Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
Department of Imaging, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Eur Radiol. 2024 Apr;34(4):2608-2618. doi: 10.1007/s00330-023-10255-5. Epub 2023 Oct 16.
To develop a bimodal nomogram to reduce unnecessary biopsies in breast lesions with discordant ultrasound (US) and mammography (MG) Breast Imaging Reporting and Data System (BI-RADS) assessments.
This retrospective study enrolled 706 women following opportunistic screening or diagnosis with discordant US and MG BI-RADS assessments (where one assessed a lesion as BI-RADS 4 or 5, while the other assessed the same lesion as BI-RADS 0, 2, or 3) from two medical centres between June 2019 and June 2021. Univariable and multivariable logistic regression analyses were used to develop the nomogram. DeLong's and McNemar's tests were used to assess the model's performance.
Age, MG features (margin, shape, and density in masses, suspicious calcifications, and architectural distortion), and US features (margin and shape in masses as well as calcifications) were independent risk factors for breast cancer. The nomogram obtained an area under the curve of 0.87 (95% confidence interval (CI), 0.83-0.91), 0.91 (95% CI, 0.87 - 0.96), and 0.92 (95% CI, 0.86-0.98) in the training, internal validation, and external testing samples, respectively, and demonstrated consistency in calibration curves. Coupling the nomogram with US reduced unnecessary biopsies from 74 to 44% and the missed malignancies rate from 13 to 2%. Similarly, coupling with MG reduced missed malignancies from 20 to 6%, and 63% of patients avoided unnecessary biopsies. Interobserver agreement between US and MG increased from - 0.708 (poor agreement) to 0.700 (substantial agreement) with the nomogram.
When US and MG BI-RADS assessments are discordant, incorporating the nomogram may improve the diagnostic accuracy, avoid unnecessary breast biopsies, and minimise missed diagnoses.
The nomogram developed in this study could be used as a computer program to assist radiologists with detecting breast cancer and ensuring more precise management and improved treatment decisions for breast lesions with discordant assessments in clinical practice.
• Coupling the nomogram with US and mammography improves the detection of breast cancers without the risk of unnecessary biopsy or missed malignancies. • The nomogram increases mammography and US interobserver agreement and enhances the consistency of decision-making. • The nomogram has the potential to be a computer program to assist radiologists in identifying breast cancer and making optimal decisions.
建立一种双模态列线图，以减少超声（US）和乳腺摄影（MG）乳腺成像报告和数据系统（BI-RADS）评估不一致的乳腺病变中不必要的活检。
本回顾性研究纳入了 2019 年 6 月至 2021 年 6 月期间，在两个医疗中心进行机会性筛查或诊断的 706 名 US 和 MG BI-RADS 评估不一致的女性（其中一个评估病变为 BI-RADS 4 或 5，而另一个评估相同病变为 BI-RADS 0、2 或 3）。使用单变量和多变量逻辑回归分析来开发列线图。使用 DeLong 检验和 McNemar 检验评估模型性能。
年龄、MG 特征（肿块的边缘、形状和密度、可疑钙化和结构扭曲）和 US 特征（肿块的边缘和形状以及钙化）是乳腺癌的独立危险因素。该列线图在训练、内部验证和外部测试样本中的曲线下面积分别为 0.87（95%置信区间（CI）：0.83-0.91）、0.91（95%CI：0.87-0.96）和 0.92（95%CI：0.86-0.98），校准曲线具有一致性。将列线图与 US 相结合，将不必要的活检率从 74%降至 44%，将漏诊恶性肿瘤率从 13%降至 2%。同样，将列线图与 MG 相结合，将漏诊的恶性肿瘤率从 20%降至 6%，并使 63%的患者避免了不必要的活检。MG 和 US 的观察者间一致性从-0.708（差）增加到 0.700（中）。
当 US 和 MG BI-RADS 评估不一致时，加入列线图可能会提高诊断准确性，避免不必要的乳腺活检，并最大限度地减少漏诊。
本研究中开发的列线图可作为计算机程序，用于协助放射科医生检测乳腺癌，并确保在临床实践中对评估不一致的乳腺病变进行更精确的管理和改善治疗决策。
将列线图与 US 和 mammography 相结合，可以提高乳腺癌的检出率，同时避免不必要的活检或漏诊恶性肿瘤的风险。
列线图增加了 mammography 和 US 观察者间的一致性，并增强了决策的一致性。
列线图有可能成为一种计算机程序，帮助放射科医生识别乳腺癌并做出最佳决策。
