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Nipple-sparing mastectomy: external validation of a three-dimensional automated method to predict nipple occult tumour involvement on preoperative breast MRI.
European Radiology Experimental Pub Date : 2019-08-07 , DOI: 10.1186/s41747-019-0108-3
Marta D'Alonzo 1 , Laura Martincich 2 , Agnese Fenoglio 1 , Valentina Giannini 2, 3 , Lisa Cellini 4 , Viola Liberale 1 , Nicoletta Biglia 1
Affiliation  

Background

Preoperative evaluation of nipple-areola complex (NAC) tumour involvement is crucial to select patients candidates for nipple-sparing mastectomy. Our aim was to validate a previously developed automated method able to compute the three-dimensional (3D) tumour-to-NAC distance (the most predictive parameter of nipple involvement), using magnetic resonance imaging (MRI) datasets acquired with a scanner and protocol different from those of the development phase.

Methods

We performed a retrospective analysis of 77 patients submitted to total mastectomy and preoperatively studied with MRI. The new method consisted of automated segmentation of both NAC and tumour and subsequent computation of the 3D distance between them; standard manual two-dimensional segmentation was independently performed. Paraffin-embedded section examination of the removed NAC was performed to identify the neoplastic involvement. The ability of both methods to discriminate between patients with and without NAC involvement was compared using receiver operating characteristic (ROC) analysis.

Results

The 3D tumour-to-NAC distance was correctly computed for 72/77 patients (93.5%); tumour and NAC segmentation method failed in two and three cases, respectively. The diagnostic performance of the 3D automated method at best cut-off values was consistently better than that of the 2D manual method (sensitivity 78.3%, specificity 71.4%, positive predictive value 87.5%, negative predictive value 56.3%, and AUC 0.77 versus 73.9%, 61.2%, 47.2%, 83.3%, and 0.72, respectively), even if the difference did not reach statistical significance (p = 0.431).

Conclusions

The introduction of the 3D automated method in a clinical setting could improve the diagnostic performance in the preoperative assessment of NAC tumour involvement.


中文翻译:

保留乳头的乳房切除术:三维自动化方法的外部验证,以预测术前乳腺MRI上是否存在乳头隐匿性肿瘤。

背景

术前评估乳头-乳晕复合体(NAC)肿瘤的参与对选择保留乳头的乳房切除术的患者至关重要。我们的目的是使用扫描仪和协议采集的磁共振成像(MRI)数据集,验证先前开发的能够计算三维(3D)肿瘤到NAC距离(乳头受累的最具预测性的参数)的自动化方法与开发阶段的不同。

方法

我们对77例行全乳切除术并经MRI术前研究的患者进行了回顾性分析。新方法包括NAC和肿瘤的自动分割以及随后的3D距离计算。标准手动二维分割是独立执行的。对切​​除的NAC进行石蜡包埋切片检查,以发现肿瘤累及。使用接收器工作特征(ROC)分析比较了两种方法区分有NAC和无NAC的患者的能力。

结果

正确计算了72/77名患者(93.5%)的3D肿瘤到NAC的距离;肿瘤和NAC分割方法分别在2例和3例中失败。3D自动化方法在最佳临界值时的诊断性能始终优于2D手动方法(敏感性78.3%,特异性71.4%,阳性预测值87.5%,阴性预测值56.3%,AUC 0.77与73.9)即使差异没有达到统计显着性(p = 0.431),也分别为%,61.2%,47.2%,83.3%和0.72 )。

结论

在临床环境中引入3D自动化方法可以改善NAC肿瘤受累术前评估中的诊断性能。
更新日期:2019-08-07
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