数字乳腺体层合成用于乳腺内结构扭曲病变临床诊断价值分析

Value of Digital Breast Tomosynthesis in Clinical Diagnosis of Breast Internal Structural Distortion

目的探讨数字乳腺体层合成(DBT)在乳腺内结构扭曲病变诊断中的价值。方法选取医院2020年1月至2021年1月收治的乳腺内结构扭曲病变患者99例,患者依次接受磁共振成像(MRI)和DBT检查,以手术病理学结果为金标准,比较两种检查方法的影像学特征、美国放射学会磁共振成像乳腺影像报告与数据系统(MRIBI-RADS)分类诊断效果和诊断效能差异。结果99例患者中,乳腺为致密型11例,占11.11%。采用MRIBI-RADS评估,DBT与MRI检查乳腺肿瘤分级均以5级和6级为主。DBT和MRI诊断病灶边界及毛刺比较差异不显著(P>0.05);DBT诊断钙化阳性概率显著高于MRI,MRI诊断血管穿入征概率显著高于DBT(49.49%比29.29%和22.22%比60.61%,P<0.05)。DBT和MRI诊断准确度比较差异不显著(92.93%比87.88%,P>0.05);DBT诊断灵敏度显著高于MRI,MRI诊断特异度显著高于DBT(95.60%比79.12%和62.50%比100.00%,P<0.05)。结论对于钼靶X线摄片中发现乳腺内结构扭曲的患者,建议首选DBT检查方法;对于DBT表现不典型者,可行MRI做进一步检查,以提高诊断准确度。

Objective To investigate the value of digital breast tomosynthesis(DBT)in the diagnosis of structural distortion in breast.Methods A total of 99 patients with structural distortion in breast admitted to the hospital from January 2020 to January 2021 were selected.The patients underwent the magnetic resonance imaging(MRI)and DBT examination in turn.The surgical pathological results were taken as the gold standard to compare the imaging characteristics,breast imaging reporting and data systern(BI-RADS)classification,difference of diagnostic effect and diagnostic efficiency.Results Among the 99 patients,there were 11 patients with dense breast,accounting for 11.11%.The MRI BI-RADS evaluation results showed that the breast tumor grades diagnosed by DBT and MRI examination were mainly grade 5 and grade 6.There was no significant difference in the lesion boundary and spiculation diagnosed by DBT and MRI examination.The positive probability of calcification diagnosed by DBT was significantly higher than that by MRI,while the probability of vascular penetration sign by MRI was significantly higher than that by DBT(49.49%vs.29.29%and 22.22%vs.60.61%,P<0.05).There was no significant difference in the diagnostic accuracy of DBT and MRI(92.93%vs.87.88%,P>0.05).The diagnostic sensitivity of DBT was significantly higher than that of MRI,while the diagnostic specificity of MRI was significantly higher than that of DBT(95.60%vs.79.12%and 62.50%vs.100.00%,P<0.05).Conclusion DBT is recommended as the first choice for the patients with structural distortion in breast in the molybdenum target X-ray film.For those with atypical manifestations by DBT,MRI can be used for further examination to improve the diagnostic accuracy.