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Clinically and Mammographically Occult Breast Lesions on MR Images: Potential Effect of Computerized Assessment on Clinical Reading¹

¹ From the Departments of Radiology (E.E.D., S.H.M., A.P.E.B., K.G.A.G.) and Pathology (J.L.P.), Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. From the 2002 RSNA Annual Meeting. Received September 29, 2003; revision requested December 10; final revision received June 1, 2004; accepted June 18. Supported in part by Dutch Cancer Society grant NKI 99–2035. Address correspondence to K.G.A.G.

View larger version (21K): [in a new window]   Figure 1. Bar graph shows distribution of 72 clinically and mammographically occult lesions among the five rating categories as total number of lesions (white bars) and number of malignant lesions (black bars).

View larger version (42K): [in a new window]   Figure 2. Graph shows effect and weight of covariates in logistic regression analysis. Probability of malignancy of lesions in each of five rating categories, according to results of computerized analysis, is shown on the horizontal axis; probability of lesion malignancy according to results of analysis with the combined model is shown on the vertical axis. Each curve represents a rating category.

View larger version (24K): [in a new window]   Figure 3. ROC curves show performance with clinical reading (dashed-dotted line; Az = 0.86), computerized analysis (dotted line; Az = 0.85), and combined model (solid line; Az = 0.91) in the set of 72 clinically and mammographically occult (52 benign, 20 malignant) lesions. TPF = true-positive fraction, FPF = false-positive fraction.

View larger version (123K): [in a new window]   Figure 4a. Transverse MR images of the right breast of a woman who underwent MR imaging for screening because of an increased lifetime risk. (a) Unenhanced, (b) early contrast-enhanced, (c) wash-in (subtraction), and (d) washout (subtraction) images show incidental enhancing lesion of 12 mm, rated indeterminate by the radiologist. Images at US performed for correlation showed no abnormalities. At follow-up MR imaging, the lesion was no longer visible. The combined model calculated a 9.7% probability of malignancy.

View larger version (123K): [in a new window]   Figure 4b. Transverse MR images of the right breast of a woman who underwent MR imaging for screening because of an increased lifetime risk. (a) Unenhanced, (b) early contrast-enhanced, (c) wash-in (subtraction), and (d) washout (subtraction) images show incidental enhancing lesion of 12 mm, rated indeterminate by the radiologist. Images at US performed for correlation showed no abnormalities. At follow-up MR imaging, the lesion was no longer visible. The combined model calculated a 9.7% probability of malignancy.

View larger version (96K): [in a new window]   Figure 4c. Transverse MR images of the right breast of a woman who underwent MR imaging for screening because of an increased lifetime risk. (a) Unenhanced, (b) early contrast-enhanced, (c) wash-in (subtraction), and (d) washout (subtraction) images show incidental enhancing lesion of 12 mm, rated indeterminate by the radiologist. Images at US performed for correlation showed no abnormalities. At follow-up MR imaging, the lesion was no longer visible. The combined model calculated a 9.7% probability of malignancy.

View larger version (95K): [in a new window]   Figure 4d. Transverse MR images of the right breast of a woman who underwent MR imaging for screening because of an increased lifetime risk. (a) Unenhanced, (b) early contrast-enhanced, (c) wash-in (subtraction), and (d) washout (subtraction) images show incidental enhancing lesion of 12 mm, rated indeterminate by the radiologist. Images at US performed for correlation showed no abnormalities. At follow-up MR imaging, the lesion was no longer visible. The combined model calculated a 9.7% probability of malignancy.