根据乳腺 X 线造影检查结果评估乳腺 US 筛查发现的非肿块病变。

IF 12.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiology Pub Date : 2024-11-01 DOI:10.1148/radiol.240043
Su Min Ha, Woo Jung Choi, Boo Kyung Han, Hak Hee Kim, Woo Kyung Moon, Min-Ji Kim, Kyunga Kim, Heera Yoen, Hee Jeong Kim, Haejung Kim, Ji Soo Choi
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The diagnostic performance of each sonographic feature according to mammographic findings was calculated. A reader study was performed to assess interreader agreement for sonographic features. Results Among 993 NMLs in 993 patients (mean age, 50 years ± 9 [SD]), 914 (92.0%) were benign and 79 (8.0%) were malignant. Mean size was larger for malignant NMLs than for benign NMLs (2.6 cm ± 1.1 vs 1.9 cm ± 0.8; <i>P</i> < .001). In multivariable analysis, associated calcifications (odds ratio [OR], 21.6 [95% CI: 8.0, 58.2]; <i>P</i> < .001), posterior shadowing (OR, 6.9 [95% CI: 2.6, 18.4]; <i>P</i> < .001), segmental distribution (OR, 6.2 [95% CI: 2.7, 14.4]; <i>P</i> < .001), mixed echogenicity (OR, 5.0 [95% CI: 1.8, 14.0]; <i>P</i> < .001), and size (OR, 1.5 [95% CI: 1.1, 2.1]; <i>P</i> = .01) at US were associated with malignancy. Associated calcifications, posterior shadowing, segmental distribution, and mixed echogenicity showed positive predictive values (PPVs) of 44%, 22%, 22.9%, and 16.6%, respectively. Having a negative mammogram was associated with a lower malignancy rate (2.8% vs 28.8%) and lower PPVs for sonographic features (0.7%-10.4% vs 24%-55%) than having a positive mammogram. Interreader agreement for sonographic features was good to excellent (Fleiss κ 95% CI lower bound range, 0.63-0.81). Conclusion Calcifications, posterior shadowing, segmental distribution, and mixed echogenicity associated with NMLs can be considered suspicious features for malignancy at screening US. 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However, knowledge is limited on imaging features of NMLs at screening US. Purpose To identify features of NMLs at screening US that are suspicious for malignancy based on mammographic findings. Materials and Methods This retrospective, multicenter study included asymptomatic women who underwent screening US between January 2012 and December 2019. Eligible women had NMLs at US, concurrent screening mammography, and record of a final diagnosis. Logistic regression analyses were used to identify factors associated with malignancy. The diagnostic performance of each sonographic feature according to mammographic findings was calculated. A reader study was performed to assess interreader agreement for sonographic features. Results Among 993 NMLs in 993 patients (mean age, 50 years ± 9 [SD]), 914 (92.0%) were benign and 79 (8.0%) were malignant. Mean size was larger for malignant NMLs than for benign NMLs (2.6 cm ± 1.1 vs 1.9 cm ± 0.8; <i>P</i> < .001). In multivariable analysis, associated calcifications (odds ratio [OR], 21.6 [95% CI: 8.0, 58.2]; <i>P</i> < .001), posterior shadowing (OR, 6.9 [95% CI: 2.6, 18.4]; <i>P</i> < .001), segmental distribution (OR, 6.2 [95% CI: 2.7, 14.4]; <i>P</i> < .001), mixed echogenicity (OR, 5.0 [95% CI: 1.8, 14.0]; <i>P</i> < .001), and size (OR, 1.5 [95% CI: 1.1, 2.1]; <i>P</i> = .01) at US were associated with malignancy. Associated calcifications, posterior shadowing, segmental distribution, and mixed echogenicity showed positive predictive values (PPVs) of 44%, 22%, 22.9%, and 16.6%, respectively. Having a negative mammogram was associated with a lower malignancy rate (2.8% vs 28.8%) and lower PPVs for sonographic features (0.7%-10.4% vs 24%-55%) than having a positive mammogram. Interreader agreement for sonographic features was good to excellent (Fleiss κ 95% CI lower bound range, 0.63-0.81). 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引用次数: 0

摘要

背景 乳腺非肿块病变(NMLs)可在乳腺超声筛查和诊断中观察到。然而,人们对乳腺非肿块病变的影像学特征了解有限。目的 根据乳腺 X 线造影检查结果,确定在乳腺 X 线造影筛查中疑似恶性肿瘤的 NMLs 特征。材料和方法 这项回顾性多中心研究纳入了在 2012 年 1 月至 2019 年 12 月期间接受 US 筛查的无症状女性。符合条件的女性在接受 US 检查时出现了 NML,同时接受了乳腺放射摄影筛查,并有最终诊断记录。逻辑回归分析用于确定与恶性肿瘤相关的因素。根据乳腺 X 线造影结果计算了每个声像图特征的诊断性能。进行了一项读者研究,以评估读片者之间对声像图特征的一致性。结果 在993名患者(平均年龄为50岁±9 [SD])的993个NML中,914个(92.0%)为良性,79个(8.0%)为恶性。恶性 NML 的平均大小大于良性 NML(2.6 厘米 ± 1.1 对 1.9 厘米 ± 0.8;P < .001)。在多变量分析中,相关钙化(几率比 [OR],21.6 [95% CI: 8.0, 58.2];P < .001)、后部阴影(OR,6.9 [95% CI: 2.6, 18.4];P < .001)、节段分布(OR,6.2[95%CI:2.7,14.4];P < .001)、混合回声(OR,5.0 [95% CI:1.8,14.0];P < .001)和US时的大小(OR,1.5 [95% CI:1.1,2.1];P = .01)与恶性相关。伴发钙化、后方阴影、节段分布和混合回声的阳性预测值(PPV)分别为 44%、22%、22.9% 和 16.6%。与阳性乳房 X 线照片相比,阴性乳房 X 线照片的恶性肿瘤率较低(2.8% vs 28.8%),声像图特征的 PPV 值也较低(0.7%-10.4% vs 24%-55%)。读片者之间的声像图特征一致性良好至极佳(Fleiss κ 95% CI 下限范围,0.63-0.81)。结论 与 NML 相关的钙化、后方阴影、节段分布和混合回声可被视为乳腺超声筛查中恶性肿瘤的可疑特征。由于乳腺造影异常的恶性率和 PPV 不同,因此必须进行综合评估。©RSNA,2024 这篇文章有补充材料。另请参阅本期 Grimm 的社论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessment of Nonmass Lesions Detected with Screening Breast US Based on Mammographic Findings.

Background Breast nonmass lesions (NMLs) are observed at screening and diagnostic US. However, knowledge is limited on imaging features of NMLs at screening US. Purpose To identify features of NMLs at screening US that are suspicious for malignancy based on mammographic findings. Materials and Methods This retrospective, multicenter study included asymptomatic women who underwent screening US between January 2012 and December 2019. Eligible women had NMLs at US, concurrent screening mammography, and record of a final diagnosis. Logistic regression analyses were used to identify factors associated with malignancy. The diagnostic performance of each sonographic feature according to mammographic findings was calculated. A reader study was performed to assess interreader agreement for sonographic features. Results Among 993 NMLs in 993 patients (mean age, 50 years ± 9 [SD]), 914 (92.0%) were benign and 79 (8.0%) were malignant. Mean size was larger for malignant NMLs than for benign NMLs (2.6 cm ± 1.1 vs 1.9 cm ± 0.8; P < .001). In multivariable analysis, associated calcifications (odds ratio [OR], 21.6 [95% CI: 8.0, 58.2]; P < .001), posterior shadowing (OR, 6.9 [95% CI: 2.6, 18.4]; P < .001), segmental distribution (OR, 6.2 [95% CI: 2.7, 14.4]; P < .001), mixed echogenicity (OR, 5.0 [95% CI: 1.8, 14.0]; P < .001), and size (OR, 1.5 [95% CI: 1.1, 2.1]; P = .01) at US were associated with malignancy. Associated calcifications, posterior shadowing, segmental distribution, and mixed echogenicity showed positive predictive values (PPVs) of 44%, 22%, 22.9%, and 16.6%, respectively. Having a negative mammogram was associated with a lower malignancy rate (2.8% vs 28.8%) and lower PPVs for sonographic features (0.7%-10.4% vs 24%-55%) than having a positive mammogram. Interreader agreement for sonographic features was good to excellent (Fleiss κ 95% CI lower bound range, 0.63-0.81). Conclusion Calcifications, posterior shadowing, segmental distribution, and mixed echogenicity associated with NMLs can be considered suspicious features for malignancy at screening US. As malignancy rates and PPVs differ according to mammographic abnormalities, combined assessment is mandatory. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grimm in this issue.

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来源期刊
Radiology
Radiology 医学-核医学
CiteScore
35.20
自引率
3.00%
发文量
596
审稿时长
3.6 months
期刊介绍: Published regularly since 1923 by the Radiological Society of North America (RSNA), Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology. Each month the journal publishes approximately 240 pages of peer-reviewed original research, authoritative reviews, well-balanced commentary on significant articles, and expert opinion on new techniques and technologies. Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health.
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