数字乳腺断层摄影对乳腺良恶性疾病的诊断价值  

The diagnostic value of digital breast tomosynthesis in benign and malignant breast diseases

作　　者：郑福玲[1] 孔令燕[1] 王晓[1] 高鑫[1] 薛华丹[1] 金征宇[1] 孙强[2] ZHENG Fuling;KONG Lingyan;WANG Xiao;GAO Xin;XUE Huadan;JIN Zhengyu;SUN Qiang(Department of Radiology,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Breast Surgery,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院放射科,北京100730 [2]中国医学科学院北京协和医院乳腺外科,北京100730

出　　处：《肿瘤影像学》2020年第3期221-225,共5页Oncoradiology

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项(2018PT32003,2017PT32004)。

摘　　要：目的:探讨数字乳腺断层摄影(digital breast tomosynthesis,DBT)对乳腺良恶性疾病的诊断价值,并与全数字化乳腺X线摄影(full-field digital mammography,FFDM)和乳腺超声结果进行比较。方法:回顾并分析2019年6—7月67例患者的临床资料,患者均接受FFDM、DBT及乳腺超声检查,并接受穿刺活检或手术后病理学检查。依照乳腺影像报告和数据系统(Breast Imaging Report and Data System,BI-RADS)评分分别计算DBT、FFDM和超声检查诊断乳腺良恶性病变的准确率、灵敏度、特异度。用Kappa分析分别评价DBT、FFDM、超声与病理学检查结果的一致性。用Fisher确切检验法,评价DBT、FFDM和超声检查对恶性病变的灵敏度、特异度差异。结果:DBT、FFDM和超声检查对乳腺良恶性病变诊断的准确率分别为85.07%、64.18%和76.12%,灵敏度分别为90.32%、67.74%和83.87%,特异度分别为80.56%、61.11%和69.44%;DBT、FFDM和超声检查与病理学检查结果进行一致性评价,Kappa值分别为0.70、0.28和0.52。不同检查方法对恶性病变检出的灵敏度比较:DBT与FFDM间差异有统计学意义(P<0.05),DBT与超声及FFDM与超声间差异无统计学意义(P>0.05)。不同检查方法对恶性病变检出的特异度比较:DBT的特异度最高,但3种方法的特异度差异无统计学意义(P>0.05)。结论:DBT对乳腺良恶性病变诊断的灵敏度、特异度、准确率均高于FFDM及超声检查,与病理学检查结果高度一致,虽然特异度差异无统计学意义,但诊断恶性病变的灵敏度优于FFDM,是乳腺癌筛查、诊断更为敏感的检查方法。Objective:To investigate the diagnostic value of digital breast tomosynthesis(DBT)in benign and malignant breast diseases,and compare with the results of conventional full-field digital mammography(FFDM)and breast ultrasound(US).Methods:A retrospective analysis was made of 67 patients between Jun.and Jul.2019,all of whom received FFDM,DBT and US,and were confirmed by biopsy or operation pathology.The accuracy,sensitivity,specificity of DBT,FFDM and US for benign and malignant breast lesions were evaluated according to Breast Imaging Report and Data System(BI-RADS)score.Results:The diagnostic accuracy of DBT,FFDM and US for benign and malignant breast lesions were 85.07%,64.18%and 76.12%.The sensitivity was 90.32%,67.74%,83.87%respectively,and the specificity was 80.56%,61.11%,69.44%respectively.DBT,FFDM and US were evaluated for consistency with pathological results,and Kappa values were 0.70,0.28 and 0.52,respectively.Comparison of the sensitivity of different examination methods in the detection of malignant lesions:the difference between DBT and FFDM was statistically significant(P<0.05);the difference between DBT and ultrasound and the difference between FFDM and ultrasound was not statistically significant(P>0.05).Different inspection methods for detection of malignant change sensitivity comparison:The highest specificity of DBT,but the specificity of the three methods had no significant difference in statistics(P>0.05).Conclusion:The sensitivity,specificity and accuracy of DBT in the diagnosis of benign and malignant breast lesions are higher than conventional FFDM and US,which are highly consistent with the pathological results.The sensitivity of malignant lesions evaluation is better than conventional FFDM,and DBT is a more sensitive examination method for breast cancer screening and diagnosis.

关 键 词：数字乳腺断层摄影 全数字化乳腺X线摄影 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤] R445.4[医药卫生—临床医学]