比较超声与数字乳腺断层摄影在致密型乳腺中的应用价值
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摘要
目的比较超声与数字乳腺断层摄影(DBT)在女性致密型乳腺中的应用价值。方法收集同时接受超声和DBT检查的148例致密型乳腺病变患者(148个病灶),按照乳腺成分、年龄、病灶大小及有无钙化进行分组;以病理结果为金标准,绘制ROC曲线,获得并比较超声和DBT诊断致密型乳腺良恶性病变的AUC和敏感度、特异度。结果超声与DBT诊断致密型乳腺良恶性病变的AUC分别为0.956和0.815(Z=3.866,P<0.001)。在不均匀致密型乳腺(0.967 vs 0.821,P<0.001)、病灶最大径≤1 cm(0.935 vs 0.680,P=0.022)及年龄≤40岁(0.973 vs 0.817,P=0.030)和>40～55岁患者(0.946 vs 0.801,P=0.013)中,超声与DBT诊断良恶性病变的AUC均有统计学意义。根据临床诊断标准,超声和DBT诊断致密型乳腺良恶性病变的敏感度为94.32%(83/88)和93.18%(82/88,χ~2=0.096,P=1.000);特异度为83.33%(50/60)和61.67%(37/60,χ~2=7.060,P=0.007)。结论超声对致密型乳腺病灶的整体诊断效能优于DBT。对于病灶较小、不均匀致密型乳腺及年龄≤55岁的患者,更适宜以超声作为首选检查方法。
Objective To compare the diagnostic performances of ultrasonography and digital breast tomosynthesis(DBT) in women with dense breasts. Methods A total of 148 women(148 breast lesions) with dense breasts underwent DBT and ultrasonography. Then the patients were divided into groups according to the composition of the breast, patients' age, lesion size and with or without calcification. Taking pathological results as gold standards, ROC curve was used to evaluate the diagnostic performances of ultrasonography DBT, and the AUC, sensitivity and specificity of them were compared. Results AUC of ultrasonography and DBT in diagnosis of dense breast lesions was 0.956 and 0.815(Z=3.866, P<0.001). There were significant differences of AUC between ultrasonography and DBT in heterogeneously dense breast(0.967 vs 0.821, P<0.001), maximum diameter of lesions ≤1 cm(0.935 vs 0.680, P=0.022), patients' age ≤40 years(0.973 vs 0.817, P=0.030) or >40—55 years(0.946 vs 0.801, P=0.013) groups. According to clinical diagnostic criteria, the sensitivity of ultrasonography and DBT in diagnosis of benign and malignant lesions in dense breast was 94.32%(83/88) and 93.18%(82/88, χ~2=0.096, P=1.000), and the specificity was 83.33%(50/60) and 61.67%(37/60, χ~2=7.060, P=0.007). Conclusion Ultrasonography shows better diagnostic performance than DBT in women with dense breast. Ultrasonography is suitable to be chosen as the preferred examination in women with small lesions in heterogeneously dense breasts and aged ≤55 years than DBT.
Objective To compare the diagnostic performances of ultrasonography and digital breast tomosynthesis(DBT) in women with dense breasts. Methods A total of 148 women(148 breast lesions) with dense breasts underwent DBT and ultrasonography. Then the patients were divided into groups according to the composition of the breast, patients' age, lesion size and with or without calcification. Taking pathological results as gold standards, ROC curve was used to evaluate the diagnostic performances of ultrasonography DBT, and the AUC, sensitivity and specificity of them were compared. Results AUC of ultrasonography and DBT in diagnosis of dense breast lesions was 0.956 and 0.815(Z=3.866, P<0.001). There were significant differences of AUC between ultrasonography and DBT in heterogeneously dense breast(0.967 vs 0.821, P<0.001), maximum diameter of lesions ≤1 cm(0.935 vs 0.680, P=0.022), patients' age ≤40 years(0.973 vs 0.817, P=0.030) or >40—55 years(0.946 vs 0.801, P=0.013) groups. According to clinical diagnostic criteria, the sensitivity of ultrasonography and DBT in diagnosis of benign and malignant lesions in dense breast was 94.32%(83/88) and 93.18%(82/88, χ~2=0.096, P=1.000), and the specificity was 83.33%(50/60) and 61.67%(37/60, χ~2=7.060, P=0.007). Conclusion Ultrasonography shows better diagnostic performance than DBT in women with dense breast. Ultrasonography is suitable to be chosen as the preferred examination in women with small lesions in heterogeneously dense breasts and aged ≤55 years than DBT.
引文
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[10]Berg WA,Zhang Z,Lehrer D,et al.Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.JAMA,2012,307(13):1394-1404.
[11]Crystal P,Strano SD,Shcharynski S,et al.Using sonography to screen women with mammographically dense breasts.AJRAm J Roentgenol,2003,181(1):177-182.
[12]王乐,张玥,石菊芳,等.中国女性乳腺癌疾病负担分析.中华流行病学杂志,2016,37(7):970-976.
[13]代敏,石菊芳,李霓.中国城市癌症早诊早治项目设计及预期目标.中华预防医学杂志,2013,47(2):179-182.
[14]Kopans D,Gavenonis S,Halpern E,et al.Calcifications in the breast and digital breast tomosynthesis.Breast J,2011,17(6):638-644.
[2]Gierach GL,Ichikawa L,Kerlikowske K,et al.Relationship between mammographic density and breast cancer death in the Breast Cancer Surveillance Consortium.J Natl Cancer Inst,2012,104(16):1218-1227.
[3]Boyd NF,Martin LJ,Yaffe MJ,et al.Mammographic density and breast cancer risk:Current understanding and future prospects.Breast Cancer Res,2011,13(6):223.
[4]Berg WA.Current status of supplemental screening in dense breasts.J Clin Oncol,2016,34(16):1840-1843.
[5]边甜甜,吴增杰,林青,等.数字乳腺断层摄影诊断致密型乳腺无钙化肿块.中国医学影像技术,2018,34(4):553-557.
[6]Kim WH,Chang JM,Lee J,et al.Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts:A prospective comparison study.Breast Cancer Res Treat,2017,162(1):85-94.
[7]Tagliafico AS,Calabrese M,Mariscotti G,et al.Adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts:Interim report of a prospective comparative trial.J Clin Oncol,2016 Mar.pii:JCO634147.[Epub ahead of print]
[8]Sickles EA,D'Orsi CJ,Bassett LW,et al.ACR BI-RADS?atlas:Breast imaging reporting and data system.5th ed.Reston:American College of Radiology,2013:1-15.
[9]Lee WK,Chung J,Cha ES,et al.Digital breast tomosynthesis and breast ultrasound:Additional roles in dense breasts with category 0at conventional digital mammography.Eur J Radiol,2016,85(1):291-296.
[10]Berg WA,Zhang Z,Lehrer D,et al.Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.JAMA,2012,307(13):1394-1404.
[11]Crystal P,Strano SD,Shcharynski S,et al.Using sonography to screen women with mammographically dense breasts.AJRAm J Roentgenol,2003,181(1):177-182.
[12]王乐,张玥,石菊芳,等.中国女性乳腺癌疾病负担分析.中华流行病学杂志,2016,37(7):970-976.
[13]代敏,石菊芳,李霓.中国城市癌症早诊早治项目设计及预期目标.中华预防医学杂志,2013,47(2):179-182.
[14]Kopans D,Gavenonis S,Halpern E,et al.Calcifications in the breast and digital breast tomosynthesis.Breast J,2011,17(6):638-644.