数字乳腺断层合成摄影联合二维合成乳腺X线图像对乳腺肿块性病变的诊断效能分析

Research of digital breast tomosynthesis combined with two-dimensional synthesized mammography in diagnosis of breast masses

目的:探讨数字乳腺断层合成摄影(DBT)联合二维合成乳腺X线图像(2DSM)对乳腺肿块性病变的诊断价值。方法:回顾性分析因乳腺肿块就诊的104例女性患者全数字化乳腺X线摄影(FFDM)和DBT检查资料,对FFDM、2DSM、2DSM+DBT、FFDM+DBT 4种检查方法的图像进行分析,2位医师对FFDM与2DSM在乳腺肿块性病变检出率、乳腺腺体类型及肿块是否伴钙化的诊断行一致性检验。记录FFDM和DBT检查单体位单次曝光的平均腺体剂量(AGD)。以病理结果作为金标准,评估4种方法对乳腺肿块性病变的诊断敏感度、特异度、准确率及ROC曲线。结果:104例共发现肿块108枚,其中良性66枚,恶性42枚。单体位乳腺DBT的AGD与FFDM相近,其中乳腺内外侧斜位DBT的AGD较FFDM稍高,在致密性乳腺中更明显。2位医师判断FFDM与2DSM对乳腺肿块性病变的检出率、乳腺腺体类型,以及肿块伴钙化情况具有较好的一致性。2DSM与FFDM对乳腺肿块性病变的诊断效能相当(AUC=0.741,0.781),差异无统计学意义(P>0.05),2DSM+DBT与FFDM+DBT对乳腺肿块性病变的诊断效能差异无统计学意义(P>0.05),2DSM+DBT对乳腺肿块性病变的诊断效能明显高于FFDM,且差异有统计学意义(P<0.05)。结论:2DSM与FFDM对乳腺内肿块性病变的诊断效能相当,在相近的辐射剂量下,一次DBT检查可同时获得2DSM+DBT图像,且具有更好的诊断效能。

Objective:To investigate the diagnostic value of digital breast tomosynthesis(DBT)combined with two-dimensional synthesized mammography(2DSM)for breast masses.Methods:A retrospectively analysis of 104 female patients with breast masses was made.All patients performed full field digital mammography(FFDM)and DBT.Four sets images of FFDM,2DSM,2DSM combined with DBT,FFDM combined with DBT were analyzed.Consistency test was taken to analyze the detection rate of breast mass lesions,the breast glands type,calcification in mass on FFDM and 2DSM of two radiologists.Average glandular dose(AGD)of FFDM and DBT in the single exposure and single position was recorded.Taking histopathological results as the diagnostic gold standards,the diagnostic sensitivity,specificity,accuracy and ROC curve of four methods on breast masses were evaluated.Results:104 female had 108 masses,in which 66 were benign,and 42 were malignant.The AGD of DBT was similar to that of FFDM in breast single position,while AGD of DBT was slightly higher than AGD of FFDM in the mediolateral oblique position of the breast,especially in the dense breasts.There were good consistencies between two radiologists on detection rate,breast gland type and calcification in masses by FFDM and 2DSM.Diagnostic efficacy of the breast masses using 2DSM and FFDM was very close(AUC of 0.741 and 0.781,respectively,P>0.05).There was no significant difference in the diagnosis efficacy between 2DSM combined with DBT and FFDM combined with DBT to breast masses(P>0.05).However,the diagnosis efficacy of 2DSM combined with DBT for breast masses was significantly higher than that of FFDM,and the difference was statistically significant(P<0.05).Conclusions:2DSM and FFDM have equivalent diagnostic efficacy for breast masses.With the similar radiation dose,2DSM combined with DBT images can be obtained after one DBT examination which has better diagnostic efficacy.