数字乳腺断层融合X线摄影与常规影像学检查诊断效能的对比研究

发布时间：2018-03-23 19:18

本文选题：乳腺疾病　切入点：全屏数字乳腺X线摄影　出处：《中国癌症杂志》2017年06期

【摘要】：背景与目的:乳腺癌已成为女性最常见的恶性肿瘤,乳腺X线摄影新技术的出现对乳腺癌诊断起重要作用;该研究旨在对比数字乳腺断层融合X线摄影(digital breast tomosynthesis,DBT)与常规影像学检查诊断乳腺良、恶性病变的效能。方法:收集2015年3月—2015年12月在复旦大学附属肿瘤医院就诊且经临床或超声检查怀疑乳腺病变的227例患者。所有患者均行B超、全屏数字乳腺X线摄影(full-field digital mammography,FFDM)、DBT和MRI检查。高年资影像医师双盲阅片,参照2013版BI-RADS分类标准,以病理结果为金标准,采用受试者工作特征(operating characteristic,ROC)曲线分析各种检查方法的诊断效能,并利用Z检验比较DBT与其他检查方法的统计学差异。结果:30例患者因图像不符合诊断要求而排除,剩余197例患者共发现205个病灶,其中良性病灶73例,恶性病灶132例。B超、FFDM、DBT、DBT+FFDM和MRI基于BI-RADS分类诊断乳腺良、恶性病变的ROC曲线的曲线下面积(area under the curve,AUC)分别为0.830 8、0.859 2、0.9167、0.919 8和0.935 4;两两比较结果显示,DBT的AUC高于B超和FFDM,且差异均有统计学意义(比B超相比,Z=7.36,P=0.006 7;与FFDM相比,Z=4.89,P=0.027 1);DBT与MRI、DBT+FFDM的AUC差异无统计学意义(与MRI相比,Z=0.02,P=0.900 2;与DBT+FFDM相比,Z=0.69,P=0.404 8)。结论:DBT较B超、FFDM能显著提高乳腺良、恶性病灶的诊断效能;并与MRI诊断效能相当。DBT作为乳腺X摄影新技术,具有良好的应用前景。
[Abstract]:Background and objective: breast cancer has become the most common malignant tumors in women, breast X-ray photography of new technology for the diagnosis of breast cancer plays an important role; the aim of this study was to compare digital breast X-ray photography tomography (Digital breast tomosynthesis, DBT) and conventional imaging examination in the diagnosis of breast malignant lesions, efficacy. Methods: from March 2015 to December 2015 in Tumour Hospital Affiliated to Fudan University and the clinical or ultrasonic diagnosis of 227 cases of breast disease patients. All patients were examined by ultrasonography, full digital mammography (full-field digital, mammography, FFDM, DBT) and MRI examination. Senior radiologists double blind, according to the 2013 edition of the BI-RADS classification standard, with pathological results as the gold standard, the receiver operating characteristic (operating characteristic, ROC) diagnosis effect analysis curves of different examination methods, Z test was used to compare the D Significant differences between BT and other examination methods. Results: 30 patients were excluded because the image does not meet the diagnostic requirements, the remaining 197 cases were found in 205 lesions, including 73 cases of benign lesions, 132 cases with malignant lesions. Ultrasound, FFDM, DBT, DBT+FFDM and MRI based on the BI-RADS classification of mammary gland benign, ROC curve malignant lesions under the curve (area under the curve, AUC) were 0.830 8,0.859 and 0.9354 2,0.9167,0.919 8; 22 the comparison results show that the DBT AUC is higher than that of ultrasound and FFDM, and the differences were statistically significant (compared to Z=7.36, P= than B, 0.0067; compared with FFDM, Z=4.89, P=0.027, DBT and MRI 1); and there was no significant difference of AUC DBT+FFDM (compared with MRI, Z=0.02, P=0.900 2; compared with DBT+FFDM, Z=0.69, P=0.404 8). Conclusion: DBT ultrasound, FFDM can significantly improve the diagnostic efficacy of breast benign and malignant lesions; and MRI diagnostic efficacy quite.DBT as a breast X. The new technology has good prospects for application.

【作者单位】：复旦大学附属肿瘤医院放射诊断科复旦大学上海医学院肿瘤学系;复旦大学附属肿瘤医院超声科复旦大学上海医学院肿瘤学系;复旦大学附属肿瘤医院病理科复旦大学上海医学院肿瘤学系;
【基金】：上海申康医院发展中心适宜技术推广项目(SHDC12016224) 复旦大学附属肿瘤医院横向基金(HX-1317)
【分类号】：R730.44;R737.9

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