Weaver Olena O, Contreras Alejandro, Cohen Ethan O, Guirguis Mary S, Kapoor Megha M, Scoggins Marion E, Hwang Rosa F, Candelaria Rosalind P, Yang Wei T, Dennison Jennifer B, Sun Jia, Whitman Gary J
Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, United States.
Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, United States.
Curr Probl Diagn Radiol. 2025 Apr 17. doi: 10.1067/j.cpradiol.2025.04.005.
To evaluate combined digital breast tomosynthesis and contrast-enhanced mammography (DBT/CEM) for predicting pectoralis muscle invasion.
This retrospective multi-reader cohort study included research patients who underwent combined DBT/CEM for breast cancer staging and had prepectoral masses. Images were independently reviewed by six fellowship-trained breast radiologists. Diagnostic performance, reader confidence, and inter-reader agreement were calculated for each image type/modality.
Among 10 patients with prepectoral masses on DBT/CEM, muscle invasion was present in 3 and absent in 7. The overall diagnostic accuracy of DBT/CEM for PMI was 0.6 (range 0.4-0.9); for predefined radiologic signs it was 0.5-0.7 for low energy (LE) CEM, 0.4-0.7 for DBT, and 0.4-0.8 for recombined (RC) CEM. Muscle deformity on MLO views had the highest accuracy (0.7-0.8). On a scale of 1-3, mean radiologist confidence for combined DBT/CEM was 1.9 (1.5-2.3; SD=0.65). Median confidence ranged from 1.9 for RC to 2.2 for DBT. Per-case reader agreement was poor (K=-0.01) for DBT/CEM; poor to slight (K= -0.13-0.40, median 0.28) for RC; slight to fair (K = 0.04-0.43, median 0.27 and K = 0.02-0.42, median 0.19, respectively) for DBT and LE. In two patients with subpectoral breast implants CEM was accurate in PMI detection, while MRI had one false-positive result.
Combined DBT/CEM accuracy and inter-reader agreement are suboptimal for PMI evaluation, except in patients with breast implants. RC images marginally improve accuracy compared to LE images but have lowest radiologist confidence. DBT has lowest accuracy but highest confidence. Muscle deformity on MLO view was the most accurate sign.
Combined DBT/CEM demonstrated suboptimal diagnostic accuracy, reader confidence, and inter-reader agreement for detecting pectoralis muscle invasion (PMI) in prepectoral breast cancer (BC) except for patients with subpectoral breast implants, where recombined images on implant-displaced CEM views performed better than MRI.
评估数字化乳腺断层合成与对比增强乳腺摄影（DBT/CEM）联合应用对预测胸肌侵犯的价值。
这项回顾性多阅片者队列研究纳入了因乳腺癌分期而行DBT/CEM联合检查且有胸肌前肿块的研究患者。图像由6名经过乳腺放射学专科培训的放射科医生独立阅片。计算每种图像类型/模式的诊断性能、阅片者信心及阅片者间一致性。
在10例DBT/CEM检查发现有胸肌前肿块的患者中，3例存在肌肉侵犯，7例无肌肉侵犯。DBT/CEM对胸肌侵犯（PMI）的总体诊断准确性为0.6（范围0.4 - 0.9）；对于预定义的放射学征象，低能量（LE）CEM为0.5 - 0.7，DBT为0.4 - 0.7，重组（RC）CEM为0.4 - 0.8。MLO位片上的肌肉变形准确性最高（0.7 - 0.8）。在1 - 3分的量表上，放射科医生对DBT/CEM联合检查的平均信心评分为1.9（1.5 - 2.3；标准差 = 0.65）。中位信心评分范围从RC的1.9到DBT的2.2。DBT/CEM的病例间阅片者一致性较差（K = -0.01）；RC的一致性为差到轻度（K = -0.13 - 0.40，中位数0.28）；DBT和LE的一致性为轻度到中度（K分别为0.04 - 0.43，中位数0.27和K = 0.02 - 0.42，中位数0.19）。在2例胸肌下有乳房植入物的患者中，CEM对PMI的检测准确，而MRI有1例假阳性结果。
DBT/CEM联合检查在PMI评估方面的准确性和阅片者间一致性欠佳，乳房植入物患者除外。与LE图像相比RC图像准确性略有提高，但放射科医生信心最低。DBT准确性最低但信心最高。MLO位片上的肌肉变形是最准确的征象。
DBT/CEM联合检查在检测胸肌前乳腺癌（BC）的胸肌侵犯（PMI）方面，诊断准确性、阅片者信心及阅片者间一致性欠佳，胸肌下有乳房植入物的患者除外，在此类患者中，植入物移位CEM视图上的重组图像表现优于MRI。
