 for CI BI-RADS and kappa = 0.28-0.44 for CI&DOT BI-RADS.
Integration of US-guided DOT information achieved a 23.5% reduction in suspicious BI-RADS assessments for benign lesions. Larger studies are warranted, with attention to improved reader agreement.
评估在接受超声引导下乳腺活检的女性中，辅助超声引导漫射光学断层扫描（US-guided DOT）对 BI-RADS 评估的影响。
本前瞻性研究纳入了 2019 年 3 月 5 日至 2020 年 3 月 19 日期间因超声引导下乳腺活检而就诊的女性。参与者在活检前接受 US-guided DOT 检查。US-guided DOT 采集生成平均最大总血红蛋白（HbT）空间图谱和定量 HbT 值。四位放射科医师对常规影像学（CI）进行盲法评估，以分配 CI BI-RADS 评估，然后整合 DOT 信息以分配 CI&DOT BI-RADS 评估。使用方差分析和 Tukey 检验比较良性和恶性病变之间的 HbT。良性活检被制表，将 BI-RADS≥4A 视为阳性。评估读者间的一致性。
在 61 名纳入的女性（平均年龄 48 岁）中，活检显示 15 例（24.6%）为恶性病变，46 例（75.4%）为良性病变。良性病变的平均 HbT 为 55.3±22.6µM，恶性病变的平均 HbT 为 85.4±15.6µM（p<0.001）。HbT 阈值为 78.5µM 时，恶性病变的敏感性为 80%（12/15），特异性为 89%（41/46）。在读者和患者中，197 对 CI BI-RADS 和 CI&DOT BI-RADS 评估被分配。辅助 US-guided DOT 实现了可疑（CI BI-RADS≥4A）良性病变评估的 23.5%（31/132）的净降低（34 例正确降级和 3 例错误升级）。4A 评估中有 38.3%（31/81）被适当降级。没有癌症被降级为非操作性评估。读者间一致性分析显示，CI BI-RADS 的 Kappa 值为 0.48-0.53，CI&DOT BI-RADS 的 Kappa 值为 0.28-0.44。
整合 US-guided DOT 信息可使良性病变的可疑 BI-RADS 评估减少 23.5%。需要进行更大规模的研究，并注意提高读者间的一致性。
