医学
放射科
乳腺癌
接收机工作特性
诊断试验中的似然比
逻辑回归
腋窝淋巴结
转移
核医学
癌症
内科学
诊断准确性
作者
Pascal Baltzer,Matthias Dietzel,H Burmeister,R Zoubi,Mieczysław Gajda,Oumar Camara,Werner A. Kaiser
出处
期刊:American Journal of Roentgenology
[American Roentgen Ray Society]
日期:2011-05-01
卷期号:196 (5): W641-W647
被引量:114
摘要
The purpose of our study was to clinically test an extended MR mammography (MRM) protocol for combined local staging (T-staging) and locoregional staging (N-staging) of breast cancer within one single examination using a dedicated whole-body scanner.Fifty-six consecutive primary breast cancer patients without prior treatment underwent MRM and surgicopathological N-staging. The MRM protocol (10 minutes; axial T1-weighted gradient-recalled echo; dynamic contrast-enhanced; T2-weighted; turbo spin-echo) was extended to evaluate axillary lymph nodes (90 seconds; coronal T2-weighted HASTE; T1-weighted volumetric breath-hold examination; field of view, both axillae, supraclavicular nodes, and cervical nodes). A dedicated whole-body scanner was used. First, two experienced radiologists independently rated the presence of lymph node metastasis (present or absent, weighted kappa). Second, predefined descriptors were applied by both readers to differentiate lymph node status. These were statistically analyzed using univariate chi-square statistics, sensitivity and specificity, positive likelihood ratio, diagnostic odds ratio (OR), and multivariate statistics (binary logistic-regression, receiver operating characteristics, and chi-squared automatic interaction detection [CHAID] tree).Most significant predictors (p < 0.001) of present metastasis were "irregular margin" (diagnostic OR, 14.0), "inhomogeneous cortex" (diagnostic OR, 8.4), "perifocal edema" (positive likelihood ratio, 100) and "asymmetry" (diagnostic OR, 19.5). CHAID tree identified "asymmetry" and "irregular margin" as significant predictors (adjusted-p < 0.05) for present metastasis (PPV: 100%), whereas absence of "asymmetry" and "homogeneous internal structure" were highly predictive of absent metastasis (negative predictive value, 94.3%). Combination of significant descriptors using binary logistic regression revealed an area under the receiver operating characteristic curve of 0.93 (p < 0.001). Interrater agreement was "almost-perfect" (κ = 0.95).Combined T-staging and locoregional staging (N-staging) was possible within one imaging session using the proposed protocol. Despite a minimal increase in examination time, high diagnostic accuracy and excellent interrater reliability were achieved.
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