Mohebbi Alisa, Abdi Ali, Mohammadzadeh Saeed, Mirza-Aghazadeh-Attari Mohammad, Ardakani Ali Abbasian, Mohammadi Afshin
Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Tehran University of Medical Sciences, School of Medicine, Tehran, Iran.
J Med Imaging (Bellingham). 2025 Sep;12(5):051806. doi: 10.1117/1.JMI.12.5.051806. Epub 2025 Jun 18.
Our purpose is to assess the inter-rater agreement between digital mammography (DM) and contrast-enhanced spectral mammography (CESM) in evaluating the Breast Imaging Reporting and Data System (BI-RADS) grading.
This retrospective study included 326 patients recruited between January 2019 and February 2021. The study protocol was pre-registered on the Open Science Framework platform. Two expert radiologists interpreted the CESM and DM findings. Pathological data are used for radiologically suspicious or malignant-appearing lesions, whereas follow-up was considered the gold standard for benign-appearing lesions and breasts without lesions.
For intra-device agreement, both imaging modalities showed "almost perfect" agreement, indicating that different radiologists are expected to report the same BI-RADS score for the same image. Despite showing a similar interpretation, a paired -test showed significantly higher agreement for CESM compared with DM ( ). Subgrouping based on the side or view did not show a considerable difference for both imaging modalities. For inter-device agreement, "almost perfect" agreement was also achieved. However, for proven malignant lesions, an overall higher BI-RADS score was achieved for CESM, whereas for benign or normal breasts, a lower BI-RADS score was reported, indicating a more precise BI-RADS classification for CESM compared with DM.
Our findings demonstrated strong agreement among readers regarding the identification of DM and CESM findings in breast images from various views. Moreover, it indicates that CESM is equally precise compared with DM and can be used as an alternative in clinical centers.
我们的目的是评估数字乳腺摄影（DM）和对比增强光谱乳腺摄影（CESM）在评估乳腺影像报告和数据系统（BI-RADS）分级方面的阅片者间一致性。
这项回顾性研究纳入了2019年1月至2021年2月招募的326例患者。该研究方案已在开放科学框架平台上预先注册。两位专家放射科医生解读了CESM和DM的检查结果。病理数据用于放射学上可疑或表现为恶性的病变，而对于表现为良性的病变和无病变的乳房，随访被视为金标准。
对于设备内一致性，两种成像方式均显示出“几乎完美”的一致性，这表明不同的放射科医生预计会对同一图像报告相同的BI-RADS评分。尽管显示出相似的解读，但配对t检验显示，与DM相比，CESM的一致性显著更高（ ）。基于乳房侧别或投照位进行亚组分析时，两种成像方式均未显示出明显差异。对于设备间一致性，也实现了“几乎完美”的一致性。然而，对于已证实的恶性病变，CESM的BI-RADS评分总体更高，而对于良性或正常乳房，报告的BI-RADS评分更低，这表明与DM相比，CESM的BI-RADS分类更精确。
我们的研究结果表明，在从不同视角识别乳腺图像中的DM和CESM检查结果方面，阅片者之间具有高度一致性。此外，这表明CESM与DM同样精确，可在临床中心用作替代方法。
