TY - JOUR
T1 - Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screening
AU - Van Zelst, Jan C.M.
AU - Vreemann, Suzan
AU - Witt, Hans Joerg
AU - Gubern-Merida, Albert
AU - Dorrius, Monique D.
AU - Duvivier, Katya
AU - Lardenoije-Broker, Susanne
AU - Lobbes, Marc B.I.
AU - Loo, Claudette
AU - Veldhuis, Wouter
AU - Veltman, Jeroen
AU - Drieling, Daniel
AU - Karssemeijer, Nico
AU - Mann, Ritse M.
N1 - Funding Information:
This work was supported by the European Union’s Seventh Framework Programme FP7 (grant agreement number 306088) and the Netherlands Organisation for Health Research and Development (grant agreement number 90514524).
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - OBJECTIVES: Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP).MATERIALS AND METHODS: The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions.RESULTS: For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90) versus 0.84 (95% CI, 0.78-0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74-0.79) versus 0.82 (95% CI, 0.79-0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36-0.45) versus 0.45 (95% CI, 0.41-0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82-0.96) versus 0.89 (95% CI, 0.82-0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P < 0.001). Interreader agreement is significantly better for ultrafast breast MRI (κ = 0.730; 95% CI, 0.699-0.761) than for the FDP (κ = 0.665; 95% CI, 0.633-0.696).CONCLUSIONS: Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
AB - OBJECTIVES: Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP).MATERIALS AND METHODS: The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions.RESULTS: For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90) versus 0.84 (95% CI, 0.78-0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74-0.79) versus 0.82 (95% CI, 0.79-0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36-0.45) versus 0.45 (95% CI, 0.41-0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82-0.96) versus 0.89 (95% CI, 0.82-0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P < 0.001). Interreader agreement is significantly better for ultrafast breast MRI (κ = 0.730; 95% CI, 0.699-0.761) than for the FDP (κ = 0.665; 95% CI, 0.633-0.696).CONCLUSIONS: Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
KW - abbreviated breast MRI
KW - breast cancer
KW - breast MRI
KW - multireader, multicase study
KW - screening
KW - ultrafast breast MRI
KW - Breast Neoplasms/diagnostic imaging
KW - Reproducibility of Results
KW - Prospective Studies
KW - Breast/diagnostic imaging
KW - Humans
KW - Middle Aged
KW - Magnetic Resonance Imaging/methods
KW - Time
KW - Early Detection of Cancer/methods
KW - Contrast Media
KW - Sensitivity and Specificity
KW - Adult
KW - Female
KW - ROC Curve
KW - Aged
KW - Image Enhancement/methods
KW - Observer Variation
KW - multicase study
KW - multireader
UR - http://www.scopus.com/inward/record.url?scp=85053389554&partnerID=8YFLogxK
U2 - 10.1097/RLI.0000000000000494
DO - 10.1097/RLI.0000000000000494
M3 - Article
C2 - 29944483
AN - SCOPUS:85053389554
SN - 0020-9996
VL - 53
SP - 579
EP - 586
JO - Investigative Radiology
JF - Investigative Radiology
IS - 10
ER -