North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.
Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK.
Breast Cancer Res. 2022 Jul 30;24(1):55. doi: 10.1186/s13058-022-01549-5.
Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2).
Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset.
37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84-87%; 1776/2072) and specificity 86% (95%CI 85-86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86-91%) and higher specificity (2957/3298; 90%; 95%CI 89-91%) than Group 2 (sensitivity = 83%; 95%CI 81-85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81-83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68-0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45-0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90-89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88-89%) and Group 2 (83-84%).
Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.
缩短式乳腺磁共振成像（abMRI）正在被引入乳腺筛查试验和临床实践中，特别是用于乳腺致密的女性。扩大 abMRI 的供应需要 mammogram 读者的劳动力来学习有效地解释 abMRI。本研究的目的是检查 mammogram 读者在接受为期一天的标准化小组培训后解读 abMRI 的诊断准确性，并比较具有完整协议乳腺磁共振成像（fpMRI）解释经验的 mammogram 读者（第 1 组）与没有 fpMRI 解释经验的 mammogram 读者（第 2 组）的诊断性能。
从六个 NHS 乳腺筛查计划地点招募 mammogram 读者。提供了小组实践工作站培训，随后对具有已知结果的富集数据集进行了前瞻性、独立、盲法解释。使用简化形式的 abMRI（第一 post-contrast 减去图像（FAST MRI），显示为最大强度投影（MIP）和减去切片堆栈）。进行了每乳房和每病变的诊断准确性分析，并在组间进行了比较，并对连续筛查子集中的双读模拟。
37 名读者（第 1 组：17 名，第 2 组：20 名）完成了 125 次扫描（250 个乳房）（总计 9250 次阅读）的阅读任务。总体敏感性为 86%（95%置信区间（CI）84-87%；1776/2072），特异性为 86%（95%CI 85-86%；6140/7178）。第 1 组的敏感性（843/952；89%；95%CI 86-91%）和特异性（2957/3298；90%；95%CI 89-91%）显著高于第 2 组（敏感性=83%；95%CI 81-85%（933/1120）p < 0.0001；特异性=82%；95%CI 81-83%（3183/3880）p < 0.0001）。第 1 组的读者间一致性更高（kappa = 0.73；95%CI 0.68-0.79），而第 2 组的读者间一致性较低（kappa = 0.51；95%CI 0.45-0.56）。第 2 组的特异性从第 55 例（81%）提高到剩余的 70 例（83%）（p = 0.02），但第 1 组的特异性没有提高（90-89%，p = 0.44），而敏感性对第 1 组（88-89%）和第 2 组（83-84%）均保持一致。
mammogram 读者的为期一天的 abMRI 解释培训达到了为 fpMRI 发布的基准内的整体诊断性能，但对于乳腺磁共振成像新手的 mammogram 读者的诊断准确性还不足以与具有经验的 fpMRI 读者相匹配。新手 MRI 读者的表现随着阅读任务的进行而提高，这表明额外的培训可以进一步缩小这一表现差距。
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