Introduction
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Summarise and compare the ability to detect microcalcifications utilising magnification and zoom.
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Summarise and compare the sensitivity and specificity of diagnosing microcalcifications utilising magnification and zoom in connection with recall due to suspicion of microcalcifications.
Method
Literature search strategy
Study selection
Data extraction and quality assessment
Data synthesis and analysis
Results
Study selection
Characteristics of included studies
Author | Year | Location | No. of readers | Reader experience, years/mean/SD/ range | Apparatus/detector technology | Pixel size/pixel depth | Effective pixel size magnification | Zoom factor | Magnification factor | Target/filter material | Current-time product (mAs) | Tube potential (kVp) | Phantom/simulated composition | Phantom thickness/simulated glandularity | Size of simulated microcalcifications/disks | Outcome measures |
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Alkhalifah et al [36] | 2016 | Kuwait | 5 | 15/NS/NS | GE Senographe DS/indirect CsI scintillator detector | 100 μm | 63 μm | 1.5 | 1.6 | Mo/Mo Mo/Rh Rh/Rh | AEC | Range 26 kVp-32 kVp at intervals of 2 kVp | ACR [45]/ Al2O3 specs, diameter 0.16–0.54 mm | 4.5 cm/ 50% | 0.16–0.54 mm (diameter) | Rank sum scores and mean scores for visibility of microcalcifications |
Egan et al [37] | 2012 | Ireland | NA* | NA* | Philips MDM/Photon counter Hololic Selenia/direct amorphous Selenium detector Ge Seno Essential/indirect CsI scintillator detector | 50 μm 70 μm 100 μm | NA 39 μm 56 μm | A preset zoom NU NU | NA 1.8 1.8 | W/Al W/Rh W/Ag Mo/Mo Mo/Rh Rh/Rh | AEC and manually chosen value to obtain a constant reference pixel value | Range 24 kVp-36 kVp at intervals of 2 kVp | Al square of 0.2-mm thickness embedded in PMMA | 4, 5 and 6 cm/ NS | Al square of 0.2 mm thickness | Normalised PI PI = CNRn/AGD |
Vaheyn et al [38] | 2012 | Australia | 2 | NS/NS/NS | GE Senographe DS/indirect CsI scintillator detector | 100 μm | 56 μm | 1.8 | 1.8 | Rh/Rh | AEC | Zoom: 29 kVp Mag.: 31 kVp | CDMAM [46]/ gold disks, diameters 0.13–2 mm | 5 cm/NS | 0.13–2.00 mm (diameter) | IQF and CDD |
Koutalonis et al [39] | 2010 | UK | NA* | NA* | Monte Carlo model | 50 μm | 50 μm | Range 1.0–2.0, at intervals of 0.1 | Range 1.0–2.0 at intervals of 0.1 | Mo/Mo | AEC | 28 kVp | Monte Carlo model [47]/ CO and HA radii 0.05–0.75 mm | 4 cm / Range 10% -90% at intervals of 10% | 0.05–0.75 mm (diameter) | CNR |
Hermann et al [40] | 2002 | Germany | 3 | NS/NS/NS | GE Senographe DS/indirect CsI scintillator detector | 100 μm | 56 μm | NU | 1.8 | Mo/Mo | 25 mAs 50 mAs 70 mAs 100 mAs 140 mAs | 27 kVp | CDMAM [46]/ gold disks, diameters 0.1–0.5 mm | NS | 0.10–0.50 mm (diameter) | CDD and COR |
Author | Results |
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Alkhalifah et al [36] | The choice of tube potential (kVp) did not have a statistically significant effect on scores for either magnification or zoom. Magnification: Rank sum scores were 32.58, 22.38 and 36.55 for target/filter Mo/Mo, Mo/Rh and Rh/Rh respectively. Zoom: Rank sum scores were 29.10, 39.15 and 23.25 for target/filter Mo/Mo, Mo/Rh and Rh/Rh respectively. Target/filter Mo/Mo and Rh/Rh: Rank sum scores and mean scores are significantly better (p < 0.05) for magnification than for zoom. Target/filter Mo/Rh: Rank sum scores and mean scores are significantly better (p < 0.05) for zoom than for magnification. |
Egan et al [37] | PI was higher for mass detection than detection of microcalcifications when standardised AEC was utilised. Adjusting the exposure factors accordingly increased the normalised PI and the detection of microcalcifications for all three imaging systems. The scanning photon counting system had normalised PI comparable to the conventional magnification imaging systems for detection of microcalcifications when optimised exposure factors were used. These results apply to three breast thicknesses and all three detector technologies in the experiment. |
Vahey et al [38] | Magnification: IQF = 1.28 ± 0.33 Zoom: IQF = 1.91 ± 0.47, p = 0.055 The difference between IQF for magnification and zoom was not statistically significant. CDD: Contrast-detail detection for most disk diameters under or equal to 0.63 mm and all disk diameters under 0.20 mm are statistically significantly better for magnification than for zoom. p values are 0.044, 0.026, 0.035, 0.217, 0.101, 0.018, 0.005 and 0.005 for diameters 0.63 mm, 0.50 mm, 0.40 mm, 0.31 mm, 0.25 mm, 0.20 mm, 0.16 mm and 0.13 mm, respectively. For disk diameters 0.80–2.00 mm the differences are not statistical significant. |
Koutalonis et al [39] | A microcalcification is visible if CNR > 1 CNR increases when magnification/zoom factor increases. CNR increases when the size of the microcalcification increases. CNR decreases when glandularity increases. CNR for magnification > CNR for zoom for all magnification zoom factors, all glandularities and for all sizes of microcalcifications. The relative difference is largest for the smallest microcalcifications and for the highest glandularity. Microcalcifications of radii 0.05 mm or smaller are only visible with magnifications and magnification factors > 1.7 Microcalcifications of radii 0.1 mm are only visible with magnifications and magnification factors > 1.4 or zoom factors > 1.7 Microcalcifications of radii 0.25 mm and larger are visible in both magnification and zoom |
Hermann et al [40] | Contrast-detail detection improves when current-time product (mAs) increases. Correct observation ratio (COR) of simulated microcalcifications of diameters 0.10–0.50 mm improves with increased mAs; COR = 0.55, 0.81, 0.83, 0.90 and 0.95 for 25 mAs, 50 mAs, 70 mAs, 100 mAs and 140 mAs, respectively. |
Author | Year | Location | Study period | No. of readers | Reader experience, years/mean/SD/range | Apparatus/detector technology | Pixel size/pixel depth | Effective pixel size magnification | Magnification factor | Zoom factor | No. of patients/lesions/images | Patient age, years/mean/SD/range | Case characteristics and reference standard | Pre-test probability (%) |
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Fallenberg et al [41] | 2014 | Germany | Jan. 2000–Dec. 2007 | 6 | 8.6/6.2/[1.5–19] | GE Senographe 2000D/indirect CsI scintillator detector | 100 μm/NS | 57 μm | 1.75 | 2.0 | 100/100/NS | 57.3/8.9/[37–76] | Positive cases: 35 malign cases with biopsy as reference standard: 12 invasive carcinomas, 23 DCIS. Negative cases: 65 cases: 11 nodular fibrosis, 16 fibrocystic mastopathy, 1 radial scar, 1 dysplastic hyaline scar, 3 papilloma, 1 fatty tissue, all biopsy proven, and 32 benign with 2-year follow-up as reference standard. | 35.0 |
Moraux-Wallyn et al [42] | 2010 | France | Feb. 2005–Mar. 2007 | 2 | NS/NS/NS | Siemens Mammomat Novation DR/direct amorphous Selenium detector | 70 μm/NS | 39 μm | 1.8 | 1.8 | 82/88/328 | NS/NS/NS | Positive cases: 19 malign cases, including ductal carcinoma, invasive lobular carcinoma and DCIS .10 atypical cases, including atypical lobular or atypical hyperplasia, lobular carcinoma in situ, all with biopsy as reference standard. Negative cases: 59 benign cases, including benign with biopsy as reference standard and benign with two-year follow-up as reference standard. | 33.1 |
Kim et al [43] | 2010 | South Korea | Oct. 2006–Feb. 2008 | 3 | 7.0/4.4/[4–12] | Lorad-Hololic Selenia/direct amorphous Selenium detector | 70 μm/14 bits | 39 μm | 1.8 | 2.0 | 185/185/740 | 49.9/NS/[27–69] | Positive cases: 43 malign cases with biopsy as reference standard. Negative cases: 142 benign cases with biopsy as reference standard. | 23.2 |
Kim et al [44] | 2009 | South Korea | May 2005–Oct. 2006 | 3 | 6.3/4.9/[1–10] | Lorad- Hololic Selenia/direct amorphous Selenium detector | 70 μm/ 12 bits | 39 μm | 1.8 | 1.3 | 111/ 120/ 480 | NS/ NS/ NS | Positive cases: 28 malign cases with biopsy as reference standard. Negative cases: 51 benign cases with biopsy as reference standard, 41 benign cases with at least two-year follow-up as reference standard. | 23.3 |
Zoom | Magnification | |||||||
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Author | TP | FP | FN | TN | TP | FP | FN | TN |
Fallenberg et al [41] | 124 | 164 | 86 | 226 | 178 | 167 | 32 | 223 |
Moraux-Wallyn et al [42] | 53 | 61 | 5 | 46 | 58 | 50 | 0 | 67 |
Kim et al [43] | 119 | 184 | 10 | 242 | 119 | 211 | 10 | 215 |
Kim et al [44] | 73 | 104 | 11 | 172 | 77 | 119 | 7 | 157 |