数字乳腺融合断层技术在乳腺癌诊断中的应用价值

Clinical value of digital breast tomosynthesis for breast cancer

目的探讨数字乳腺融合断层(digital breast tomosynthesis,DBT)技术在乳腺癌诊断中的应用价值。方法收集759例来院做乳腺X线检查的患者,分别采用全数字乳腺X线摄影(full-field digital mammography,FFDM)和DBT摄影,并独立诊断,以病理诊断作为金标准,比较FFDM、FFDM结合DBT诊断乳腺癌的能力。结果 759例患者中,正常和良性病变555例,恶性病变204例。FFDM与FFDM结合DBT检查诊断乳腺疾病的差异有统计学意义(Z=-6.594,P<0.000 1),两者对于乳腺癌的诊断差异有统计学意义(Z=-8.082,P<0.000 1)。以病理诊断作为金标准,FFDM诊断乳腺癌的灵敏度67.6%,特异度96.2%,Youden指数0.638,阳性预测值86.8%,阴性预测值89%;FFDM结合DBT诊断乳腺癌的灵敏度80.9%,特异度97.1%,Youden指数0.78,阳性预测值91.2%,阴性预测值93.3%。FFDM诊断乳腺癌的ROC曲线下面积(the area under the curve,AUC)为0.899,FFDM结合DBT诊断乳腺癌的AUC值为0.969。FFDM结合DBT和FFDM的AUC差异有统计学意义(Z=7.126,P<0.001)。DBT的辐射剂量高于FFDM,两者差异有统计学意义(CC位:Z=-27.005,P<0.000 1;MLO位:Z=-27.514,P<0.000 1)。结论 FFDM结合DBT诊断乳腺癌的能力高于FFDM,然而辐射剂量也高于FFDM,所以DBT不适于乳腺普查,更适用于对可疑病灶的鉴别诊断。

Objective To assess the clinical value of digital breast tomosynthesis （DBT） in the diagnosis of breast cancer. Methods Seven hundreds and fifty-nine women taking bilateral mammography in our department from October 2014 to March 2015 were recruited in this study. They all received full-field digital mammography （FFDM） and DBT. Then 3 doctors independently made the diagnosis of each examination by reading FFDM and FFDM plus DBT. The diagnostic capacities of FFDM and FFDM combined with DBT were compared with pathological diagnosis as the gold standard. Results Among these 759 participants, 555 were diagnosed as benign and normal, and 204 were determined as being malignant by pathology. There were statistical differences in breast diseases （ Z =- 6. 594, P 〈 0. 000 1 ）, and in malignant diagnoses （Z = -8.082, P 〈 0. 000 1 ） between FFDM and FFDM plus DBT. The sensitivity, specificity, Youden index, positive value （PPV）, and negative predictive value （NPV） were 67.6%, 96. 2%, O. 638, 86.8%, and 89%, respectively, for FFDM, and were 80.9%, 97.1%, 0.78, 91.2% , and 93.3% respectively for FFDM plus DBT. Receiving operating characteristic （ROC） curve analysis showed that the area under the curve （AUC） of ROC was 0. 899 for FFDM and was increased to 0.969 for FFDM plus DBT. And there was statistical difference between their AUC （Z = 7. 126, P 〈 0. 001 ）. But, the averageglandular dose （AGD） was significantly higher in DBT 0.000 1; mediolateral oblique view： Z = -27. 514, superior to FFDM in the diagnosis of breast cancer, but used for differential diagnosis of suspicious lesions, but than FFDM （craniocaudal view： Z = - 27. 005, P 〈 P 〈 0. 000 1 ）. Conclusion FFDM plus DBT is the AGD of DBT is higher. Therefore, DBT should be not for general investigation.