Breast Imaging Division, Medical Imaging Department, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
Tomography. 2023 Nov 6;9(6):2067-2078. doi: 10.3390/tomography9060162.
Our institution is part of a provincial program providing annual breast MRI screenings to high-risk women. We assessed how MRI experience, background parenchymal enhancement (BPE), and the amount of fibroglandular tissue (FGT) affect the biopsy-proven predictive value (PPV3) and accuracy for detecting suspicious MRI findings. From all high-risk screening breast MRIs conducted between 1 July 2011 and 30 June 2020, we reviewed all BI-RADS 4/5 observations with pathological tissue diagnoses. Overall and annual PPV3s were computed. Radiologists with fewer than ten observations were excluded from performance analyses. PPV3s were computed for each radiologist. We assessed how MRI experience, BPE, and FGT impacted diagnostic accuracy using logistic regression analyses, defining positive cases as malignancies alone (definition A) or malignant or high-risk lesions (definition B). There were 536 BI-RADS 4/5 observations with tissue diagnoses, including 77 malignant and 51 high-risk lesions. A total of 516 observations were included in the radiologist performance analyses. The average radiologist's PPV3 was 16 ± 6% (definition A) and 25 ± 8% (definition B). MRI experience in years correlated significantly with positive cases (definition B, OR = 1.05, = 0.03), independent of BPE or FGT. Diagnostic accuracy improved exponentially with increased MRI experience (definition B, OR of 1.27 and 1.61 for 5 and 10 years, respectively, = 0.03 for both). Lower levels of BPE significantly correlated with increased odds of findings being malignant, independent of FGT and MRI experience. More extensive MRI reading experience improves radiologists' diagnostic accuracy for high-risk or malignant lesions, even in MRI studies with increased BPE.
我们机构是为高风险女性提供年度乳房 MRI 筛查的省级项目的一部分。我们评估了 MRI 经验、背景实质增强（BPE）和纤维腺体组织（FGT）的数量如何影响经活检证实的预测值（PPV3）和检测可疑 MRI 结果的准确性。从 2011 年 7 月 1 日至 2020 年 6 月 30 日期间进行的所有高风险筛查乳房 MRI 中，我们回顾了所有 BI-RADS 4/5 观察结果和组织学诊断。计算了总体和年度 PPV3。将 MRI 经验少于 10 次的放射科医生排除在性能分析之外。为每位放射科医生计算了 PPV3。我们使用逻辑回归分析评估了 MRI 经验、BPE 和 FGT 如何影响诊断准确性，将阳性病例定义为仅恶性肿瘤（定义 A）或恶性或高危病变（定义 B）。共有 536 个 BI-RADS 4/5 观察结果和组织学诊断，包括 77 例恶性和 51 例高危病变。共有 516 个观察结果纳入放射科医生性能分析。平均放射科医生的 PPV3 为 16 ± 6%（定义 A）和 25 ± 8%（定义 B）。MRI 经验（以年为单位）与阳性病例显著相关（定义 B，OR = 1.05， = 0.03），与 BPE 或 FGT 无关。随着 MRI 经验的增加，诊断准确性呈指数级提高（定义 B，分别为 5 年和 10 年的 OR 为 1.27 和 1.61， = 0.03）。BPE 水平越低，与发现恶性的几率增加独立相关，与 FGT 和 MRI 经验无关。更广泛的 MRI 阅读经验可提高放射科医生对高危或恶性病变的诊断准确性，即使在 BPE 增加的 MRI 研究中也是如此。
