Double reading of diffusion-weighted magnetic resonance imaging for breast cancer detection
- 14 January 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Breast Cancer Research and Treatment
- Vol. 180 (1), 111-120
- https://doi.org/10.1007/s10549-019-05519-y
Abstract
Purpose To estimate the performance of diffusion-weighted imaging (DWI) for breast cancer detection. Methods Consecutive breast magnetic resonance imaging examinations performed from January to September 2016 were retrospectively evaluated. Examinations performed before/after neoadjuvant therapy, lacking DWI sequences or reference standard were excluded; breasts after mastectomy were also excluded. Two experienced breast radiologists (R1, R2) independently evaluated only DWI. Final pathology or > 1-year follow-up served as reference standard. Mc Nemar, χ2, and κ statistics were applied. Results Of 1,131 examinations, 672 (59.4%) lacked DWI sequence, 41 (3.6%) had no reference standard, 30 (2.7%) were performed before/after neoadjuvant therapy, and 10 (0.9%) had undergone bilateral mastectomy. Thus, 378 women aged 49 ± 11 years (mean ± standard deviation) were included, 51 (13%) with unilateral mastectomy, totaling 705 breasts. Per-breast cancer prevalence was 96/705 (13.6%). Per-breast sensitivity was 83/96 (87%, 95% confidence interval 78–93%) for both R1 and R2, 89/96 (93%, 86–97%) for double reading (DR) (p = 0.031); per-lesion DR sensitivity for cancers ≤ 10 mm was 22/31 (71%, 52–86%). Per-breast specificity was 562/609 (93%, 90–94%) for R1, 538/609 (88%, 86–91%) for R2, and 526/609 (86%¸ 83–89%) for DR (p < 0.001). Inter-observer agreement was substantial (κ = 0.736). Acquisition time varied from 3:00 to 6:22 min:s. Per-patient median interpretation time was 46 s (R1) and 51 s (R2). Conclusions DR DWI showed a 93% sensitivity and 88% specificity, with 71% sensitivity for cancers ≤ 10 mm, pointing out a potential for DWI as stand-alone screening method.Keywords
This publication has 55 references indexed in Scilit:
- Multicenter Surveillance of Women at High Genetic Breast Cancer Risk Using Mammography, Ultrasonography, and Contrast-Enhanced Magnetic Resonance Imaging (the High Breast Cancer Risk Italian 1 Study)Investigative Radiology, 2011
- Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesionsBMC Cancer, 2010
- Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working groupEuropean Journal Of Cancer, 2010
- Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA TrialJournal of Clinical Oncology, 2010
- A pooled analysis of interval cancer rates in six European countriesEuropean Journal Of Cancer Prevention, 2010
- Breast Cancer Screening With Imaging: Recommendations From the Society of Breast Imaging and the ACR on the Use of Mammography, Breast MRI, Breast Ultrasound, and Other Technologies for the Detection of Clinically Occult Breast CancerJournal of the American College of Radiology, 2010
- Frequency and Severity of Adverse Effects of Iodinated and Gadolinium Contrast Materials: Retrospective Review of 456,930 DosesAmerican Journal of Roentgenology, 2009
- American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to MammographyCA: A Cancer Journal for Clinicians, 2007
- Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer ScreeningNew England Journal of Medicine, 2005