数字乳腺断层摄影诊断致密型乳腺无钙化肿块

Digital breast tomosynthesis for diagnosing non-calcified masses in dense breasts

目的通过与常规乳腺X线摄影(DM)和超声进行对比,分析数字乳腺断层摄影(DBT)对致密型乳腺内无钙化肿块的诊断价值。方法参照乳腺影像报告和数据系统(BI-RADS)标准,回顾性分析DBT、DM及超声表现为无钙化肿块的致密型乳腺的1 144例患者资料,以组织病理结果为金标准,评估DBT、DM及超声对乳腺无钙化肿块的检出率、诊断符合率、敏感度、特异度、假阴性率及BI-RADS分类,并进行统计学分析。结果 DBT、DM及超声检查对致密型乳腺无钙化肿块的检出率和诊断符合率分别为86.62%(991/1 144)、77.80%(890/1 144)、99.65%(1 140/1 144)和83.92%(960/1 144)、75.00%(858/1 144)、94.67%(1 083/1 144),差异均有统计学意义(P均<0.05)。DBT、DM及超声对致密型乳腺肿块恶性病变的诊断敏感度、特异度和假阴性率分别为89.39%(312/349)、79.93%(231/289)、92.70%(432/466),81.51%(648/795)、73.33%(627/855)、96.02%(651/678)和10.60%(37/349)、20.07%(58/289)、7.30%(34/466)。3种检查对乳腺良性肿块病变的BI-RADS分类评估差异无统计学意义(P=0.75),对乳腺恶性肿块的BI-RADS分类差异有统计学意义(P<0.01),其中超声与DM和DBT、DBT与DM对乳腺恶性肿块的BI-RADS分类评估差异均有统计学意义(P均<0.016 7)。结论 DBT对致密型乳腺无钙化肿块的检出及诊断较DM具有更大优势;DBT和超声对致密型乳腺无钙化肿块的检出及诊断价值相近。

Objective To analyze the clinical value of digital breast tomosynthesis （DBT） compared with digital mammography （DM） and ultrasound for diagnosing non-calcified masses in dense breasts. Methods Images taken with DBT, DM and ultrasound of 1 144 patients with non-calcified masses in dense breasts were retrospectively analyzed using breast imaging reporting and data system （BI-RADS）. Taking histopathologic results as golden standards, the detection rate and diagnostic accuracy, sensitivity, specificity, false negative and BI-RADS category were evaluated and compared statistically. Results The detection rate of DBT, DM and ultrasound for non-calcified massed in dense breasts was 86.62% （991/1 144）, 77.80% （890/1 144） and 99.65% （1 140/1 144）, respectively （P〈0.05）, while the diagnostic accuracy was 83. 92%/00 （960/1 144）, 75.00% （858/1 144） and 94.67% （1 083/1 144）, respectively （P〈0.01）. The sensitivity of DBT, DM and ultrasound was 89.39% （312/349）, 79.93% （231/289） and 92.70% （432/466）, the specificity was 81.51% （648/795）, 73.33% （627/855） and 96.02% （651/678）, while the false negative rate was 10.60% （37/349）, 20.07% （58/289） and 7.30% （34/466）, respectively. No significant difference was found for benign lesions among three examination methods （P= 0.75）, while there was significant difference for malignant lesions among three examination methods （P〈0.01）, and the differences of ultrasonography with DM and DBT, DBT and DM in the for BI RADS category of malignant lesions were statistically significant （all P〈0. 016 7）. Conclusion For suspected masses in dense breasts, DBT shows significant advantage than DM, while DBT has the similar advantage compared with ultrasound for the detection and diagnosis of non-calcified masses in dense breasts.