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Lexicon for standardized interpretation of gamma camera molecular breast imaging: observer agreement and diagnostic accuracy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine interobserver agreement and diagnostic accuracy using a lexicon for standardized interpretation of molecular breast imaging (MBI) studies by breast radiologists.

Methods

An MBI lexicon was developed, including descriptors of lesion type, background uptake, and associated findings by a consensus of experts. In an institutional review board-exempted protocol, six breast imaging radiologist observers without prior MBI experience attended a 2-h MBI interpretation training session, including definitions of lexicon terminology, case examples, and ten unknown cases with expert feedback. Following training, each radiologist observer interpreted an independent set of MBI images of 50 breasts, including 20 (40%) with malignancies with a median invasive tumor size of 1.7 cm (range 1.0 to 6.3 cm). The findings were described using the lexicon and each breast was given a final assessment of 1 to 5, paralleling BI-RADS assessment categories. Sensitivity, specificity, positive and negative predictive values were determined with core or surgical pathology results or 1-year imaging follow-up as the reference standard. Interobserver agreement for lesion-type classification, lesion and background uptake intensity, and final assessments were determined using Cohen’s kappa.

Results

For the six observers, median sensitivity was 1.0 (range 0.90–1.0), specificity 0.88 (range 0.83–0.97), and AUC 0.94 (range 0.93–0.98). Fair interobserver agreement was shown for background uptake (κ = 0.31). Agreement was substantial for lesion type (κ = 0.79) and non-mass distribution (κ = 0.63), and near-perfect for final assessment (κ = 0.84).

Conclusion

Dedicated breast imaging radiologists, newly trained to interpret MBI with the proposed lexicon, achieved high agreement and diagnostic accuracy.

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Acknowledgments

We gratefully acknowledge Drs. Darcy Adamczyk, Kathy Brandt, Tara Henrichsen, Gina Hesley, Katie Jones, and Marilyn Morton for participating as the radiologist observers in this study. Both Gamma Medica-Ideas and GE supplied the equipment used to acquire the images shown.

Conflicts of interest

Dr. Hruska discloses a potential financial interest associated with technologies described in this article due to licensing arrangements between Mayo Clinic and Gamma Medica-Ideas. Dr. Berg is a consultant to Naviscan, Inc., has prepared educational materials for Gamma Medica-Ideas, is on the Medical Advisory Board of Philips, and has received travel support and been compensated for case review and manuscript preparation by SuperSonic Imagine.

The remaining authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA

    Amy Lynn Conners, Carrie B. Hruska, Cindy L. Tortorelli & Robert W. Maxwell

  2. Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Deborah J. Rhodes

  3. Department of General Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Judy C. Boughey

  4. Department of Radiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Wendie A. Berg

Authors
  1. Amy Lynn Conners
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  2. Carrie B. Hruska
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  3. Cindy L. Tortorelli
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  4. Robert W. Maxwell
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  5. Deborah J. Rhodes
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  6. Judy C. Boughey
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  7. Wendie A. Berg
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Correspondence to Amy Lynn Conners.

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Conners, A.L., Hruska, C.B., Tortorelli, C.L. et al. Lexicon for standardized interpretation of gamma camera molecular breast imaging: observer agreement and diagnostic accuracy. Eur J Nucl Med Mol Imaging 39, 971–982 (2012). https://doi.org/10.1007/s00259-011-2054-z

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  • DOI: https://doi.org/10.1007/s00259-011-2054-z

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