不典型乳腺纤维腺瘤的DBT、DM和US比较

Breast fibroadenoma with atypical imaging:comparison of diagnostic accuracy of digital breast tomosynthesis,digital mammography,and ultrasonography

目的对比分析数字乳腺断层合成(digital breast tomosynthesis,DBT)摄影新技术与常规数字乳腺摄影(digital mammography,DM)以及超声扫描(ultrasonography,US)对乳腺纤维腺瘤(breast fibroadenoma,FA)的检出率和诊断准确率。方法回顾性分析673例共868个经微创旋切或手术病理证实的FA的DBT、DM和US资料,以DM及US图像为基准,将有一项影像表现不典型如:形态不规则、边界不清、边缘成角或毛刺、高密度、纵横比>1、后方回声衰减、伴有可疑恶性钙化、不对称致密、结构扭曲、杂乱腺体区、低回声区或单一某种检查方法假阴性归为不典型,其中影像表现为不典型688个。以乳腺影像报告及数据系统(breast imaging report and data system,2013,BI-RADS第五版)为诊断标准,比较DBT、DM及US检查对FA、不典型FA的检出率、诊断准确率的差异,P<0.05差异有统计学意义。结果1)所有FA,DBT较DM对FA的检出率(75.8%vs 55.4%)及诊断准确率(68.8%vs 38.8%)均较高,DBT较US的检出率(75.8%vs 99.5%)及诊断准确率(68.8%vs 93.0%)均较低,差异均有统计学意义;2)影像表现为不典型FA,DBT较DM的检出率(69.5%vs 43.8%)及诊断准确率(60.8%vs 23.3%)均较高,DBT较US的检出率(69.5%vs 99.4%)及诊断准确率(60.8%vs 91.1%)均较低,差异有统计学意义。结论DBT较DM大大提高了乳腺纤维腺瘤,尤其是影像表现不典型纤维腺的检出率及诊断准确率,但弱势于US。

Objective To retrospectively compare the detection rate and diagnostic accuracy of digital breast tomosynthesis(DBT),digital mammography(DM),and ultrasonography(US)in breast fibroadenoma(FA).Methods A retrospectively analysis was performed on total 868 lesions in 673 patients who were confirmed by operation and pathology as breast fibrodenoma.The FA whose digital mammography(DM)or ultrasonography(US)images showed the following atypical imagings irregular shape,obscure boundary,angular or burr-shaped edge,high density,aspect ratio>1,rear echo attenuation,suspicious malignant calcification,focal asymmetry density,structure distortion and false negative under single examination method were classified as atypical.Among them,688 were atypical group.Then,the mass lesions were assessed with reference to the 5th edition of breast imaging report and data system(BI-RADS)to perform the BI-RADS classification and breast density classification.Next,we compared the differences in the detection rate and diagnostic accuracy of DBT,DM and US in breast fibroadenoma,fibroadenoma with atypical imaging.P<0.05 was considered statistically significant.Results 1)In all cases,DBT had a higher detection rate(75.8%vs 55.4%)and diagnostic accuracy(68.8%vs 38.8%)of breast fibroadenoma compared with DM,and had a lower detection rate(75.8%vs 99.5%)and diagnostic accuracy(68.8%vs 93.0%)compared with US,the difference was statistically significance;2)In the breast fibroadenoma with atypical imaging group,DBT had a higher detection rate(69.5%vs 43.8%)and diagnostic accuracy(60.8%vs 23.3%)of breast fibroadenoma compared with DM,and had a lower detection rate(69.5%vs 99.4%)and diagnostic accuracy(60.8%vs 91.1%)compared with US,the difference was statistically significance.Conclusion DBT greatly improved the detection rate and diagnostic accuracy of fibroadenoma,especially fibroadenoma with atypical iamging findings compared with DM,but weaker than US.