Inter-Reader Agreement Of Diffusion-Weighted Magnetic Resonance Imaging For Breast Cancer Detection: A Multi-Reader Retrospective Study
CANCERS(2021)
摘要
Simple SummaryThe role of magnetic resonance imaging (MRI) in breast cancer has expanded in the last decade, and studies have demonstrated good sensitivity and specificity of diffusion-weighted imaging (DWI), a functional imaging technique reflecting water diffusion properties in tissues. However, clear results about the reproducibility of DWI are still missing. To utilize DWI as a reliable stand-alone technique for breast cancer detection, the inter-reader agreement of the measurement must be assessed. Accordingly, in this study, we assess the inter-reader reproducibility to retrospectively evaluate the agreement of breast cancer detection using DWI as a stand-alone technique. As our results show a good agreement only in expert readers, the assumption that a breast MRI based only on qualitative analysis of DWI, with fewer variables, may be easier for a non-expert reader to learn seems disproved, and future prospective studies should assess the right time for appropriate training for radiologists to investigate the potential role of DWI as a stand-alone method for un-enhanced breast MRI.Purpose: In order to evaluate the use of un-enhanced magnetic resonance imaging (MRI) for detecting breast cancer, we evaluated the accuracy and the agreement of diffusion-weighted imaging (DWI) through the inter-reader reproducibility between expert and non-expert readers. Material and Methods: Consecutive breast MRI performed in a single centre were retrospectively evaluated by four radiologists with different levels of experience. The per-breast standard of reference was the histological diagnosis from needle biopsy or surgical excision, or at least one-year negative follow-up on imaging. The agreement across readers (by inter-reader reproducibility) was examined for each breast examined using Cohen's and Fleiss' kappa (kappa) statistics. The Wald test was used to test the difference in inter-reader agreement between expert and non-expert readers. Results: Of 1131 examinations, according to our inclusion and exclusion criteria, 382 women were included (49.5 +/- 12 years old), 40 of them with unilateral mastectomy, totaling 724 breasts. Overall inter-reader reproducibility was substantial (kappa = 0.74) for expert readers and poor (kappa = 0.37) for non- expert readers. Pairwise agreement between expert readers and non-expert readers was moderate (kappa = 0.60) and showed a statistically superior agreement of the expert readers over the non-expert readers (p = 0.003). Conclusions: DWI showed substantial inter-reader reproducibility among expert-level readers. Pairwise comparison showed superior agreement of the expert readers over the non-expert readers, with the expert readers having higher inter-reader reproducibility than the non-expert readers. These findings open new perspectives for prospective studies investigating the actual role of DWI as a stand-alone method for un-enhanced breast MRI.
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关键词
breast cancer, radiology, diffusion-weighted imaging, oncology, agreement, reproducibility
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