数字乳腺断层摄影与超声对致密型乳腺内病变的诊断效能对比研究
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摘要
目的比较数字乳腺断层摄影(DBT)及超声对致密型乳腺内病变的诊断效能。方法收集2017年3月至2018年5月于中国医科大学附属盛京医院行DBT及超声检查的致密型乳腺内病变患者资料,严格按照2013年版乳腺影像报告和数据系统(BI-RADS)标准分析并记录患者腺体分型、DBT及超声病灶检查结果,以手术病理或活检结果为金标准,BI-RADS 1～4A类为良性,4B类及以上为恶性。绘制受试者工作特征(ROC)曲线,比较DBT、超声及联合检查诊断致密型乳腺内病变的效能。结果本研究共纳入221例患者,共检出236个病灶,其中良性病灶108个(45. 8%),恶性病灶128个(54. 2%)。DBT与超声对致密型乳腺内病灶的敏感度、特异度比较,差异均无统计学意义(均P> 0. 05)。联合诊断对致密型乳腺内病灶的敏感度高于DBT和超声(97. 65%比95. 31%、89. 06%),特异度低于DBT和超声(68. 51%比75. 92%、85. 18%),差异均有统计学意义(均P <0. 01)。DBT、超声及联合诊断的ROC曲线下面积分别为0. 86、0. 87、0. 94,DBT曲线下面积与超声比较差异无统计学意义(P> 0. 05),联合诊断曲线下面积大于DBT和超声,差异均有统计学意义(均P <0. 01)。结论 DBT和超声对致密型乳腺内病变的诊断效能相似,二者联合有利于致密型乳腺内病变的诊断。
Objective To compare the diagnostic efficiencies of digital breast tomosynthesis( DBT) and ultrasound in women with dense breasts. Methods Imaging data,surgical pathology and biopsy results of women with dense breast lesions who underwent DBT and ultrasound examinations in Shengjing Hospital of China Medical University from March 2017 to May 2018 were classified by the 2013 Breast Imaging Reporting and Data System( BI-RADS). BI-RADS 1-4 A were considered as benign and BI-RADS 4 B-5 were considered as malignant.Diagnostic efficiencies of DBT,ultrasound and combined detection were analyzed by the receiver operating characteristic( ROC) curve. Results A total of 221 patients with 236 breast lesions were included; 108 lesions( 45. 8%) were benign and 128 lesions( 54. 2%) were malignant. There was no significant difference of the sensitivity and specificity between DBT and ultrasound in diagnosing dense breasts( P > 0. 05). The sensitivity of combined diagnosis was higher( 97. 65% vs 95. 31%,89. 06%) and the specificity was lower( 68. 51% vs75. 92%,85. 18%) than those of DBT and ultrasound alone( all P < 0. 01). The area under ROC curve of DBT,ultrasound and combined diagnosis was 0. 86,0. 87 and 0. 94,respectively. There was no significant difference of the area under curve between DBT and ultrasound( P > 0. 05). The area under the curve of combined diagnosis was larger than that of DBT and ultrasound( both P < 0. 01). Conclusions Diagnostic performances of DBT and ultrasound are similar in dense breasts. Combined diagnosis helps the accurate diagnosis of dense breast lesions.
Objective To compare the diagnostic efficiencies of digital breast tomosynthesis( DBT) and ultrasound in women with dense breasts. Methods Imaging data,surgical pathology and biopsy results of women with dense breast lesions who underwent DBT and ultrasound examinations in Shengjing Hospital of China Medical University from March 2017 to May 2018 were classified by the 2013 Breast Imaging Reporting and Data System( BI-RADS). BI-RADS 1-4 A were considered as benign and BI-RADS 4 B-5 were considered as malignant.Diagnostic efficiencies of DBT,ultrasound and combined detection were analyzed by the receiver operating characteristic( ROC) curve. Results A total of 221 patients with 236 breast lesions were included; 108 lesions( 45. 8%) were benign and 128 lesions( 54. 2%) were malignant. There was no significant difference of the sensitivity and specificity between DBT and ultrasound in diagnosing dense breasts( P > 0. 05). The sensitivity of combined diagnosis was higher( 97. 65% vs 95. 31%,89. 06%) and the specificity was lower( 68. 51% vs75. 92%,85. 18%) than those of DBT and ultrasound alone( all P < 0. 01). The area under ROC curve of DBT,ultrasound and combined diagnosis was 0. 86,0. 87 and 0. 94,respectively. There was no significant difference of the area under curve between DBT and ultrasound( P > 0. 05). The area under the curve of combined diagnosis was larger than that of DBT and ultrasound( both P < 0. 01). Conclusions Diagnostic performances of DBT and ultrasound are similar in dense breasts. Combined diagnosis helps the accurate diagnosis of dense breast lesions.
引文
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[14]Cho SH,Park SH. Mimickers of breast malignancy on breast sonography[J]. J Ultrasound Med,2013,32(11):2029-2036.DOI:10. 7863/ultra. 32. 11. 2029.
[2]Peres J. Little progress in how to advise women with dense breasts[J].J Natl Cancer Inst,2015,107(9):djv266. DOI:10. 1093/jnci/djv266.
[3]American College of Radiology. ACR BI-RADS Atlas?5th Edition[EB/OL]. https://www. acr. org/Clinical-Resources/Reportingand-Data-Systems/Bi-Rads#Mammography.
[4]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[J].JAMA, 2012,307(13):1394-1404. DOI:10. 1001/jama.2012. 388.
[5]Ohuchi N,Suzuki A,Sobue T,et al. Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial(J-START):a randomised controlled trial[J]. Lancet,2016,387(10016):341-348. DOI:10. 1016/S0140-6736(15)00774-6.
[6]Sprague BL,Stout NK,Schechter C,et al. Benefits,harms,and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts[J]. Ann Intern Med,2015,162(3):157-166. DOI:10. 7326/M14-0692.
[7]Kopans DB. Digital breast tomosynthesis from concept to clinical care[J]. AJR Am J Roentgenol,2014,202(2):299-308. DOI:10. 2214/AJR. 13. 11520.
[8]Ciatto S,Houssami N,Bernardi D,et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening(STORM):a prospective comparison study[J]. Lancet Oncol,2013,14(7):583-589. DOI:10. 1016/S1470-2045(13)70134-7.
[9]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(3):694-700.DOI:10. 1148/radiol. 13130307.
[10]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,multireader trial[J]. Radiology,2013,266(1):104-113. DOI:10. 1148/radiol. 12120674.
[11]Elizalde A,Pina L,Etxano J,et al. Additional US or DBT after digital mammography:which one is the best combination?[J].Acta Radiol,2016,57(1):13-18. DOI:10. 1177/0284185114563641.
[12]Lee WK,Chung J,Cha ES,et al. Digital breast tomosynthesis and breast ultrasound:Additional roles in dense breasts with category 0 at conventional digital mammography[J]. Eur J Radiol,2016,85(1):291-296. DOI:10. 1016/j. ejrad. 2015. 09. 026.
[13]Kim WH,Chang JM,Lee J,et al. Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts:a prospective comparison study[J]. Breast Cancer Res Treat,2017,162(1):85-94. DOI:10. 1007/s10549-017-4105-z.
[14]Cho SH,Park SH. Mimickers of breast malignancy on breast sonography[J]. J Ultrasound Med,2013,32(11):2029-2036.DOI:10. 7863/ultra. 32. 11. 2029.