Zarcaro Calogero, Santonocito Ambra, Zeitouni Layla, Ferrara Francesca, Kapetas Panagiotis, Milos Ruxandra-Iulia, Helbich Thomas H, Baltzer Pascal A T, Clauser Paola
Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Palermo, Italy.
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Eur Radiol. 2025 May;35(5):2378-2386. doi: 10.1007/s00330-024-11176-7. Epub 2024 Nov 6.
The purpose of this study was to assess the inter-reader agreement of the breast imaging reporting and data system (BI-RADS) contrast-enhanced mammography (CEM) lexicon.
In this IRB-approved, single-center, retrospective study, three breast radiologists, each with different levels of experience, reviewed 462 lesions in 421 routine clinical CEM according to the fifth edition of the BI-RADS lexicon for mammography and to the first version of the BI-RADS lexicon for CEM. Readers were blinded to patient outcomes and evaluated breast and lesion features on low-energy (LE) images (breast density, type of lesion, associated architectural distortion), lesion features on recombined (RC) images (type of enhancement, characteristic of mass enhancement, non-mass enhancement or enhancing asymmetry), and provided a final BI-RADS assessment. The inter-reader agreement was calculated for each evaluated feature using Fleiss' kappa coefficient. Sensitivity and specificity were calculated.
The inter-reader agreement was moderate to substantial for breast density (ĸ = 0.569), type of lesion on LE images (ĸ = 0.654), and type of enhancement (ĸ = 0.664). There was a moderate to substantial agreement on CEM mass enhancement descriptors. The agreement was fair to moderate for non-mass enhancement and enhancing asymmetry descriptors. Inter-reader agreement for LE and LE with RC BI-RADS assessment was moderate (ĸ = 0.421) and fair (ĸ = 0.364). Diagnostic performance was good and comparable for all readers.
Inter-reader agreement of the CEM lexicon was moderate to substantial for most features. There was a low agreement for some RC descriptors, such as non-mass enhancement and enhancing asymmetry, and BI-RADS assessment, but this did not impact the diagnostic performance.
Question Data on the reproducibility and inter-reader agreement for the first version of the BI-RADS lexicon dedicated to CEM are missing. Finding The inter-reader agreement for the lexicon was overall substantial to moderate, but it was lower for the descriptors for non-mass enhancement and enhancing asymmetry. Clinical relevance A common lexicon simplifies communication between specialists in clinical practice. The good inter-reader agreement confirms the effectiveness of the CEM-BIRADS in ensuring consistent communication. Detailed definitions of some descriptors (non-mass, enhancing asymmetry) are needed to ensure higher agreements.
本研究旨在评估乳腺影像报告和数据系统（BI-RADS）对比增强乳腺X线摄影（CEM）词汇表在不同阅片者之间的一致性。
在这项经机构审查委员会（IRB）批准的单中心回顾性研究中，三名经验水平不同的乳腺放射科医生，根据乳腺X线摄影BI-RADS词汇表第五版和CEM的BI-RADS词汇表第一版，对421例常规临床CEM中的462个病灶进行了评估。阅片者对患者的预后情况不知情，并在低能量（LE）图像上评估乳腺和病灶特征（乳腺密度、病灶类型、相关的结构扭曲），在重组（RC）图像上评估病灶特征（强化类型、肿块强化特征、非肿块强化或强化不对称），并给出最终的BI-RADS评估。使用Fleiss卡方系数计算每个评估特征在不同阅片者之间的一致性。计算敏感性和特异性。
对于乳腺密度（κ = 0.569）、LE图像上的病灶类型（κ = 0.654）和强化类型（κ = 0.664），不同阅片者之间的一致性为中等至高度。对于CEM肿块强化描述符存在中等至高度的一致性。对于非肿块强化和强化不对称描述符，一致性为一般至中等。LE以及LE与RC的BI-RADS评估在不同阅片者之间的一致性为中等（κ = 0.421）和一般（κ = 0.364）。所有阅片者的诊断性能良好且相当。
CEM词汇表在大多数特征上，不同阅片者之间的一致性为中等至高度。对于一些RC描述符，如非肿块强化和强化不对称以及BI-RADS评估，一致性较低，但这并未影响诊断性能。
问题 缺少关于专门用于CEM的BI-RADS词汇表第一版再现性和不同阅片者之间一致性的数据。发现 词汇表在不同阅片者之间的一致性总体上为高度至中等，但非肿块强化和强化不对称描述符的一致性较低。临床意义 通用词汇表简化了临床实践中专家之间的沟通。良好的不同阅片者之间的一致性证实了CEM-BIRADS在确保一致沟通方面的有效性。需要对一些描述符（非肿块、强化不对称）进行详细定义以确保更高的一致性。
