乳腺三维断层摄影与乳腺彩超在乳腺疾病诊断中的效能对比

Comparison of the efficacy of digital breast tomosynthesis and color Doppler ultrasound in the diagnosis of breast diseases

目的:研究数字乳腺三维断层技术(DBT)和乳腺超声在诊断乳腺病变效能的不同以及联合应用对于乳腺诊断的价值。方法:收集1 065例乳腺病变患者,其中333例有完整的病理检查资料。以乳腺影像报告和数据系统(BI-RADS)分类为标准,分析DBT、超声、DBT+超声在乳腺病变诊断中的分布差异。根据333例病理结果,比较3种诊断模式的诊断效能。结果:DBT与超声的BI-RADS分布有显着性差异(P=0.001),DBT与DBT+超声或超声与DBT+超声的BI-RADS分布无显著性差异(P=0.258, 0.394)。3种诊断模式均可明显区分恶性和良性乳腺病变(P<0.001)。多组独立样本Kruskal-Wallis秩和检验分析显示3种诊断模型存在差异(χ~2=14.982, P=0.001)。DBT的特异性、误诊率、准确性和阳性预测值明显优于超声。超声显示囊性病变优于DBT,且超声对确定良性肿块的敏感性优于DBT。DBT+超声的特异性为99.5%,误诊率为0.5%,阳性预测值也达到99%。DBT+超声的检查模式优于单独使用DBT或超声。结论:与单独的DBT或超声相比,DBT和超声的组合可以提高乳腺病变的诊断效能。

Objective To compare the efficacy of digital breast tomosynthesis(DBT),color Doppler ultrasound,and DBT+color Doppler ultrasound for the diagnosis of breast lesions.Methods Among the 1 065 patients with breast lesions enrolled in this study,333 cases had complete pathological examination data.Using breast imaging reporting and data system(BI-RADS)classification as the criterion,the distribution differences among DBT,ultrasound,and DBT+ultrasound in diagnosis of breast lesions were analyzed.Based on the pathological results of 333 cases,the diagnostic efficacies of 3 diagnostic models were compared.Results There were significant differences in BI-RADS distribution between DBT and ultrasound(P=0.001),and no significant differences were found between DBT and DBT+ultrasound or between ultrasound and DBT+ultrasound(P=0.258,0.394).All 3 diagnostic models distinctly discriminated the malignant and benign breast lesions(all P<0.001).The analysis with multi-group independent-sample Kruskal-Wallis test showed that there were differences among 3 diagnostic models(χ2=14.982,P=0.001).DBT was superior to ultrasound in the specificity,misdiagnosis rate,accuracy and positive predictive value.Ultrasound was better than DBT in displaying the cystic lesions,and the sensitivity of ultrasound in determining benign masses was higher than that of DBT.The specificity,misdiagnosis rate and positive predictive value of DBT+ultrasound were 99.5%,0.5%and 99%,respectively.The combined use of DBT and ultrasound was better than using DBT or ultrasound alone in the diagnosis of breast diseases.Conclusion Compared with using DBT or ultrasound alone,the combination of DBT and ultrasound can improve the diagnostic efficacy of breast lesions.