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PURPOSE: To determine the diagnostic value of breast magnetic resonance imaging (MRI) in detecting axillary metastatic node in newly diagnosed breast cancer, we assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of breast MRI. MATERIAL AND METHODS: Data were collected retrospectively from January 2011 to December 2018. Preoperative breast MRI of women with newly diagnosed breast cancer were reviewed to evaluate the axillary nodal staging by using the morphological characteristic of metastatic axillary lymph node. Statistical analysis was performed to assess the performance of breast MRI in diagnosing metastatic axillary lymph nodes based on the pathological result. RESULTS: A total of 131 women with breast cancer were analysed. Two hundred and twenty-seven axillary lymph nodes from preoperative breast MRIs were considered to be metastasis. 65.65% (86 patients) of the breast MRI results matched with the pathological results: 37 patients with N0 stage, 39 patients with N1 stage, eight patients with N2 stage, and two patients with N3 stage. Sensitivity of breast MRI for axillary nodal staging was 98.5% (95% CI: 92-100%), and the negative predictive value was 96.4% (86.2-99.9%). Specificity of breast MRI for axillary nodal staging was 57.8% (44.8-70.1%) and the positive predictive value was 71% (60.6-79.9%). CONCLUSIONS: Our study showed that the breast MRI had a high sensitivity (98.5%) and high NPV (96.4%) in detecting metastatic axillary lymph nodes, but its specificity was only fair (57.8%). Overestimation and underestimation of the MRI in N staging were also found in 20.61% and 12.98% of cases, respectively.
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OBJECTIVE: The purpose of this study was to assess the sensitivities and false-detection rates of two computer-aided detection (CADe) systems when applied to digital or film-screen mammograms in detecting the known breast cancer cases from the Digital Mammographic Imaging Screening Trial (DMIST) breast cancer screening population. MATERIALS AND METHODS: Available film-screen and digital mammograms of 161 breast cancer cases from DMIST were analyzed by two CADe systems, iCAD Second-Look and R2 ImageChecker. Three experienced breast-imaging radiologists reviewed the CADe marks generated for each available cancer case, recording the number and locations of CADe marks and whether each CADe mark location corresponded with the known location of the cancer. RESULTS: For the 161 cancer cases included in this study, the sensitivities of the DMIST reader without CAD were 0.43 (69/161, 95% CI 0.35-0.51) for digital and 0.41 (66/161, 0.33-0.49) for film-screen mammography. The sensitivities of iCAD were 0.74 (119/161, 0.66-0.81) for digital and 0.69 (111/161, 0.61-0.76) for film-screen mammography, both significantly higher than the DMIST study sensitivities (p < 0.0001 for both). The average number of false CADe marks per case of iCAD was 2.57 (SD, 1.92) for digital and 3.06(1.72) for film-screen mammography. The sensitivity of R2 was 0.74 (119/161, 0.66-0.81) for digital, and 0.60 (97/161, 0.52-0.68) for film-screen mammography, both significantly higher than the DMIST study sensitivities (p < 0.0001 for both). The average number of false CADe marks per case of R2 was 2.07 (1.57) for digital and 1.52 (1.45) for film-screen mammography. CONCLUSION: Our results suggest the use of CADe in interpretation of digital and film-screen mammograms could lead to improvements in cancer detection.