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浙江大学学报（医学版）
浙江大学学报（医学版）  2019, Vol. 48 Issue (2): 186-192    DOI: 10.3785/j.issn.1008-9292.2019.04.10
原著     
数字化乳腺断层融合摄影对致密型乳腺病变的诊断价值
徐阿巧1(),何红琴1,施秋军1,李芝清2,张盛箭3,*()
1. 绍兴市中心医院放射科, 浙江 绍兴 312030
2. 绍兴市中心医院病理科, 浙江 绍兴 312030
3. 复旦大学附属肿瘤医院放射科, 上海 200032
Digital breast tomosynthesis in diagnosis of dense breast lesions
XU A'qiao1(),HE Hongqin1,SHI Qiujun1,LI Zhiqing2,ZHANG Shengjian3,*()
1. Department of Radiology, Shaoxing Central Hospital, Shaoxing 312030, Zhejiang Province, China
2. Department of Pathology, Shaoxing Central Hospital, Shaoxing 312030, Zhejiang Province, China
3. Department of Radiology, Tumor Hospital Affiliated to Fudan University, Shanghai 200032, China
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摘要：

目的: 探讨数字化乳腺断层融合摄影（DBT）在致密型乳腺患者中诊断乳腺良恶性病变的效能。方法: 收集2017年1月至2018年12月绍兴市中心医院经病理组织学检查证实的163例乳腺良恶性病变患者的资料（良性病灶58个，恶性病灶122个，共计180个）。根据BI-RADS标准患者乳腺腺体类型均归类于不均质致密腺体型和极度致密型。所有患者术前均行乳腺MRI、DBT检查。以病理结果为金标准绘制ROC曲线，评价两种影像学检查方法: 对乳腺良恶性病变的诊断效能，用Z检验对ROC曲线下面积进行比较；采用χ2检验比较乳腺MRI和DBT检查对乳腺良恶性病变检出率、诊断准确率的差异；采用Pearson相关性分析MRI、DBT术前评估乳腺病灶大小的准确度。结果: MRI、DBT对乳腺良性病变的检出率和准确率分别为91.4%、75.9%和89.7%、67.2%，差异有统计学意义（χ2=5.098、8.617，P < 0.05或P < 0.01）；MRI、DBT对乳腺恶性病变的检出率和准确率分别为98.4%、95.1%和94.3%、91.8%，差异无统计学意义（χ2=2.068、0.569，均P>0.05）。MRI、DBT诊断致密型乳腺病变的ROC曲线下面积分别为0.910、0.832，差异无统计学意义（Z=1.860，P>0.05）。MRI、DBT诊断致密型乳腺良恶性病变的敏感度分别为93.3%、86.7%，特异度分别为68.3%、79.1%。DBT、MRI测量值与病理测量结果呈正相关（r=0.887、0.949，均P < 0.01）。结论: DBT简单易行，能较好地诊断致密腺体背景下乳腺的良恶性病变，尤其对乳腺恶性病变的诊断效能与乳腺MRI相近。
关键词： 乳腺肿瘤/影像学诊断;  乳腺肿瘤/病理学;  乳腺疾病/影像学诊断;  乳腺疾病/病理学;  磁共振波谱学;  体层摄影术, X线计算机/方法;  病例对照研究    
Abstract:

Objective: To evaluate the value of digital breast tomosynthesis (DBT) in diagnosis of dense breast lesions. Methods: Clinical and pathological data of 163 patients (58 benign lesions, 122 malignant lesions, and 180 lesions in total) with breast lesions undergoing surgical treatment in Shaoxing Central Hospital from January 2017 to December 2018 were retrospectively analyzed. The lesions were classified into non-homogeneous dense gland type and extremely dense gland type according to BI-RADS creterion. Breast MRI and DBT examinations were performed before the surgery. ROC curve was generated and the diagnostic efficacy of two examination methods for dense breast lesions was evaluated with pathological results as the gold standard. The detection rate, diagnostic accuracy of benign and malignant breast lesions were compared between two methods using chi-square test. The accuracy of lesion size preoperatively evaluated by MRI and DBT was analyzed by Pearson correlation. Results: The detection rate and diagnostic accuracy for benign breast lesions by MRI were higher than those by DBT (91.4% vs. 75.9%, χ2=5.098, P < 0.05 and 89.7% vs. 67.2%, χ2=8.617, P < 0.01). But there were no significant differences in detection rate and accuracy for malignant lesions by MRI and DBT (98.4% vs. 95.1%, χ2=2.068, P>0.05 and 94.3% vs. 91.8%, χ2=0.569, P>0.05). The areas under the ROC curves of MRI, DBT based on BI-RADS classification were 0.910 and 0.832, respectively (Z=1.860, P>0.05). The sensitivities of MRI, DBT to breast lesions were 93.3% and 86.7%, and the specificities were 68.3% and 79.1%. DBT and MRI measurements were positively correlated with pathological measurements (r=0.887 and 0.949, all P < 0.01). Conclusion: DBT can effectively diagnose benign and malignant breast lesions under dense gland background, and it has similar diagnostic efficacy with MRI for breast malignant lesions.
Key words: Breast neoplasms/diagnostic imaging    Breast neoplasms/pathology    Breast diseases/diagnostic imaging    Breast diseases/pathology    Magnetic resonance spectroscopy    Tomography, X-ray computed/methods    Case-control studies
收稿日期: 2018-11-30 出版日期: 2019-07-24
CLC:  R445  
基金资助: 浙江省医药卫生科技计划(2018KY8299);绍兴市公益性技术应用研究计划(2018C30140)
通讯作者: 张盛箭     E-mail: 737730@qq.com;zhangshengjian@yeah.net
作者简介: 徐阿巧(1983-), 女, 硕士, 副主任医师, 主要从事乳腺MRI功能成像研究; E-mail:737730@qq.com; https://orcid.org/0000-0003-3462-4949
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引用本文:

徐阿巧,何红琴,施秋军,李芝清,张盛箭. 数字化乳腺断层融合摄影对致密型乳腺病变的诊断价值[J]. 浙江大学学报（医学版）, 2019, 48(2): 186-192.

XU A'qiao,HE Hongqin,SHI Qiujun,LI Zhiqing,ZHANG Shengjian. Digital breast tomosynthesis in diagnosis of dense breast lesions. J Zhejiang Univ (Med Sci), 2019, 48(2): 186-192.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.04.10    或    http://www.zjujournals.com/med/CN/Y2019/V48/I2/186

图 1  MRI和DBT诊断致密型乳腺良恶性病变的ROC曲线
图 2  两例乳腺恶性肿瘤患者数字化乳腺断层融合摄影(DBT)、MRI图像特征对照
1 王乐, 张明, 石菊芳 et al. 中国女性乳腺癌疾病负担分析[J]. 中华流行病学杂志, 2016, 37 (7): 970- 976
WANG Le , ZHANG Ming , SHI Jufang et al. Disease burden of female breast cancer in China[J]. Chinese Journal of Epidemiology, 2016, 37 (7): 970- 976
doi: 10.3760/cma.j.issn.0254-6450.2016.07.013
2 边甜甜, 林青, 李丽丽 et al. 对比数字乳腺断层合成与乳腺X线摄影对致密型乳腺内肿块的诊断价值[J]. 中华放射学杂志, 2015, 49 (7): 483- 487
BIAN Tiantian , LIN Qing , LI Lili et al. Diagnostic value in the evaluation of mass-like lesions in dense breasts:digital breast tomosynthesis versus conventional mammography[J]. Chinese Journal of Radiology, 2015, 49 (7): 483- 487
doi: 10.3760/cma.j.issn.1005-1201.2015.07.002
3 DESTOUNIS S . Role of digital breast tomosynthesis in screening and diagnostic breast imaging[J]. Semin Ultrasound CT MR, 2018, 39 (1): 35- 44
doi: 10.1053/j.sult.2017.08.002
4 ALZAGHAL A A , DIPIRO P J . Applications of advanced breast imaging modalities[J]. Curr Oncol Rep, 2018, 20 (7): 57
doi: 10.1007/s11912-018-0700-3
5 MERCADO C L . BI-RADS update[J]. Radiol Clin North Am, 2014, 52 (3): 481- 487
doi: 10.1016/j.rcl.2014.02.008
6 尤超, 顾雅佳, 彭卫军 et al. 采用数字乳腺断层结合合成二维图像对乳腺病变的鉴别诊断价值[J]. 中华放射学杂志, 2017, 51 (11): 828- 833
YOU Chao , GU Yajia , PENG Weijun et al. The differential diagnostic value of digital breast tomosynthesis in combination with synthesized two-dimensional images in breast disease[J]. Chinese Journal of Radiology, 2017, 51 (11): 828- 833
7 LAKHANI S R , ELLIS I O , SCHNITT S J et al. WHO classification of tumours of the breast[M]. 4th ed Lyon: IARC Press, 2012.
8 WEIGEL S , HEINDEL W , HEIDRICH J et al. Digital mammography screening:sensitivity of the programme dependent on breast density[J]. Eur Radiol, 2017, 27 (7): 2744- 2751
doi: 10.1007/s00330-016-4636-4
9 HORVAT J V , KEATING D M , RODRIGUES-DUARTE H et al. Calcifications at digital breast tomosynthesis:imaging features and biopsy techniques[J]. Radiographics, 2019, 39 (2): 307- 318
doi: 10.1148/rg.2019180124
10 DE MUNCK L , FRACHEBOUD J , DE BOCK G H et al. Is the incidence of advanced-stage breast cancer affected by whether women attend a steady-state screening program?[J]. Int J Cancer, 2018, 143 (4): 842- 850
doi: 10.1002/ijc.31388
11 MALL S , LEWIS S , BRENNAN P et al. The role of digital breast tomosynthesis in the breast assessment clinic:a review[J]. J Med Radiat Sci, 2017, 64 (3): 203- 211
doi: 10.1002/jmrs.2017.64.issue-3
12 RAFFERTY E A , DURAND M A , CONANT E F et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts[J]. JAMA, 2016, 315 (16): 1784- 1786
doi: 10.1001/jama.2016.1708
13 NAKASHIMA K , UEMATSU T , ITOH T et al. Comparison of visibility of circumscribed masses on digital breast tomosynthesis (DBT) and 2D mammography:are circumscribed masses better visualized and assured of being benign on DBT?[J]. Eur Radiol, 2017, 27 (2): 570- 577
doi: 10.1007/s00330-016-4420-5
14 LUPARIA A , MARISCOTTI G , DURANDO M et al. Accuracy of tumour size assessment in the preoperative staging of breast cancer:comparison of digital mammography, tomosynthesis, ultrasound and MRI[J]. Radiol Med, 2013, 118 (7): 1119- 1136
doi: 10.1007/s11547-013-0941-z
15 OZTEKIN P S , KOSAR P N . Magnetic resonance imaging of the breast as a problem-solving method:to be or not to be?[J]. Breast J, 2014, 20 (6): 622- 631
doi: 10.1111/tbj.2014.20.issue-6
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