数字乳腺三维断层摄影与全数字化乳腺摄影在乳房肿块型疾病中的诊断价值

Digital breast tomosynthesis technique （DBT） versus full field digital mammography （FFDM） for the diagnosis of breast mass-like lesions

目的探讨数字乳腺三维断层摄影（DBT）对比全数字化乳腺摄影（FFDM）在乳房肿块型疾病中诊断的准确度。方法选择乳房肿块型疾病患者182例，分别使用DBT及FFDM进行独立诊断，评价两者诊断乳房肿块型疾病的灵敏度、特异度及准确性、乳房肿块的BI-RADS分级及病变边缘特征的差异。结果182例患者中，恶性病变101例，良性病变81例。DBT与FFDM对恶性肿块的检出率分别为95.0%及84.2%，对良性肿块的检出率分别为80.2%及64.2%，差异均有统计学意义（均P〈0.05）。DBT与FFDM对乳腺肿块诊断的灵敏度分别为93.1%（94/101）和82.2%（83/101），特异度分别为66.7%（54/81）和53.1%（43/81），准确性分别为81.3%（148/182）和69.2%（126/182），差异均有统计学意义（均P〈0.05）。FFDM与DBT对恶性肿块的BI-RADS分类差异有统计学意义（χ^2＝12.912，P＝0.044 5），对良性肿块的BI-RADS分类差异有统计学意义（χ^2＝12.739, P＝0.026 0）。DBT与FFDM分别检出边缘清晰良性肿块65例及45例，差异有统计学意义（χ^2＝10.224，P＝0.001 4）。DBT与DM分别检出恶性肿块毛刺征71例及50例，差异有统计学意义（χ^2＝8.244, P＝0.0041）, DBT使恶性肿块毛刺的检出率由49.5%提高到66.4%。结论DBT较传统FFDM摄影提高病灶缘可见性，增加诊断的敏感性和特异性，有利于病变的良恶性鉴别。

Objective To evaluate the diagnostic value of breast mass-like lesions by digital breast tomosynthesis technique （DBT） versus full field digital mammography （FFDM）. Methods 182 breast mass cases undergoing respectively DBT and FFDM diagnosis were reviewed to evaluate the the sensitivity, specificity and accuracy, breast BI-RADS classification and differences of edge character. Results Of the 182 cases, 101 cases were malignant, 81 cases were benign. DBT and FFDM in malignant mass detection rate were 95.0% and 95.0% respectively, the benign tumor detection rate were 80. 2% and 80. 2% respectively, the difference was statistically significant （ P 〈 0.05 ）. The diagnostic sensitivity was 93.1% （94/101） and 82. 2% （83/101）, specificity was 66. 7% （54/81） and 53.1% （43/81）, accuracy was 81.3% （148/182） and 69. 2% （ 126/182）, all the differences were statistically significant （P 〈 0. 05 ）. The BI-RADS classification difference of the malignant mass was statistically significant （χ^2= 12. 912, P = 0.0445） , and the benign mass was also statistically significant （χ^2 = 12. 739, P =0. 026 0）. The clear edge benign tumors detected by DBT and FFDM respectively were 65 and 45 cases （χ^2 = 10. 224, P = 0. 001 4）. The spicule sign detected by DBT and FFDM respectively in malignant tumors were 71 and 50 cases （χ^2= 8. 244, P = 0. 004 1 ）. Conclusion DBT compared to traditional FFDM photography improves the lesion visibility, increases the diagnostic sensitivity and specificity, conducing to the identification of benign and malignant lesions.