Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study.

R. M. Warren, D. Thompson, L. J. Pointon, R. J. Hoff, Fiona Jane Gilbert, A. R. Padhani

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose: To evaluate prospectively the accuracy of a lesion classification system designed for use in a magnetic resonance (MR) imaging high-breast-cancer-risk screening study.

Materials and Methods: All participating patients provided written informed consent. Ethics committee approval was obtained. The results of 1541 contrast material-enhanced breast MR imaging examinations were analyzed; 1441 screening examinations were performed in 638 women aged 24 - 51 years at high risk for breast cancer, and 100 examinations were performed in 100 women aged 23 - 81 years. Lesion analysis was performed in 991 breasts, which were divided into design (491 breasts) and testing (500 breasts) sets. The reference standard was histologic analysis of biopsy samples, fine-needle aspiration cytology, or minimal follow- up of 24 months. The scoring system involved the use of five features: morphology (MOR), pattern of enhancement (POE), percentage of maximal focal enhancement (PMFE), maximal signal intensity-time ratio (MITR), and pattern of contrast material washout (POCW). The system was evaluated by means of (a) assessment of interreader agreement, as expressed in kappa statistics, for 315 breasts in which both readers analyzed the same lesion, (b) assessment of the diagnostic accuracy of the scored components with receiver operating characteristic curve analysis, and (c) logistic regression analysis to determine which components of the scoring system were critical to the final score. A new simplified scoring system developed with the design set was applied to the testing set.

Results: There was moderate reader agreement regarding overall lesion outcome (ie, malignant, suspicious, or benign) (kappa = 0.58) and less agreement regarding the scored components. The area under the receiver operating characteristic curve (AUC) for the overall lesion score, 0.88, was higher than the AUC for any one component. The components MOR, POE, and POCW yielded the best overall result. PMFE and MITR did not contribute to diagnostic utility. Applying a simplified scoring system to the testing set yielded a nonsignificantly (P = .2) higher AUC than did applying the original scoring system (sensitivity, 84%; specificity, 86.0%).

Conclusion: Good diagnostic accuracy can be achieved by using simple qualitative descriptors of lesion enhancement, including POCW. In the context of screening, quantitative enhancement parameters appear to be less useful for lesion characterization.

Original languageEnglish
Pages (from-to)677-685
Number of pages8
JournalRadiology
Volume239
Publication statusPublished - 2006

Keywords

  • CONTRAST-ENHANCED MRI
  • GENETIC RISK
  • WOMEN
  • CANCER
  • AGREEMENT
  • PROTOCOL
  • LESIONS
  • BENIGN

Cite this

Warren, R. M., Thompson, D., Pointon, L. J., Hoff, R. J., Gilbert, F. J., & Padhani, A. R. (2006). Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study. Radiology, 239, 677-685.

Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study. / Warren, R. M.; Thompson, D.; Pointon, L. J.; Hoff, R. J.; Gilbert, Fiona Jane; Padhani, A. R.

In: Radiology, Vol. 239, 2006, p. 677-685.

Research output: Contribution to journalArticle

Warren, RM, Thompson, D, Pointon, LJ, Hoff, RJ, Gilbert, FJ & Padhani, AR 2006, 'Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study.', Radiology, vol. 239, pp. 677-685.
Warren RM, Thompson D, Pointon LJ, Hoff RJ, Gilbert FJ, Padhani AR. Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study. Radiology. 2006;239:677-685.
Warren, R. M. ; Thompson, D. ; Pointon, L. J. ; Hoff, R. J. ; Gilbert, Fiona Jane ; Padhani, A. R. / Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study. In: Radiology. 2006 ; Vol. 239. pp. 677-685.
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abstract = "Purpose: To evaluate prospectively the accuracy of a lesion classification system designed for use in a magnetic resonance (MR) imaging high-breast-cancer-risk screening study.Materials and Methods: All participating patients provided written informed consent. Ethics committee approval was obtained. The results of 1541 contrast material-enhanced breast MR imaging examinations were analyzed; 1441 screening examinations were performed in 638 women aged 24 - 51 years at high risk for breast cancer, and 100 examinations were performed in 100 women aged 23 - 81 years. Lesion analysis was performed in 991 breasts, which were divided into design (491 breasts) and testing (500 breasts) sets. The reference standard was histologic analysis of biopsy samples, fine-needle aspiration cytology, or minimal follow- up of 24 months. The scoring system involved the use of five features: morphology (MOR), pattern of enhancement (POE), percentage of maximal focal enhancement (PMFE), maximal signal intensity-time ratio (MITR), and pattern of contrast material washout (POCW). The system was evaluated by means of (a) assessment of interreader agreement, as expressed in kappa statistics, for 315 breasts in which both readers analyzed the same lesion, (b) assessment of the diagnostic accuracy of the scored components with receiver operating characteristic curve analysis, and (c) logistic regression analysis to determine which components of the scoring system were critical to the final score. A new simplified scoring system developed with the design set was applied to the testing set.Results: There was moderate reader agreement regarding overall lesion outcome (ie, malignant, suspicious, or benign) (kappa = 0.58) and less agreement regarding the scored components. The area under the receiver operating characteristic curve (AUC) for the overall lesion score, 0.88, was higher than the AUC for any one component. The components MOR, POE, and POCW yielded the best overall result. PMFE and MITR did not contribute to diagnostic utility. Applying a simplified scoring system to the testing set yielded a nonsignificantly (P = .2) higher AUC than did applying the original scoring system (sensitivity, 84{\%}; specificity, 86.0{\%}).Conclusion: Good diagnostic accuracy can be achieved by using simple qualitative descriptors of lesion enhancement, including POCW. In the context of screening, quantitative enhancement parameters appear to be less useful for lesion characterization.",
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T1 - Evaluation of a prospective scoring system designed for a multicentre breast MR imaging screening study.

AU - Warren, R. M.

AU - Thompson, D.

AU - Pointon, L. J.

AU - Hoff, R. J.

AU - Gilbert, Fiona Jane

AU - Padhani, A. R.

PY - 2006

Y1 - 2006

N2 - Purpose: To evaluate prospectively the accuracy of a lesion classification system designed for use in a magnetic resonance (MR) imaging high-breast-cancer-risk screening study.Materials and Methods: All participating patients provided written informed consent. Ethics committee approval was obtained. The results of 1541 contrast material-enhanced breast MR imaging examinations were analyzed; 1441 screening examinations were performed in 638 women aged 24 - 51 years at high risk for breast cancer, and 100 examinations were performed in 100 women aged 23 - 81 years. Lesion analysis was performed in 991 breasts, which were divided into design (491 breasts) and testing (500 breasts) sets. The reference standard was histologic analysis of biopsy samples, fine-needle aspiration cytology, or minimal follow- up of 24 months. The scoring system involved the use of five features: morphology (MOR), pattern of enhancement (POE), percentage of maximal focal enhancement (PMFE), maximal signal intensity-time ratio (MITR), and pattern of contrast material washout (POCW). The system was evaluated by means of (a) assessment of interreader agreement, as expressed in kappa statistics, for 315 breasts in which both readers analyzed the same lesion, (b) assessment of the diagnostic accuracy of the scored components with receiver operating characteristic curve analysis, and (c) logistic regression analysis to determine which components of the scoring system were critical to the final score. A new simplified scoring system developed with the design set was applied to the testing set.Results: There was moderate reader agreement regarding overall lesion outcome (ie, malignant, suspicious, or benign) (kappa = 0.58) and less agreement regarding the scored components. The area under the receiver operating characteristic curve (AUC) for the overall lesion score, 0.88, was higher than the AUC for any one component. The components MOR, POE, and POCW yielded the best overall result. PMFE and MITR did not contribute to diagnostic utility. Applying a simplified scoring system to the testing set yielded a nonsignificantly (P = .2) higher AUC than did applying the original scoring system (sensitivity, 84%; specificity, 86.0%).Conclusion: Good diagnostic accuracy can be achieved by using simple qualitative descriptors of lesion enhancement, including POCW. In the context of screening, quantitative enhancement parameters appear to be less useful for lesion characterization.

AB - Purpose: To evaluate prospectively the accuracy of a lesion classification system designed for use in a magnetic resonance (MR) imaging high-breast-cancer-risk screening study.Materials and Methods: All participating patients provided written informed consent. Ethics committee approval was obtained. The results of 1541 contrast material-enhanced breast MR imaging examinations were analyzed; 1441 screening examinations were performed in 638 women aged 24 - 51 years at high risk for breast cancer, and 100 examinations were performed in 100 women aged 23 - 81 years. Lesion analysis was performed in 991 breasts, which were divided into design (491 breasts) and testing (500 breasts) sets. The reference standard was histologic analysis of biopsy samples, fine-needle aspiration cytology, or minimal follow- up of 24 months. The scoring system involved the use of five features: morphology (MOR), pattern of enhancement (POE), percentage of maximal focal enhancement (PMFE), maximal signal intensity-time ratio (MITR), and pattern of contrast material washout (POCW). The system was evaluated by means of (a) assessment of interreader agreement, as expressed in kappa statistics, for 315 breasts in which both readers analyzed the same lesion, (b) assessment of the diagnostic accuracy of the scored components with receiver operating characteristic curve analysis, and (c) logistic regression analysis to determine which components of the scoring system were critical to the final score. A new simplified scoring system developed with the design set was applied to the testing set.Results: There was moderate reader agreement regarding overall lesion outcome (ie, malignant, suspicious, or benign) (kappa = 0.58) and less agreement regarding the scored components. The area under the receiver operating characteristic curve (AUC) for the overall lesion score, 0.88, was higher than the AUC for any one component. The components MOR, POE, and POCW yielded the best overall result. PMFE and MITR did not contribute to diagnostic utility. Applying a simplified scoring system to the testing set yielded a nonsignificantly (P = .2) higher AUC than did applying the original scoring system (sensitivity, 84%; specificity, 86.0%).Conclusion: Good diagnostic accuracy can be achieved by using simple qualitative descriptors of lesion enhancement, including POCW. In the context of screening, quantitative enhancement parameters appear to be less useful for lesion characterization.

KW - CONTRAST-ENHANCED MRI

KW - GENETIC RISK

KW - WOMEN

KW - CANCER

KW - AGREEMENT

KW - PROTOCOL

KW - LESIONS

KW - BENIGN

M3 - Article

VL - 239

SP - 677

EP - 685

JO - Radiology

JF - Radiology

SN - 0033-8419

ER -