数字乳腺断层摄影对小肿块的诊断价值

The diagnostic value of digital breast tomosynthesis for small mass

目的:探讨数字乳腺X线断层摄影(DBT)对小肿块(≤20 mm)的诊断价值。方法:回顾性分析2021年7月至10月在我院就诊行乳腺X线摄影(DM)和DBT检查且病灶最大径小于等于20 mm的肿块120例,由两名诊断医生参照BI-RADS诊断标准对DM图像、DBT图像进行诊断,以病理结果为金标准,影像诊断为4A及4A以下病灶为良性符合,4B及4B以上病灶为恶性符合。通过受试者工作特性(ROC)曲线比较DM和DBT对小肿块的诊断价值,Z检验比较曲线下面积;采用独立样本t检验比较良性组和恶性组患者年龄、肿块最大径的差异。结果:共113名患者120个肿块纳入研究,其中良性51个,恶性69个。恶性组肿块最大径、患者年龄均高于良性组,差异有统计学意义(t值分别为3.30、6.64,P值分别为0.001,0.000);DBT对≤20 mm肿块、10 mm~20 mm之间肿块及≤10 mm肿块的诊断效能均高于DM,差异有统计学意义(Z值分别为3.06、2.10、2.89,P值分别为0.002、0.035、0.004);在致密型乳腺中,DM的诊断效能明显下降,低于DBT,差异有统计学意义(Z=3.99,P=0.000);在非致密型乳腺中,DM和DBT诊断性能均较高,无统计学差异。结论:DBT对小肿块的诊断价值高于DM,且肿块越小,乳腺越致密,DBT的优势越明显。

Objective:To investigate the value of digital breast tomosynthesis(DBT)in the diagnosis of small masses(≤20 mm).Methods:A retrospective analysis of 120 cases of masses with a maximum diameter of less than or equal to 20 mm who underwent digital mammography(DM)and DBT in our hospital from July to October 2021.Two doctors diagnose DM images and DBT images according to the BI-RADS diagnostic criteria.Taking pathological results as the gold standard,lesions with imaging diagnosis of 4A and below were considered benign,and lesions of 4B and above were considered malignant.The diagnostic efficacy of DM and DBT for small masses was compared by receiver operating characteristic(ROC)curve,and the area under the curve was compared by Z-test.The differences of age and maximum diameter of masses between benign group and malignant group were compared by independent sample t-test.Results:A total of 113 patients with 120 masses were included in the study,of which 51 were benign and 69 were malignant.The maximum diameter of masses and the age of patients in malignant group were significantly higher than those in benign group(t values were 3.30 and 6.64,P values were 0.001 and 0.000,respectively).The diagnostic efficiency of DBT for masses≤20 mm,masses between 10 mm and 20 mm and masses≤10 mm are higher than those of DM,and the difference are statistically significant(Z values are 3.06,2.10,2.89,respectively,P values are 0.002,0.035,0.004,respectively).In dense breasts,the diagnostic efficacy of DM was significantly lower than that of DBT(Z=3.99,P=0.000).In non-dense breasts,both DM and DBT have high diagnostic performance,and there was no significant difference.Conclusion:The diagnostic value of DBT for small masses is higher than that of DM,and the smaller the masses,the denser the breasts,and the more obvious advantages of DBT.