Does adding diffuse optical tomography to sonography improve differentiation between benign and malignant breast lesions? Observer performance study.
OBJECTIVE
The purpose of this study was to investigate the added value of diffuse optical tomographic categories combined with conventional sonography for differentiating between benign and malignant breast lesions.


METHODS
In this retrospective database review, we included 145 breast lesions (116 benign and 29 malignant) from 145 women (mean age, 46 years; range, 16-86 years). Five radiologists independently reviewed sonograms with and without a diffuse optical tomographic category. Each lesion was scored on a scale of 0% to 100% for suspicion of malignancy and rated according to the American College of Radiology Breast Imaging Reporting and Data System classification. Diagnostic performance was analyzed by comparing area under receiver operating characteristic curve values. Reader agreement was assessed by intraclass correlation coefficients.


RESULTS
In the multireader multicase receiver operating characteristic analysis, adding a diffuse optical tomographic category to sonography improved the diagnostic accuracy of sonography (mean areas under the curve, 0.923 for sonography alone and 0.969 for sonography with diffuse optical tomography; P = .039). The interobserver correlation was also improved (0.798 for sonography alone and 0.904 for sonography with diffuse optical tomography). The specificity increased for 4 reviewers from a mean of 19.5% to 45.8% (P < .001 for reviewers 1-4; P = .238 for reviewer 5) with no significant change in the sensitivity. When the diffuse optical tomographic category was applied strictly, the specificity increased for all reviewers from a mean of 19.5% to 68.3% (P < .001 for all reviewers) with no significant change in the sensitivity.


CONCLUSIONS
The addition of diffuse optical tomographic categories to sonography may improve diagnostic performance and markedly decrease false-positive biopsy recommendations.
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Bo
B
La Yun
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.). kimsmlms@daum.net.
Sun Mi
SM
Kim
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Mijung
M
Jang
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Hye Shin
HS
Ahn
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Chae Yeon
CY
Lyou
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Mi Sun
MS
Kim
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Sun Ah
SA
Kim
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Tai-Kyong
TK
Song
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Yangmo
Y
Yoo
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Jin Ho
JH
Chang
Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B.L.Y., S.M.K., M.J.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.S.A.); Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (C.Y.L.); CHA Gangnam Health Promotion Center, Seoul, Korea (M.S.K.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.A.K.); Department of Electronic Engineering and Sogang Institute of Advanced Technology, Sogang University, Seoul, Korea (T.-K.S., Y.Y., J.H.C.); and Department of Radiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea (Y.K.).
Youngmi
Y
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D041622:Tomography, Optical / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
breast neoplasms; breast ultrasound; diagnosis; differential diagnosis; optical tomography; receiver operating characteristic curve; sonography