O Brave New World A Look at Identity and Dissonance
O Brave New World A Look at Identity and Dissonance
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DOI：
10.2214/ajr.18.20294
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Britt, Kelly M.
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文献类型：
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作者：
George, Diane F.;Kurchin, Bernice;Britt, Kelly M.
OBJECTIVE.本研究的目的是检验双视图广角数字乳腺断层合成摄影（DBT）是否可以取代全视野数字乳腺X射线摄影（FFDM）用于乳腺癌检测的假设。在一项多阅片人多病例研究中，在间隔超过1个月的两次阅读会话中，独立查看双侧双视图FFDM和双侧双视图广角DBT图像以进行乳腺癌检测。从接受筛查和诊断性乳腺X射线摄影的764例患者中，选择了330例患者病例。研究终点为阅片者的平均ROC AUC/乳房（乳房水平）、ROC AUC/患者（受试者水平）、非癌症回忆率、敏感性和特异性。无论乳腺密度如何，31名阅片人中有29名使用DBT的表现优于FFDM。DBT的阅片者平均诊断准确率在统计学上有显著提高。受试者水平AUC从FFDM的0.765（标准误[SE]，0.027）增加至DBT的0.835（SE，0.027）（p = 0.002）。乳房水平AUC从FFDM的0.818（SE，0.019）增加至DBT的0.861（SE，0.019）（p = 0.011）。DBT组每例患者的非癌症回忆率降低了19%（p < 0.001）。DBT检测到的肿块和结构扭曲更多（p < 0.001）;钙化倾向较低（p = 0.136）。DBT检测浸润性癌的准确性显著更高（p < 0.001）。使用广角双视图DBT（独立于FFDM）进行乳腺癌检测的阅片员性能显著更高，验证了DBT作为单一视图的稳健性。然而，视觉科学中的感知研究的结果支持包括概览图像。
OBJECTIVE. The purpose of this study was to test the hypothesis whether two-view wide-angle digital breast tomosynthesis (DBT) can replace full-field digital mammography (FFDM) for breast cancer detection.SUBJECTS AND METHODS. In a multi reader multicase study, bilateral two-view FFDM and bilateral two-view wide-angle DBT images were independently viewed for breast cancer detection in two reading sessions separated by more than 1 month. From a pool of 764 patients undergoing screening and diagnostic mammography, 330 patient-cases were selected. The endpoints were the mean ROC AUC for the reader per breast (breast level), ROC AUC per patient (subject level), noncancer recall rates, sensitivity, and specificity.RESULTS. Twenty-nine of 31 readers performed better with DBT than FFDM regardless of breast density. There was a statistically significant improvement in readers' mean diagnostic accuracy with DBT. The subject-level AUC increased from 0.765 (standard error [SE], 0.027) for FFDM to 0.835 (SE, 0.027) for DBT (p = 0.002). Breast-level AUC increased from 0.818 (SE, 0.019) for FFDM to 0.861 (SE, 0.019) for DBT (p = 0.011). The noncancer recall rate per patient was reduced by 19% with DBT (p < 0.001). Masses and architectural distortions were detected more with DBT (p < 0.001); calcifications trended lower (p = 0.136). Accuracy for detection of invasive cancers was significantly greater with DBT (p < 0.001).CONCLUSION. Reader performance in breast cancer detection is significantly higher with wide-angle two-view DBT independent of FFDM, verifying the robustness of DBT as a sole view. However, results of perception studies in the vision sciences support the inclusion of an overview image.