Small lesion classification on abbreviated breast MRI: training can improve diagnostic performance and inter-reader agreement

• Published in: European radiology 2022-08, Vol.32 (8), p.5742-5751
• Main Authors: Liu, Zhuangsheng, Liang, Keming, Zhang, Ling, Lai, Chan, Li, Ruqiong, Yi, Lilei, Li, Ronggang, Long, Wansheng
• Format: Article
• Language: English
• Subjects: Accuracy; Agreements; Breast; Breast cancer; Classification; Diagnostic Radiology; Diagnostic systems; Imaging; Internal Medicine; Interventional Radiology; Lesions; Magnetic resonance imaging; Medical diagnosis; Medicine; Medicine & Public Health; Neuroradiology; Radiology; Training; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-022-08622-9

Objective To determine whether the diagnostic performance and inter-reader agreement for small lesion classification on abbreviated breast MRI (AB-MRI) can be improved by training, and can achieve the level of full diagnostic protocol MRI (FDP-MRI). Methods This retrospective study enrolled 1165 breast lesions (≤ 2 cm; 409 malignant and 756 benign) from 1165 MRI examinations for reading test. Twelve radiologists were assigned into a trained group and a non-trained group. They interpreted each AB-MRI twice, which was extracted from FDP-MRI. After the first read, the trained group received a structured training for AB-MRI interpretation while the non-trained group did not. FDP-MRIs were interpreted by the trained group after the second read. BI-RADS category for each lesion was compared to the standard of reference (histopathological examination or follow-up) to calculate diagnostic accuracy. Inter-reader agreement was assessed using multirater k analysis. Diagnostic accuracy and inter-reader agreement were compared between the trained and non-trained groups, between the first and second reads, and between AB-MRI and FDP-MRI. Results After training, the diagnostic accuracy of AB-MRI increased from 77.6 to 84.4%, and inter-reader agreement improved from 0.410 to 0.579 (both p < 0.001), which were higher than those of the non-trained group (accuracy, 84.4% vs 78.0%; weighted k , 0.579 vs 0.461; both p < 0.001). The post-training accuracy and inter-reader agreement of AB-MRI were lower than those of FDP-MRI (accuracy, 84.4% vs 92.8%; weighted k , 0.579 vs 0.602; both p < 0.001). Conclusions Training can improve the diagnostic performance and inter-reader agreement for small lesion classification on AB-MRI; however, it remains inferior to those of FDP-MRI. Key Points • Training can improve the diagnostic performance for small breast lesions on AB-MRI. • Training can reduce inter-observer variation for breast lesion classification on AB-MRI, especially among junior radiologists. • The post-training diagnostic performance and inter-reader agreement of AB-MRI remained inferior to those of FDP-MRI.