全视野数字化乳腺摄影及数字乳腺断层摄影诊断致密型乳腺内病变

Full-field digital mammography and digital breast tomosynthesis in diagnosis of lesions in dense breast

目的探讨全视野数字化乳腺摄影(FFDM)及数字乳腺断层摄影(DBT)对致密型乳腺内病变的诊断价值。方法收集经病理证实的176例乳腺病变患者,均为致密型乳腺,分别采用FFDM、DBT、FFDM联合DBT进行诊断。以病理结果作为金标准,评价FFDM、FFDM联合DBT对致密型乳腺内病变的诊断价值;比较FFDM与DBT对致密型乳腺内结构扭曲、不同病理类型乳腺癌的检出率及对病灶边缘特征的显示情况。结果 176例中,良性病变83例,恶性病变93例。单纯采用FFDM及以FFDM联合DBT鉴别致密型乳腺内病变良恶性的敏感度分别为77.42%(72/93)、90.32%(84/93),特异度分别为55.42%(46/83)、71.08%(59/83),ROC曲线下面积(AUC)分别为0.757、0.885。FFDM、DBT对致密型乳腺内恶性肿块型病变的诊断敏感度分别为81.43%(57/70)、92.86%(65/70),特异度分别为56.52%(26/46)、76.09%(35/46),AUC分别为0.787、0.895。恶性肿块中,FFDM、DBT对毛刺征的检出率分别为31.43%(22/70)、54.29%(38/70),差异有统计学意义(χ~2=7.467,P=0.006)。DBT检出结构扭曲22例,FFDM仅检出其中5例,差异有统计学意义(χ~2=27.704,P<0.001)。FFDM及DBT对原位癌的检出率均为84.62%(11/13);对浸润癌的检出率分别为77.22%(61/79)、92.41%(73/79),差异有统计学意义(χ~2=7.075,P=0.008)。结论对于致密型乳腺,DBT可提高病变检出率,FFDM联合DBT具有较高诊断效能。

Objective To explore the value of full-field digital mammography(FFDM)and digital breast tomosynthesis(DBT)in diagnosis of lesions in dense breast.Methods Totally 176 patients with dense breast lesions confirmed by pathology were enrolled.The diagnosis was performed with FFDM,DBT and FFDM combined with DBT,respectively,then the diagnostic value was evaluated according to pathologic results.The detection rate of architectural distortions,different pathological types of breast cancer and the features of the edge of the lesions in dense breast were compared.Results In all 176 lesions,83 were benign and 93 were malignant.The sensitivity of FFDM and FFDM combined with DBT for diagnosis of benign and malignant dense breast lesions was 77.42%(72/93)and 90.32%(84/93),the specificity was 55.42%(46/83)and 71.08%(59/83),and the area under the ROC curve was 0.757 and 0.885,respectively(all P<0.05).The sensitivity of FFDM and DBT in the mass-like lesions in dense breast were 81.43%(57/70)and 92.86%(65/70),the specificity was 56.52%(26/46)and 76.09%(35/46),the area under the ROC curve was 0.787 and 0.895,respectively.The detection rate of spicular sign of FFDM and DBT in malignant tumors was 31.43%(22/70)and 54.29%(38/70),respectively(χ~2=7.467,P=0.006).There were 22 lesions with architectural distortions detected with DBT,while only 5 with FFDM(χ~2=27.704,P<0.001).The detection rates of FFDM and DBT for carcinoma in situ were both84.62%(11/13),and the detection rate of invasive cancer was 77.22%(61/79)and 92.41%(73/79),respectively(χ~2=7.075,P=0.008).Conclusion Compared with FFDM,DBT can improve the detection rate of lesions in dense breast.FFDM combined with DBT has great performance in diagnosis of dense breast lesions.