数字乳腺三维断层摄影及全数字化乳腺摄影对乳腺疾病诊断价值对比的初步研究
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摘要
目的在乳腺影像报告数据系统(BI-RADS)的基础上,比较全数字化乳腺摄影(FFDM)与数字乳腺三维断层摄影(DBT)及FFDM结合DBT对乳腺病变的诊断效能。方法回顾性搜集乳腺疾病患者76例,入选患者具备双体位拍摄并同时进行DBT及FFDM检查,对其进行BI-RADS分类,以组织病理学结果作为金标准,比较FFDM、DBT及FFDM+DBT对乳腺良恶性、肿块型病变的诊断效能及在4种腺体类型中对乳腺良恶性的诊断效能。对有病理结果的病灶采用受试者工作特征(ROC)曲线分析及诊断性能比较。结果 76例共发现87处病灶,FFDM结合DBT及单独DBT相比,单独FFDM对于乳腺良恶性及肿块型乳腺病变诊断准确性更高,FFDM、DBT及FFDM结合DBT曲线下面积分别为0. 731、0. 945、0. 957和0. 708、0. 962、0. 962,差异具有统计学意义(P <0. 0001,P=0. 0012)。同时对于单独FFDM,在敏感性、特异性、准确性及阳性预测值(PPV)、阴性预测值(NPV)方面,FFDM结合DBT及单独DBT的诊断效能更高。在4种腺体类型中,FFDM结合DBT及单独DBT对于c类乳腺较单独FFDM有更高的敏感性、特异性及准确性。结论对比单独FFDM,FFDM结合DBT及单独DBT对乳腺病变诊断的准确性明显提高。
Objective Comparision of the diagnostic efficiency between full-field digital mammography( FFDM) and digital breast tomosynthesis( DBT). Methods A total of 76 cases were retrospectively collected. The patients were examined with double positions including Cranio-Caudal( CC) and Medio-Lateral Oblique( MLO) views. DBT and FFDM were subsequently done with the same position for each patient before surgery or biopsy. The diagnostic results were classified by Breast Imaging Reporting And Data System( BI-RADS). With the histopathological results as the gold standard,the receiver operating characteristic curve( ROC) analysis were used for the comparison of diagnostic performance of FFDM,DBT and FFDM combined with DBT respectively. Results Within 87 lesions detected from 76 cases,the diagnostic performance of DBT combined with FFDM and DBT alone were of higher accuracy,compared with FFDM alone. The area under the curve( AUC) of FFDM,DBT and FFDM combined with DBT for all lesions and masses only were 0. 731,0. 945,0. 957 and0. 708,0. 962,0. 962. There were significant differences between FFDM combined with DBT,DBT alone and FFDM alone( P < 0. 0001,P = 0. 0012). Concerning the sensitivity,specificity,accuracy,positive predictive value( PPV) and negative predictive value( NPV),the diagnostic performance of DBT combined with FFDM and DBT alone were higher. For the four types of gland,DBT combined with FFDM and DBT alone has higher sensitivity,specificity and accuracy in the c glands than FFDM alone. Conclusion Compared with FFDM alone,the accuracy of DBT combined with FFDM and DBT alone in the diagnosis of breast lesions was significantly improved.
Objective Comparision of the diagnostic efficiency between full-field digital mammography( FFDM) and digital breast tomosynthesis( DBT). Methods A total of 76 cases were retrospectively collected. The patients were examined with double positions including Cranio-Caudal( CC) and Medio-Lateral Oblique( MLO) views. DBT and FFDM were subsequently done with the same position for each patient before surgery or biopsy. The diagnostic results were classified by Breast Imaging Reporting And Data System( BI-RADS). With the histopathological results as the gold standard,the receiver operating characteristic curve( ROC) analysis were used for the comparison of diagnostic performance of FFDM,DBT and FFDM combined with DBT respectively. Results Within 87 lesions detected from 76 cases,the diagnostic performance of DBT combined with FFDM and DBT alone were of higher accuracy,compared with FFDM alone. The area under the curve( AUC) of FFDM,DBT and FFDM combined with DBT for all lesions and masses only were 0. 731,0. 945,0. 957 and0. 708,0. 962,0. 962. There were significant differences between FFDM combined with DBT,DBT alone and FFDM alone( P < 0. 0001,P = 0. 0012). Concerning the sensitivity,specificity,accuracy,positive predictive value( PPV) and negative predictive value( NPV),the diagnostic performance of DBT combined with FFDM and DBT alone were higher. For the four types of gland,DBT combined with FFDM and DBT alone has higher sensitivity,specificity and accuracy in the c glands than FFDM alone. Conclusion Compared with FFDM alone,the accuracy of DBT combined with FFDM and DBT alone in the diagnosis of breast lesions was significantly improved.
引文
1边甜甜,林青,李丽丽,等.对比数字乳腺断层合成与乳腺X线摄影对致密型乳腺内肿块的诊断价值[J].中华放射学杂志,2015,49:483-487.
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8 D'Orsi CJ,Sickles EA,Mendelson EB,et al.ACR BI-RADS Atlas,Breast Imaging Reporting and Data System.5th ed.Reston,Va:A-merican College of Radiology,2013.
9 Roubidoux MA,Bailey JE,Wray LA,et al.Invasive cancers detected after breast cancer screening yielded a negative result:relationship of mammographic density to tumor prognostic factors[J].Radiology,2004,230:42-48.
10 Niklason LT,Christian BT,Niklason LE,et al.Digital tomosynthesis in breast imaging[J].Radiology,1997,205:399-406.
11 Diekmann F,Bick U.Tomosynthesis and contrast-enhanced digital mammography:recent advances in digital mammography[J].Eur Radiol,2007,17:3086-3092.
12 Rafferty EA,Park JM,Philpotts LE,et al.Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone:results of a multicenter,multireadertrial[J].Radiology,2013,266:104-113.
13 Haas BM,Kalra V,Geisel J,et al.Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening[J].Radiology,2013,269:694-700.
14 Gong X,Glick S,Liu B,et al.A computer simulation study comparing lesion detection accuracy with digital mammography,breast tomosynthesis,and cone-beam CT breast imaging[J].Med Phys,2006,33:1041-1052.
15 Gur D,Bandos AI,Rockette HE,et al.Localized detection and classification of abnormalities on FFDM and tomosynthesis examinations rated under an FROC paradigm[J].AJR,2011,196:737-741.
16 Good WF,Abrams GS,Catullo VJ,et al.Digital breast tomosynthesis:a pilot observer study[J].AJR,2008,190:865-869.
17 Gur D,Abrams GS,Chough DM,et al.Digital breast tomosynthesis:observer performance study[J].AJR,2012,193:586-591.
18 Michell MJ,Iqbal A,Wasan RK,et al.A comparison of the accuracy of film-screen mammography,full-field digital mammography,and digital breast tomosynthesis[J].Clin Radiol,2012,67:976-981.
19 Skaane P,Gullien R,Bjrndal H,et al.Digital breast tomosynthesis(DBT):initial experience in a clinical setting[J].Acta Radiol,2012,53:524-529.
20 Chan HP,Wei J,Sahiner B,et al.Computer-aided detection system for breast masses on digital tomosynthesis mammograms:preliminary experience[J].Radiology,2005,237:1075-1080.
21 Zuley ML,Bandos AI,Ganott MA,et al.Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions[J].Radiology,2013,266:89-95.
22 Wallis MG,Moa E,Zanca F,et al.Two-view and single-view tomosynthesis versus full-field digital mammography:high-resolution X-ray imaging observer study[J].Radiology,2012,262:788-796.
23李弋,叶兆祥.数字乳腺断层摄影诊断乳腺癌现状[J].国际医学放射学杂志,2010,33:114-117.
24 Helvie MA.Digital mammography imaging:breast tomosynthesis and advanced applications[J].Radiol Clin North Am,2010,48:917-929.
2 Tejerina Bernal A,Tejerina Bernal A,Rabadán Doreste F,et al.Breast imaging:how we manage diagnostic technology at a multidisciplinary breast center[J].J Oncol,2012,2012:213421.
3 Holloway CM,Easson A,Escallon J,et al.Technology as a force for improved diagnosis and treatment of breast disease[J].Can J Surg,2010,53:268-277.
4 Roth RG,Maidment ADA,Weinstein SP,et al.Digital breast tomosynthesis:lessons learned from early clinical implementation[J].Radiographics,2014,34:E89-102.
5胡东,周轲,朱昭环,等.断层融合技术在乳腺癌诊断中的应用[J].中国医疗设备,2012,27:179-181.
6赵永霞,秦维昌.数字乳腺X线摄影的现状与进展[J].中华放射学杂志,2007,41:1421-1424.
7 Park JM,Franken EA,Garg M,et al.Breast tomosynthesis:present considerations and future applications[J].Radiographics,2007,27:S231-240.
8 D'Orsi CJ,Sickles EA,Mendelson EB,et al.ACR BI-RADS Atlas,Breast Imaging Reporting and Data System.5th ed.Reston,Va:A-merican College of Radiology,2013.
9 Roubidoux MA,Bailey JE,Wray LA,et al.Invasive cancers detected after breast cancer screening yielded a negative result:relationship of mammographic density to tumor prognostic factors[J].Radiology,2004,230:42-48.
10 Niklason LT,Christian BT,Niklason LE,et al.Digital tomosynthesis in breast imaging[J].Radiology,1997,205:399-406.
11 Diekmann F,Bick U.Tomosynthesis and contrast-enhanced digital mammography:recent advances in digital mammography[J].Eur Radiol,2007,17:3086-3092.
12 Rafferty EA,Park JM,Philpotts LE,et al.Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone:results of a multicenter,multireadertrial[J].Radiology,2013,266:104-113.
13 Haas BM,Kalra V,Geisel J,et al.Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening[J].Radiology,2013,269:694-700.
14 Gong X,Glick S,Liu B,et al.A computer simulation study comparing lesion detection accuracy with digital mammography,breast tomosynthesis,and cone-beam CT breast imaging[J].Med Phys,2006,33:1041-1052.
15 Gur D,Bandos AI,Rockette HE,et al.Localized detection and classification of abnormalities on FFDM and tomosynthesis examinations rated under an FROC paradigm[J].AJR,2011,196:737-741.
16 Good WF,Abrams GS,Catullo VJ,et al.Digital breast tomosynthesis:a pilot observer study[J].AJR,2008,190:865-869.
17 Gur D,Abrams GS,Chough DM,et al.Digital breast tomosynthesis:observer performance study[J].AJR,2012,193:586-591.
18 Michell MJ,Iqbal A,Wasan RK,et al.A comparison of the accuracy of film-screen mammography,full-field digital mammography,and digital breast tomosynthesis[J].Clin Radiol,2012,67:976-981.
19 Skaane P,Gullien R,Bjrndal H,et al.Digital breast tomosynthesis(DBT):initial experience in a clinical setting[J].Acta Radiol,2012,53:524-529.
20 Chan HP,Wei J,Sahiner B,et al.Computer-aided detection system for breast masses on digital tomosynthesis mammograms:preliminary experience[J].Radiology,2005,237:1075-1080.
21 Zuley ML,Bandos AI,Ganott MA,et al.Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions[J].Radiology,2013,266:89-95.
22 Wallis MG,Moa E,Zanca F,et al.Two-view and single-view tomosynthesis versus full-field digital mammography:high-resolution X-ray imaging observer study[J].Radiology,2012,262:788-796.
23李弋,叶兆祥.数字乳腺断层摄影诊断乳腺癌现状[J].国际医学放射学杂志,2010,33:114-117.
24 Helvie MA.Digital mammography imaging:breast tomosynthesis and advanced applications[J].Radiol Clin North Am,2010,48:917-929.