Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis.

R. M. Warren, L. J. Pointon, D. Thompson, R. J. Hoff, Fiona Jane Gilbert, A. R. Padhani, D. Easton, S. R. Lakhani, M. O. Leach, MARIBS Study Grp

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To prospectively determine sensitivity and specificity of breast magnetic resonance (MR) imaging in a screening and symptomatic population by using independent double reading, with histologic or cytologic results or a minimum 18-month follow-up as the standard.

MATERIALS AND METHODS: Informed consent and ethical approval were obtained. Reader performance was analyzed in 44 radiologists at 18 centers from 1541 examinations, including 1441 screening examinations in 638 high-risk women aged 24-51 years (mean, 40.5 years) and 100 examinations in symptomatic women aged 23-81 years (mean, 49.2 years). A screening protocol of dynamic T1-weighted three-dimensional imaging and 0.2 mmol/kg gadolinium-based intravenous contrast agent was used. Logistic and Poisson regressions were used to analyze reader performance in relation to experience. Correlation between readers was determined with K statistics. Sensitivity and specificity were analyzed according to reader, field strength, machine type, and histologic results.

RESULTS: The proportion of studies with lesions analyzed reduced significantly with reader experience (odds ratio, 0.84 per 6 months; P < .001), and number of regions per lesion analyzed also diminished (incidence rate ratio, 0.98 per 6 months; P = .047). The two readers for each study agreed 87% of the time, with a moderately good K statistic of 0.52 (95% confidence interval [CI]: 0.45, 0.58). By taking the reading with the highest score (most likely to be malignant) from each double-read study, sensitivity was 91% (95% CI: 83%, 96%) and specificity was 81% (95% CI: 79%, 83%). Single readings had 7% lower sensitivity (95% CI: 4%, 11%) and 7% higher specificity (95% CI: 6%, 7%). Sensitivity did not differ between MR imager manufacturers or between 1.0- and 1.5-T field strength, but there were significant differences in specificity for machine type (P = .001) and for field strength adjusted for manufacturer (P =.001). Specificity, but not sensitivity, was higher in women younger than 50 years (P = .02).

CONCLUSION: Independent double reading by 44 radiologists blinded to mammography results showed sensitivity and specificity acceptable for screening; sensitivity was higher when two readings were used, at the cost of specificity. Interreader correlation was moderately good, and evidence of learning was seen. Equipment manufacturer, field strength, and age affected specificity but not sensitivity. (c) RSNA, 2005

Original languageEnglish
Pages (from-to)779-788
Number of pages9
JournalRadiology
Volume236 (3)
Publication statusPublished - 2005

Keywords

  • CANCER SUSCEPTIBILITY GENE
  • HIGH-RISK
  • WOMEN
  • MAMMOGRAPHY
  • MULTICENTER
  • CARRIERS
  • SURVEILLANCE
  • LESIONS
  • TRIALS

Cite this

Warren, R. M., Pointon, L. J., Thompson, D., Hoff, R. J., Gilbert, F. J., Padhani, A. R., ... MARIBS Study Grp (2005). Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis. Radiology, 236 (3), 779-788.

Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis. / Warren, R. M.; Pointon, L. J.; Thompson, D.; Hoff, R. J.; Gilbert, Fiona Jane; Padhani, A. R.; Easton, D.; Lakhani, S. R.; Leach, M. O.; MARIBS Study Grp.

In: Radiology, Vol. 236 (3), 2005, p. 779-788.

Research output: Contribution to journalArticle

Warren, RM, Pointon, LJ, Thompson, D, Hoff, RJ, Gilbert, FJ, Padhani, AR, Easton, D, Lakhani, SR, Leach, MO & MARIBS Study Grp 2005, 'Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis.', Radiology, vol. 236 (3), pp. 779-788.
Warren RM, Pointon LJ, Thompson D, Hoff RJ, Gilbert FJ, Padhani AR et al. Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis. Radiology. 2005;236 (3):779-788.
Warren, R. M. ; Pointon, L. J. ; Thompson, D. ; Hoff, R. J. ; Gilbert, Fiona Jane ; Padhani, A. R. ; Easton, D. ; Lakhani, S. R. ; Leach, M. O. ; MARIBS Study Grp. / Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis. In: Radiology. 2005 ; Vol. 236 (3). pp. 779-788.
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abstract = "PURPOSE: To prospectively determine sensitivity and specificity of breast magnetic resonance (MR) imaging in a screening and symptomatic population by using independent double reading, with histologic or cytologic results or a minimum 18-month follow-up as the standard.MATERIALS AND METHODS: Informed consent and ethical approval were obtained. Reader performance was analyzed in 44 radiologists at 18 centers from 1541 examinations, including 1441 screening examinations in 638 high-risk women aged 24-51 years (mean, 40.5 years) and 100 examinations in symptomatic women aged 23-81 years (mean, 49.2 years). A screening protocol of dynamic T1-weighted three-dimensional imaging and 0.2 mmol/kg gadolinium-based intravenous contrast agent was used. Logistic and Poisson regressions were used to analyze reader performance in relation to experience. Correlation between readers was determined with K statistics. Sensitivity and specificity were analyzed according to reader, field strength, machine type, and histologic results.RESULTS: The proportion of studies with lesions analyzed reduced significantly with reader experience (odds ratio, 0.84 per 6 months; P < .001), and number of regions per lesion analyzed also diminished (incidence rate ratio, 0.98 per 6 months; P = .047). The two readers for each study agreed 87{\%} of the time, with a moderately good K statistic of 0.52 (95{\%} confidence interval [CI]: 0.45, 0.58). By taking the reading with the highest score (most likely to be malignant) from each double-read study, sensitivity was 91{\%} (95{\%} CI: 83{\%}, 96{\%}) and specificity was 81{\%} (95{\%} CI: 79{\%}, 83{\%}). Single readings had 7{\%} lower sensitivity (95{\%} CI: 4{\%}, 11{\%}) and 7{\%} higher specificity (95{\%} CI: 6{\%}, 7{\%}). Sensitivity did not differ between MR imager manufacturers or between 1.0- and 1.5-T field strength, but there were significant differences in specificity for machine type (P = .001) and for field strength adjusted for manufacturer (P =.001). Specificity, but not sensitivity, was higher in women younger than 50 years (P = .02).CONCLUSION: Independent double reading by 44 radiologists blinded to mammography results showed sensitivity and specificity acceptable for screening; sensitivity was higher when two readings were used, at the cost of specificity. Interreader correlation was moderately good, and evidence of learning was seen. Equipment manufacturer, field strength, and age affected specificity but not sensitivity. (c) RSNA, 2005",
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TY - JOUR

T1 - Reading protocol for dynamic contrast-enhanced MR images of the breast: sensitivity and specificity analysis.

AU - Warren, R. M.

AU - Pointon, L. J.

AU - Thompson, D.

AU - Hoff, R. J.

AU - Gilbert, Fiona Jane

AU - Padhani, A. R.

AU - Easton, D.

AU - Lakhani, S. R.

AU - Leach, M. O.

AU - MARIBS Study Grp

PY - 2005

Y1 - 2005

N2 - PURPOSE: To prospectively determine sensitivity and specificity of breast magnetic resonance (MR) imaging in a screening and symptomatic population by using independent double reading, with histologic or cytologic results or a minimum 18-month follow-up as the standard.MATERIALS AND METHODS: Informed consent and ethical approval were obtained. Reader performance was analyzed in 44 radiologists at 18 centers from 1541 examinations, including 1441 screening examinations in 638 high-risk women aged 24-51 years (mean, 40.5 years) and 100 examinations in symptomatic women aged 23-81 years (mean, 49.2 years). A screening protocol of dynamic T1-weighted three-dimensional imaging and 0.2 mmol/kg gadolinium-based intravenous contrast agent was used. Logistic and Poisson regressions were used to analyze reader performance in relation to experience. Correlation between readers was determined with K statistics. Sensitivity and specificity were analyzed according to reader, field strength, machine type, and histologic results.RESULTS: The proportion of studies with lesions analyzed reduced significantly with reader experience (odds ratio, 0.84 per 6 months; P < .001), and number of regions per lesion analyzed also diminished (incidence rate ratio, 0.98 per 6 months; P = .047). The two readers for each study agreed 87% of the time, with a moderately good K statistic of 0.52 (95% confidence interval [CI]: 0.45, 0.58). By taking the reading with the highest score (most likely to be malignant) from each double-read study, sensitivity was 91% (95% CI: 83%, 96%) and specificity was 81% (95% CI: 79%, 83%). Single readings had 7% lower sensitivity (95% CI: 4%, 11%) and 7% higher specificity (95% CI: 6%, 7%). Sensitivity did not differ between MR imager manufacturers or between 1.0- and 1.5-T field strength, but there were significant differences in specificity for machine type (P = .001) and for field strength adjusted for manufacturer (P =.001). Specificity, but not sensitivity, was higher in women younger than 50 years (P = .02).CONCLUSION: Independent double reading by 44 radiologists blinded to mammography results showed sensitivity and specificity acceptable for screening; sensitivity was higher when two readings were used, at the cost of specificity. Interreader correlation was moderately good, and evidence of learning was seen. Equipment manufacturer, field strength, and age affected specificity but not sensitivity. (c) RSNA, 2005

AB - PURPOSE: To prospectively determine sensitivity and specificity of breast magnetic resonance (MR) imaging in a screening and symptomatic population by using independent double reading, with histologic or cytologic results or a minimum 18-month follow-up as the standard.MATERIALS AND METHODS: Informed consent and ethical approval were obtained. Reader performance was analyzed in 44 radiologists at 18 centers from 1541 examinations, including 1441 screening examinations in 638 high-risk women aged 24-51 years (mean, 40.5 years) and 100 examinations in symptomatic women aged 23-81 years (mean, 49.2 years). A screening protocol of dynamic T1-weighted three-dimensional imaging and 0.2 mmol/kg gadolinium-based intravenous contrast agent was used. Logistic and Poisson regressions were used to analyze reader performance in relation to experience. Correlation between readers was determined with K statistics. Sensitivity and specificity were analyzed according to reader, field strength, machine type, and histologic results.RESULTS: The proportion of studies with lesions analyzed reduced significantly with reader experience (odds ratio, 0.84 per 6 months; P < .001), and number of regions per lesion analyzed also diminished (incidence rate ratio, 0.98 per 6 months; P = .047). The two readers for each study agreed 87% of the time, with a moderately good K statistic of 0.52 (95% confidence interval [CI]: 0.45, 0.58). By taking the reading with the highest score (most likely to be malignant) from each double-read study, sensitivity was 91% (95% CI: 83%, 96%) and specificity was 81% (95% CI: 79%, 83%). Single readings had 7% lower sensitivity (95% CI: 4%, 11%) and 7% higher specificity (95% CI: 6%, 7%). Sensitivity did not differ between MR imager manufacturers or between 1.0- and 1.5-T field strength, but there were significant differences in specificity for machine type (P = .001) and for field strength adjusted for manufacturer (P =.001). Specificity, but not sensitivity, was higher in women younger than 50 years (P = .02).CONCLUSION: Independent double reading by 44 radiologists blinded to mammography results showed sensitivity and specificity acceptable for screening; sensitivity was higher when two readings were used, at the cost of specificity. Interreader correlation was moderately good, and evidence of learning was seen. Equipment manufacturer, field strength, and age affected specificity but not sensitivity. (c) RSNA, 2005

KW - CANCER SUSCEPTIBILITY GENE

KW - HIGH-RISK

KW - WOMEN

KW - MAMMOGRAPHY

KW - MULTICENTER

KW - CARRIERS

KW - SURVEILLANCE

KW - LESIONS

KW - TRIALS

M3 - Article

VL - 236 (3)

SP - 779

EP - 788

JO - Radiology

JF - Radiology

SN - 0033-8419

ER -