Noh Hee Yeon, Ahn Su Joa, Nam Sang Yu, Jang Young Rock, Chun Yong Soon, Park Heung Kyu, Choi Seung Joon, Choi Hye Young, Kim Jeong Ho
Department of Radiology, Gil Medical Center of Gachon University, Namdong-gu, Incheon, Republic of Korea.
Department of Internal Medicine, Gil Medical Center of Gachon University, Namdong-gu, Incheon, Republic of Korea.
J Med Ultrasound. 2022 Jun 8;30(2):116-124. doi: 10.4103/JMU.JMU_58_21. eCollection 2022 Apr-Jun.
The purpose of this study was to compare the performance between noncontrast-enhanced computed tomography (NECT) plus abdominal ultrasound (US) (NECT + US) with contrast-enhanced computed tomography (CECT) for the detection of hepatic metastasis in breast cancer patient with postsurgical follow-up.
A total of 1470 patients without already diagnosed hepatic metastasis were included. All patients underwent US and multiphase CECT including the NECT. Independent reviewers analyzed images obtained in four settings, namely, abdominal US, NECT, NECT + US, and CECT and recorded liver metastases using a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance), and area under the receiver operating characteristic curve (AUC, diagnostic confidence) were calculated. Interoperator agreement was calculated using the kappa test.
Reference standards revealed no metastases in 1108/1470 patients, and metastasis was detected in 362/1470 patients. Abdominal US ( < 0.01) and NECT ( = 0.01) significantly differed from CECT, but NECT + US did not significantly differ from CECT in terms of sensitivity ( = 0.09), specificity ( = 0.5), and AUC ( = 0.43). After an additional review of abdominal US, readers changed the diagnostic confidence scores of 106 metastatic lesions diagnosed using NECT. Interobserver agreements were good or very good in all four settings. Additional review of abdominal US with NECT allowed a change in the therapeutic plan of 108 patients.
Abdominal US + NECT showed better diagnostic performance for the detection of hepatic metastases than did NECT alone; its diagnostic performance and confidence were similar to those of CECT.
本研究旨在比较非增强计算机断层扫描（NECT）联合腹部超声（US）（NECT + US）与增强计算机断层扫描（CECT）在乳腺癌患者术后随访中检测肝转移的性能。
共纳入1470例未确诊肝转移的患者。所有患者均接受了US和包括NECT在内的多期CECT检查。独立阅片者分析了在四种情况下获得的图像，即腹部US、NECT、NECT + US和CECT，并使用5级诊断置信度量表记录肝转移情况。计算敏感性、特异性（诊断性能）和受试者操作特征曲线下面积（AUC，诊断置信度）。使用kappa检验计算阅片者间一致性。
参考标准显示，1108/1470例患者无转移，362/1470例患者检测到转移。腹部US（<0.01）和NECT（=0.01）与CECT有显著差异，但NECT + US在敏感性（=0.09）、特异性（=0.5）和AUC（=0.43）方面与CECT无显著差异。在对腹部US进行额外复查后，阅片者改变了106个使用NECT诊断的转移病灶的诊断置信度评分。在所有四种情况下，阅片者间一致性良好或非常好。对腹部US与NECT进行额外复查后，108例患者的治疗方案发生了改变。
腹部US + NECT在检测肝转移方面的诊断性能优于单独的NECT；其诊断性能和置信度与CECT相似。
