Comparions of the Diagnostic Value between Digital Breast Tomosynthesis and Full-field Digital Mammography
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摘要:
目的 研究数字乳腺断层摄影 (digital breast tomosynthesis,DBT)对于乳腺病变诊断的效能。 方法 选取2017年9月至2019年9月在昆明市延安医院就诊的乳腺疾病患者151例,患者全部进行CC位及MLO位DBT和全数字化乳腺摄影(Full-field Digital Mammography,FFDM) 拍摄。 结果 DBT诊断乳腺良、恶性病变的特异性、敏感性、阳性预测值、阴性预测值和准确性均明显高于FFDM,而敏感性、阳性预测值、阴性预测值和准确性稍低于FFDM+DBT,差异有统计学意义(P﹤0.05);对于肿块病灶,DBT诊断乳腺病变的特异性、敏感性、阳性预测值、阴性预测值和准确性均高于单独FFDM,差异有统计学意义(P﹤0.05),DBT与DBT+FFDM诊断效能相当;对于致密型腺体内病灶,DBT诊断乳腺病变的特异性、敏感性、阳性预测值、阴性预测值和准确性均明显高于单独FFDM,差异有统计学意义(P﹤0.05),DBT诊断乳腺病变的敏感性、阳性预测值、阴性预测值和准确性低于DBT+FFDM,差异有统计学意义(P﹤0.05)。 结论 对比单独FFDM,DBT+FFDM及单独DBT均明显提高了乳腺疾病诊断的准确性,尤其对于致密型乳腺;FFDM+DBT较DBT略有优势。 Abstract:Objective To investigate the diagnosistic efficiency of digital breast tomosynthesis (DBT) in breast diseases. Methods 151 women with a clinically suspicious breast disease during Sept. 2017 to Sept. 2019 were enrolled into the study and all of them received full-field digital mammography (FFDM) and DBT examinations in Yan'an Hospital of Kunming. Results The specificity, sensitivity, positive predictive value, negative predictive value and accuracy of DBT in diagnosing benign and malignant breast lesions were significantly higher than those of FFDM, while the sensitivity, positive predictive value, negative predictive value and accuracy were slightly lower than those of FFDM + DBT (P < 0.05); The specificity, sensitivity, positive predictive value, negative predictive value and accuracy of DBT in diagnosing breast lesions were higher than those of FFDM alone ( P < 0.05). The diagnostic efficacy of DBT and DBT + FFDM was comparable; For dense intraglandular lesions, the specificity, sensitivity, positive predictive value, negative predictive value and accuracy of DBT in diagnosing breast lesions were significantly higher than those of FFDM alone ( P < 0.05). The sensitivity, positive predictive value, negative predictive value and accuracy of DBT in diagnosing breast lesions were lower than those of DBT + FFDM ( P < 0.05) Conclusion As compared with FFDM, DBT + FFDM and DBT significantly can improve the accuracy of breast disease diagnosis, especially for dense breast; FFDM + DBT has some advantages over DBT. -
Key words:
- Digital breast tomosynthesis /
- Full-field digital mammography /
- Breast diseas /
- Sensitivity /
- Specificit
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表 1 3种方法对乳腺病变的诊断效能(%)
Table 1. Diagnostic efficacy of three methods for breast lesions(%)
诊断方法 良性(n) 恶性(n) χ2 P 敏感性 特异性 阳性预测值 阴性预测值 准确性 病理 72 79 FFDM 78 73 50.56 < 0.05 75.95 81.94 82.19 75.64 78.81 DBT 70 81 100.11 < 0.05 92.41 88.89 90.12 91.43 90.73 FFDM+DBT 68 83 106.93 < 0.05 94.94 88.89 90.36 94.12 92.05 表 2 3种方法对乳腺肿块病灶的诊断效能 (%)
Table 2. Diagnostic efficacy of three methods for breast masses(%)
诊断方法 良性(n) 恶性(n) χ2 P 敏感性 特异性 阳性预测值 阴性预测值 准确性 病理 58 62 FFDM 59 61 56.02 < 0.05 83.87 84.48 85.25 84.48 84.17 DBT 55 65 93.80 < 0.05 96.77 91.38 92.31 91.38 94.17 FFDM+DBT 55 65 93.80 < 0.05 96.77 91.38 92.31 91.38 94.17 表 3 3种方法对致密型腺体内病灶的诊断效能 (%)
Table 3. Diagnostic efficacy of three methods for lesions in dense glands(%)
诊断方法 良性(n) 恶性(n) χ2 P 敏感性 特异性 阳性预测值 阴性预测值 准确性 病理 59 43 FFDM 67 35 26.75 < 0.05 62.79 86.44 77.14 76.12 76.47 DBT 59 43 58.73 < 0.05 86.05 89.83 86.05 89.83 88.24 FFDM+DBT 57 45 65.42 < 0.05 90.69 89.83 86.67 92.98 90.19 -
[1] 朱陈,王乐,杜灵彬,等. 乳腺X线摄影技术应用于人群筛查准确性的Meta分析[J]. 中华流行病学杂志,2016,37(9):1296-1305. doi: 10.3760/cma.j.issn.0254-6450.2016.09.022 [2] 刘媛,归奕飞. 致密型乳腺影像学筛查技术及进展[J]. 实用放射学杂志,2017,33(1):138-140,164. doi: 10.3969/j.issn.1002-1671.2017.01.037 [3] 沈茜刚,顾雅佳,郑晓静,等. 数字乳腺断层摄影技术的辐射剂量分析[J]. 肿瘤影像学,2019,28(1):21-26. doi: 10.3969/j.issn.1008-617X.2019.01.005 [4] Mercado C L. BI-RADS update[J]. Radiol Clin North Am,2014,52(3):481-487. doi: 10.1016/j.rcl.2014.02.008 [5] 苏瑛,单海琳,夏锴,等. 数字乳腺断层融合X线成像技术对早期乳腺癌的诊断价值[J]. 癌症进展,2017,15(11):1290-1292. [6] 汤伟,杨孟,高毅,等. 数字乳腺断层融合X线摄影术前评估乳腺癌肿块大小的效能对比研究[J]. 中国癌症杂志,2018,28(11):813-818. [7] Wu T,Moore R H,Kopans D B. Voting strategy for artifact reduction in digital breast tomosynthesis[J]. Medical Physics,2006,33(7):2461-2471. [8] 金全官,齐欣,王可人,等. 非特殊型浸润性乳腺癌组织学分级与数字乳腺三维断层摄影征象之间的关系[J]. 中国实验诊断学,2019,23(1):67-70. doi: 10.3969/j.issn.1007-4287.2019.01.026 [9] 李弋,叶兆祥. 数字乳腺断层摄影诊断乳腺癌现状[J]. 国际医学放射学杂志,2010,33(2):114-117. doi: 10.3784/j.issn.1674-1897.2010.02.Z0204 [10] 黄美铃,蔡思清,颜建湘,等. 乳腺X线摄影及彩超对结构扭曲病变的诊断效能比较[J]. 分子影像学杂志,2020,43(1):117-121. doi: 10.12122/j.issn.1674-4500.2020.01.24 [11] 金雅. DBT与FFDM对乳腺结构扭曲病变的诊断对比分析[J]. 现代医用影像学,2019,28(11):2379-2383. doi: 10.3969/j.issn.1006-7035.2019.11.008 [12] 张潇潇,赵耀,鞠然,等. 全数字化乳腺钼靶X线摄影对小乳癌的诊断价值分析[J]. 中国数字医学,2016,11(11):37-39, 94. [13] 范文文,宋俊峰,周纯武. 探讨数字乳腺三维断层摄影技术新特点[J]. 中国临床医生杂志,2015,43(6):11-14. doi: 10.3969/j.issn.2095-8552.2015.06.006 [14] 叶兆祥,李弋. 数字乳腺断层摄影应用现状及展望[J]. 中国医疗器械信息,2010,16(10):1-6,14. doi: 10.3969/j.issn.1006-6586.2010.10.001 [15] Gur D,Zuley M L,Anello M I,et al. Dose reduction in digital breast tomosynthesis (DBT) screening using synthetically reconstructed projection images:An observer performance study[J]. Academic Radiology,2012,19(2):166-171. doi: 10.1016/j.acra.2011.10.003 [16] 商木岩,郭帅,张强,等. 中国乳腺癌筛查现状[J]. 实用癌症杂志,2020,35(11):1911-1914. doi: 10.3969/j.issn.1001-5930.2020.11.046 [17] 张雪,董晓平,管雅喆,等. 女性乳腺癌流行病学趋势及危险因素研究进展[J]. 肿瘤防治研究,2021,48(1):87-92. [18] Giess C S,Pourjabbar S,Ipik,et al. Comparing diagnostic performance of digital breast tomosynthesis and full-field digital mammography in a hybrid screening environment[J]. American Journal of Roentgenology,2017,9(4):929-934. [19] 边甜甜,林青,李丽丽,等. 对比数字乳腺断层合成与乳腺X线摄影对致密型乳腺内肿块的诊断价值[J]. 中华放射学杂志,2015,49(7):483-487. doi: 10.3760/cma.j.issn.1005-1201.2015.07.002 [20] 沈茜刚,彭卫军,顾雅佳,等. 数字乳腺断层摄影技术中大、小角度曝光的辐射剂量比较[J]. 中国癌症杂志,2019,29(7):494-500. [21] Knox S. The European advocacy perspective on mammography screening[J]. Breast,2011,20(1):93-95. [22] 尤超,顾雅佳,彭卫军,等. 采用数字乳腺断层结合合成二维图像对乳腺疾病的鉴别诊断价值[J]. 中华放射学杂志,2017,51(11):823-833. doi: 10.3760/cma.j.issn.1005-1201.2017.11.002