数字乳腺体层合成和全视野数字乳腺X线摄影技术在不同体位组合下的诊断效能  

Diagnostic efficiency of digital breast tomosynthesis and full-field digital mammography under different position combinations

作　　者：陈穹 潘鑫 应伟峰 侯羽宇 路明 安冬清 顾佳瑶 彭卫军[2] Chen Qiong;Pan Xing;Ying Weifeng;Hou Yuyu;Lu Ming;An Dongqin;Gu Jayao;Peng Weijun(Department of Radiology,Dahua Hospital of Xuhui District,Shanghai 200237,China;Department of Radiology,Affiliated Cancer Hospital of Fudan University,Shanghai 200231,China)

机构地区：[1]上海市徐汇区大华医院放射科,200237 [2]复旦大学附属肿瘤医院影像中心,上海200231

出　　处：《中华乳腺病杂志（电子版）》2024年第1期25-30,共6页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：上海市卫生健康委员会临床研究面上项目(202140074);上海市徐汇区卫生健康委员会面上项目(SHXH202207)。

摘　　要：目的对比分析数字乳腺体层合成(DBT)和全视野数字乳腺X线摄影(FFDM)2种不同乳腺摄影方法在不同体位组合下的辐射剂量和诊断效能。方法回顾性分析2018年5月至2022年1月在上海市徐汇区大华医院外科门诊就诊的419例(共837个乳房)同时行乳腺DBT与FFDM检查的患者资料,按照不同摄影组合分为:A组,FFDM头尾位(CC)+内外侧斜位(MLO);B组,FFDM(CC)+DBT(MLO);C组,FFDM(MLO)+DBT(CC);D组,DBT(CC+MLO);F组,FFDM(CC+MLO)+DBT(CC+MLO)。以最终病理结果为诊断依据。采用单因素方差分析与事后检验比较5组的乳腺辐射吸收剂量和影像学特征检出率,分别绘制5组恶性病变诊断的受试者操作特征曲线(ROC),曲线下面积的组间比较采用非参数检验,两两比较采用Delong检验。结果5组患者的辐射吸收量比较差异有统计学意义[A组为(1.975±0.752)mGy,B组为(3.039±1.173)mGy,C组为(2.998±1.059)mGy,D组为(4.023±1.482)mGy,F组为(6.037±2.154)mGy,F=996.373,P<0.001]。组间两两比较除了B组与C组间差异无统计学意义外,余各组间比较,差异均有统计学意义(P均<0.001)。837个乳房行X线摄影共发现乳腺恶性病变45个,各组诊断ROC曲线下面积分别为:0.913(95%CI:0.892~0.931)、0.979(95%CI:0.966~0.987)、0.983(95%CI:0.972~0.991)、0.982(95%CI:0.970~0.990)和0.986(95%CI:0.976~0.993),组间比较差异有统计学意义(Z=114.744,P<0.001)。A组与B、C、D、F组ROC曲线下面积比较,差异均有统计学意义(Z=2.358、2.497、2.442、2.607,P=0.018、0.013、0.015、0.009);B组与C、F组比较,差异也有统计学意义(Z=2.287、2.338,P=0.022、0.019);D组与F组比较,差异也有统计学意义(Z=3.096,P=0.002)。5种组合的诊断敏感度与特异度分别为:A组75.56%、96.46%;B组91.11%、95.45%;C组91.11%、96.21%;D组93.33%、95.58%;F组93.33%、95.71%。结论FFDM(MLO)+DBT(CC)的联合使乳腺X线摄影在兼顾低辐射剂量的同时,不损失诊断效能。Objective To compare the radiation dose and diagnostic efficiency of digital breast tomosynthesis(DBT)and full-field digital mammography(FFDM)under different position combinations.Methods A retrospective analysis was performed in 419 patients(837 breasts)who underwent both DBT and FFDM in the surgical clinic of Dahua Hospital,Xuhui District,Shanghai from May 2018 to January 2022.According to different photographic combinations,the patients were divided into five groups:group A,FFDM[(craniocaudal,CC)+(mediolateral oblique,MLO)];group B,FFDM(CC)+DBT(MLO);group C,FFDM(MLO)+DBT(CC);group D,DBT(CC+MLO);group F,FFDM(CC+MLO)+DBT(CC+MLO).The final pathological results were used as the diagnostic basis.One-way analysis of variance and post-hoc test were used to compare the radiation dose and detection rate of different imaging features among five groups.The receiver operating characteristic(ROC)curves of the five groups were drawn for the diagnostic efficiency of malignant lesions,the non-parametric test was used for the comparison of the area under the curve between groups,and the Delong test was used for pairwise comparison.Results There was a significant difference in the radiation dose among the five groups[group A:(1.975±0.752)mGy;group B:(3.039±1.173)mGy;group C:(2.998±1.059)mGy;group D:(4.023±1.482)mGy;group F:(6.037±2.154)mGy;F=996.373,P<0.001].Except no significant difference between group B and group C,pairwise comparison showed a significant difference between groups(all P<0.001).A total of 45 malignant lesions were found in 837 breasts.The areas under the ROC curve were 0.913(95%CI:0.892-0.931),0.979(95%CI:0.966-0.987),0.983(95%CI:0.972-0.991),0.982(95%CI:0.970-0.990)and 0.986(95%CI:0.976-0.993)in groups A-F,respectively,indicating a significant differences between groups(Z=114.744,P<0.001).There were significant differences in the area under the ROC curve between group A and group B/C/D/F(Z=2.358,2.497,2.442,2.607,P=0.018,0.013,0.015,0.009),between group B and group C/F(Z=2.287,2.338,P=0.022,0.019),betwe

关 键 词：辐射吸收剂量 诊断 乳腺X线摄影 

分 类 号：R737.9[医药卫生—肿瘤]