数字乳腺断层摄影诊断乳腺结构扭曲病变  

Diagnosis of breast architectural distortion with digital breast tomosynthesis

作　　者：邢姗姗 魏瑶 芦春花[1] 罗艳[1] 陈丽丽 XING Shanshan;WEI Yao;LU Chunhua;LUO Yan;CHEN Lili(Department of Imaging Center,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Ultrasound,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院影像中心,江西南昌330006 [2]南昌大学第二附属医院超声科,江西南昌330006

出　　处：《中国医学影像技术》2020年第7期1031-1035,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的对比观察数字乳腺断层摄影(DBT)与全数字化乳腺X线摄影(FFDM)评价乳腺结构扭曲(AD)病变的优势,探讨DBT与超声鉴别乳腺良恶性AD的价值。方法回顾性分析58例经DBT检出AD病变患者的DBT、FFDM及超声资料,以病理结果为标准,比较DBT与FFDM评价乳腺AD的敏感度、特异度、准确率,分析DBT与超声鉴别乳腺良恶性AD与病理结果的一致性;绘制DBT与超声鉴别乳腺良恶性AD的ROC曲线,比较其诊断效能。结果所有病例均接受FFDM,41例接受超声检查。对于DBT检出的58例乳腺AD,FFDM仅发现23例,差异有统计学意义(χ^2=33.03,P<0.05)。DBT评估致密型乳腺内AD的敏感度[80.65%(25/31)]及准确率[78.00%(39/50)]高于FFDM[35.48%(11/31)、48.00%(24/50),χ^2=12.98、9.65,P均<0.05],而特异度[73.68%(14/19)]与FFDM[68.42%(13/19)]差异无统计学意义(χ^2=0.13,P>0.05)。DBT及超声鉴别乳腺AD良恶性的结果与病理结果的一致性中等(Kappa=0.65、0.71,P均<0.05)。DBT及超声鉴别良恶性AD的敏感度、特异度分别为91.30%(21/23)、72.22%(13/18)及82.61%(19/23)、88.89%(16/18),AUC差异无统计学意义(Z=1.45,P>0.05)。结论DBT评估乳腺AD的敏感度及准确率均高于FFDM;DBT鉴别乳腺AD良恶性的效能与超声相当。DBT检出AD的恶性程度较高,建议及时行活检确诊。Objective To compare the value of digital breast tomosynthesis(DBT)and flly-field digital mammography(FFDM)in evaluating breast architectural distortion(AD)lesions,and the value of DBT and ultrasound in differentiating benign and malignant breast AD.Methods DBT,FFDM and ultrasound data of 58 patients with AD lesions detected with DBT were retrospectively analyzed.Taken pathological outcomes as standards,the sensitivity,specificity and accuracy of DBT and FFDM in evaluating breast AD were compared and analyzed.The consistency of results of DBT and ultrasound in differentiating benign and malignant breast AD with pathological results was analyzed.ROC curve of DBT and ultrasound for differentiating benign and malignant breast AD were drawn,and the diagnostic efficacies were compared.Results All patients underwent FFDM,and 41 of them also underwent ultrasound examination.Among 58 cases of breast AD detected with DBT,only 23 AD were found with FFDM(χ^2=33.03,P<0.05).The sensitivity(80.65%[25/31])and accuracy(78.00%[39/50])of DBT in diagnosis of dense breast with AD were higher than those of FFDM(35.48%[11/31],48.00%[24/50],χ^2=12.98,9.65,both P<0.05),but the specificity(73.68%[14/19])was no statistically different with that of FFDM(68.42%[13/19],χ^2=0.13,P>0.05).Median consistency of DBT and ultrasound results was observed in differentiating benign and malignant breast AD and pathological results(Kappa=0.65,0.71,both P<0.05).The sensitivity,specificity of DBT and ultrasound in differentiating benign and malignant breast AD was 91.30%(21/23),72.22%(13/18)and 82.61%(19/23),88.89%(16/18),respectively(Z=1.45,P>0.05).Conclusion The sensitivity and accuracy of DBT in evaluating breast AD are higher than FFDM.DBT is comparable to ultrasound in differentiating benign and malignant breast AD.AD detected with DBT has relatively high malignancy,so it is recommended to conduct timely biopsy for correct diagnosis.

关 键 词：乳腺疾病 诊断 乳房X线摄影术 超声检查 乳房 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]