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Breast Imaging |
1 From the Department of Radiologic Sciences, Hahnemann University Hospital, 246 N Broad St, MS 206, Philadelphia, PA 19102 (L.W.N.); and Department of Radiology, University of Pennsylvania Medical Center, Philadelphia (M.D.S., S.G.O.). From the 1999 RSNA scientific assembly. Received January 25, 2000; revision requested March 3; final revision received August 16; accepted September 19. L.W.N. supported in part by the Susan G. Komen Breast Cancer Foundation. M.D.S. supported in part by National Institutes of Health grants RO1-CA58358 and P41-RR02305 and General Electric Corporation. Address correspondence to L.W.N.
PURPOSE: To (a) validate a breast magnetic resonance (MR) interpretation model, (b) expand the tree-shaped prediction model to increase specificity without decreasing sensitivity, and (c) reevaluate the model’s diagnostic performance.
MATERIALS AND METHODS: Two hundred sixty-two new patients with palpable or mammographic abnormalities underwent MR imaging, and pathologic evaluation was performed. They were entered prospectively into the model, which yielded 454 patients in the construction (training) and validation (test) phases. Predictive values for previously published terminal nodes or branch points of the model were compared between the training and test data sets. Ductal enhancement morphology, regional enhancement micronodularity, regional enhancement degree, and focal mass T2 signal intensity were evaluated for model expansion. Diagnostic performance characteristics of the model were recalculated.
RESULTS: For previously published nodes, absence of a lesion visible at MR imaging, smooth masses, lobulated masses with nonenhancing internal septations, and lobulated masses with minimal or no enhancement had negative predictive values (NPVs) for malignancy similar in both data sets (96% vs 99%, 100% vs 93%, 100% vs 98%, and 100% vs 100%). Irregular masses with internal septations (100% vs 0%) and spiculated masses with no or minimal enhancement (100% vs 50%) did not. Nonseptated enhancing lobulated masses with low T2 signal intensity were added as a benign terminal node (NPV, 100%). Mild regional enhancement (NPV, 92%) was added but not considered a terminal node. Sensitivity, specificity, NPV, positive predictive value, and accuracy of the expanded model were 96%, 80%, 96%, 78%, and 87%, respectively.
CONCLUSION: Additional investigation yielded a slightly modified model, but the diagnostic performance characteristics remain high, similar to those originally published.
Index terms: Breast neoplasms, diagnosis, 00.121411, 00.121412, 00.121415, 00.12143, 00.30 • Breast neoplasms, MR, 00.121411, 00.121412, 00.121415, 00.12143, 00.30 • Computers, diagnostic aid • Magnetic resonance (MR), contrast enhancement, 00.12143, 00.30
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