Digital breast tomosynthesis in diagnosis of dense breast lesions

doi:10.3785/j.issn.1008-9292.2019.04.10

J Zhejiang Univ (Med Sci)

2019, Vol. 48

Issue (2): 186-192 DOI: 10.3785/j.issn.1008-9292.2019.04.10

Digital breast tomosynthesis in diagnosis of dense breast lesions

XU A'qiao¹(

),HE Hongqin¹,SHI Qiujun¹,LI Zhiqing²,ZHANG Shengjian^3,*(

)

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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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

Received: 30 November 2018 Published: 24 July 2019

CLC:	R445
	R737.9

Corresponding Authors: ZHANG Shengjian E-mail: 737730@qq.com;zhangshengjian@yeah.net

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	XU A'qiao
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	SHI Qiujun
	LI Zhiqing
	ZHANG Shengjian

Cite this article:

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.

URL:

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

数字化乳腺断层融合摄影对致密型乳腺病变的诊断价值

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

Fig 1 ROC curves of MRI and digital breast tomosynthesis(DBT) in diagnosis of benign and malignant breast lesions

Fig 2 Comparative features of digital breast tomosynthesis (DBT) and MRI images in breast malignant tumors


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