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.
Similar content being viewed by others
References
Rhodes DJ, Hruska CB, Phillips SW, Whaley DH, O'Connor MK. Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts. Radiology. 2011;258:106–18.
Hruska CB, Phillips SW, Whaley DH, Rhodes DJ, O'Connor MK. Molecular breast imaging: use of a dual-head dedicated gamma camera to detect small breast tumors. AJR Am J Roentgenol. 2008;191:1805–15.
Burnside ES, Sickles EA, Bassett LW, Rubin DL, Lee CH, Ikeda DM, et al. The ACR BI-RADS experience: learning from history. J Am Coll Radiol. 2009;6:851–60.
D'Orsi CJ, Bassett LW, Berg WA, et al. Breast Imaging Reporting and Data System, BI-RADS: mammography. 4th ed. Reston: American College of Radiology; 2003.
Berg WA, D'Orsi CJ, Jackson VP, Bassett LW, Beam CA, Lewis RS, et al. Does training in the Breast Imaging Reporting and Data System (BI-RADS) improve biopsy recommendations or feature analysis agreement with experienced breast imagers at mammography? Radiology. 2002;224:871–80.
Mendelson EB, Baum JK, Berg WA, Merritt CRB, Rubin E. Breast Imaging Reporting and Data System, BI-RADS: ultrasound. 1st ed. Reston: American College of Radiology; 2003.
Ikeda DM, Hylton NM, Kuhl CK, et al. Breast Imaging Reporting and Data System, BI-RADS: magnetic resonance imaging. Reston: American College of Radiology; 2003.
Narayanan D, Madsen KS, Kalinyak JE, Berg WA. Interpretation of positron emission mammography and MRI by experienced breast imaging radiologists: performance and observer reproducibility. AJR Am J Roentgenol. 2011;196:971–81.
Weinmann AL, Hruska CB, O'Connor MK. Design of optimal collimation for dedicated molecular breast imaging systems. Med Phys. 2009;36:845–56.
Boughey JC, O'Connor MK, Hruska CB, Neal L, Jakub JW, Degnim AC, et al. Molecular breast imaging in the preoperative surgical workup of women with biopsy proven breast cancer (abstract). Ann Surg Oncol. 2010;17:S49.
Rhodes DJ, Hruska CB, Tortorelli CL, Maxwell RW, Conners AL, O'Connor MK. Low-dose molecular breast imaging with Tc-99 m sestamibi for screening in women with dense breasts (abstract). J Nucl Med. 2011;52:671.
Crewson PE. Reader agreement studies. AJR Am J Roentgenol. 2005;184:1391–7.
Fleiss JL, Levin BA, Paik MC. Statistical methods for rates and proportions. 3rd ed. Hoboken: Wiley; 2003.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
Berg WA, Campassi C, Langenberg P, Sexton MJ. Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol. 2000;174:1769–77.
Abdullah N, Mesurolle B, El-Khoury M, Kao E. Breast Imaging Reporting and Data System lexicon for US: interobserver agreement for assessment of breast masses. Radiology. 2009;252:665–72.
Lazarus E, Mainiero MB, Schepps B, Koelliker SL, Livingston LS. BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology. 2006;239:385–91.
Lee HJ, Kim EK, Kim MJ, Youk JH, Lee JY, Kang DR, et al. Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound. Eur J Radiol. 2008;65:293–8.
Ikeda DM, Hylton NM, Kinkel K, Hochman MG, Kuhl CK, Kaiser WA, et al. Development, standardization, and testing of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging studies. J Magn Reson Imaging. 2001;13:889–95.
Stoutjesdijk MJ, Futterer JJ, Boetes C, van Die LE, Jager G, Barentsz JO. Variability in the description of morphologic and contrast enhancement characteristics of breast lesions on magnetic resonance imaging. Invest Radiol. 2005;40:355–62.
Baker JA, Kornguth PJ, Floyd Jr CE. Breast Imaging Reporting and Data System standardized mammography lexicon: observer variability in lesion description. AJR Am J Roentgenol. 1996;166:773–8.
Sickles EA. Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 1991;179:463–8.
Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S. Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 2002;179:691–5.
Vizcaino I, Gadea L, Andreo L, Salas D, Ruiz-Perales F, Cuevas D, et al. Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 2001;219:475–83.
Graf O, Helbich TH, Hopf G, Graf C, Sickles EA. Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy? Radiology. 2007;244:87–93.
Mainiero MB, Goldkamp A, Lazarus E, Livingston L, Koelliker SL, Schepps B, et al. Characterization of breast masses with sonography: can biopsy of some solid masses be deferred? J Ultrasound Med. 2005;24:161–7.
Raza S, Chikarmane SA, Neilsen SS, Zorn LM, Birdwell RL. BI-RADS 3, 4, and 5 lesions: value of US in management – follow-up and outcome. Radiology. 2008;248:773–81.
Eby PR, DeMartini WB, Gutierrez RL, Saini MH, Peacock S, Lehman CD. Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 2009;193:861–7.
Liberman L, Morris EA, Benton CL, Abramson AF, Dershaw DD. Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 2003;98:377–88.
Goldsmith SJ, Parsons W, Guiberteau MJ, Stern LH, Lanzkowsky L, Weigert J, et al. SNM practice guideline for breast scintigraphy with breast-specific gamma-cameras 1.0. J Nucl Med Technol. 2010;38:219–24.
Hruska CB, O'Connor MK. Quantitation of malignant and benign breast lesions with dual-head molecular breast imaging (abstract). Radiological Society of North America (RSNA) Annual Meeting. Chicago, IL; December 3, 2010.
Hruska CB, O'Connor MK. Quantification of lesion size, depth, and uptake using a dual-head molecular breast imaging system. Med Phys. 2008;35:1365–76.
Gur D, Bandos AI, Cohen CS, Hakim CM, Hardesty LA, Ganott MA, et al. The "laboratory" effect: comparing radiologists' performance and variability during prospective clinical and laboratory mammography interpretations. Radiology. 2008;249:47–53.
Rutter CM, Taplin S. Assessing mammographers' accuracy. A comparison of clinical and test performance. J Clin Epidemiol. 2000;53:443–50.
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
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-011-2054-z