CAJ | 학술논문

目的评价乳腺实质密度对计算机辅助检测(CAD)诊断乳腺癌的影响.方法收集2008年2月至2009年12月间确诊的271例乳腺恶性病变患者及随机抽取的238例正常对照者,依据美国放射学会制定的乳腺影像学报告及数据系统(BI-RADS)标准进行乳腺实质分型,乳腺X线片表现为Ⅰ型或2型的定义为非致密型乳腺,表现为3型或4型的定义为致密型乳腺.乳腺X线摄影采用全视野数字化乳腺成像X线造影成像系统,常规采用头尾位和内外斜位投照.图像采集完毕后,数据传输到SenoAdvantage回放工作站,由CAD系统对病变组和对照组分别进行标记.对CAD在非致密型乳腺与致密型乳腺间的敏感性和假阳性率进行比较.结果 271例乳腺恶性病变患者中,CAD总的敏感性为84.1％( 228/271),致密型乳腺与非致密型乳腺之间敏感性比较,差异有统计学意义(P=0.015).CAD对肿块的敏感性为76.5％ (186/243),对钙化的敏感性为79.1％ (125/158),二者之间差异无统计学意义(P=0.547).CAD对肿块的敏感性在致密型乳腺与非致密型乳腺之间差异有统计学意义(P=0.001),对钙化的敏感性在二者之间差异无统计学意义(P=0.216).正常对照组中,致密型乳腺与非致密型乳腺间假阳性肿块标记差异无统计学意义(P =0.207),假阳性钙化标记差异有统计学意义(P=0.001)；假阳性标记差异有统计学意义(P=0.043).结论乳腺实质密度影响CAD对乳腺癌探查的敏感性,在非致密型乳腺与致密型乳腺间CAD的敏感性有显著差异；CAD的假阳性率在致密型乳腺中低于非致密型乳腺.对致密型乳腺中无钙化的早期肿块,CAD的探测有明显局限性.
목적 평개유선실질밀도대계산궤보조검측(CAD)진단유선암적영향.방법 수집2008년2월지2009년12월간학진적271례유선악성병변환자급수궤추취적238례정상대조자,의거미국방사학회제정적유선영상학보고급수거계통(BI-RADS)표준진행유선실질분형,유선X선편표현위Ⅰ형혹2형적정의위비치밀형유선,표현위3형혹4형적정의위치밀형유선.유선X선섭영채용전시야수자화유선성상X선조영성상계통,상규채용두미위화내외사위투조.도상채집완필후,수거전수도SenoAdvantage회방공작참,유CAD계통대병변조화대조조분별진행표기.대CAD재비치밀형유선여치밀형유선간적민감성화가양성솔진행비교.결과 271례유선악성병변환자중,CAD총적민감성위84.1％( 228/271),치밀형유선여비치밀형유선지간민감성비교,차이유통계학의의(P=0.015).CAD대종괴적민감성위76.5％ (186/243),대개화적민감성위79.1％ (125/158),이자지간차이무통계학의의(P=0.547).CAD대종괴적민감성재치밀형유선여비치밀형유선지간차이유통계학의의(P=0.001),대개화적민감성재이자지간차이무통계학의의(P=0.216).정상대조조중,치밀형유선여비치밀형유선간가양성종괴표기차이무통계학의의(P =0.207),가양성개화표기차이유통계학의의(P=0.001)；가양성표기차이유통계학의의(P=0.043).결론 유선실질밀도영향CAD대유선암탐사적민감성,재비치밀형유선여치밀형유선간CAD적민감성유현저차이；CAD적가양성솔재치밀형유선중저우비치밀형유선.대치밀형유선중무개화적조기종괴,CAD적탐측유명현국한성.
Objective To evaluate the impact of breast density on computer-aided detection (CAD) for breast cancer and the CAD false-positive rate of normal controls.Methods Two hundred and seventy-one histologically proven breast malignant lesions (from Feb.2008 to Dec.2009) and 238 randomly selected normal cases were classified by mammographic density according to the American College of Radiology breast imaging reporting and data system (BI-RADS).Mammograms of BI-RADS 1 or BI-RADS 2 density were categorized as non-dense breasts,and those of BI-RADS 3 or BI-RADS 4 density were categorized as dense breasts.Full-field digital mammography (GEMS Senographe) were performed in all patients and controls with craniocaudal (CC) and mediolateral oblique (MLO) views.Then the image data were transferred to review workstation ( SenoAdvantage ),and the lesions were marked by Second Look Digital CAD system ( version 7.2,iCAD).The differences of sensitivity and false-positive rate between dense and non-dense breasts were compared.Results Overall,the sensitivity of CAD in detection of cancers was 84.1％ (228/271),there was a statistically significant difference in CAD of cancers in dense versus non-dense breasts (P =0.015 ).The sensitivity of CAD in detection of mass cancers was 76.5％( 186/243 ),in detection of calcification cancers was 79.1％ ( 125/158 ),there was no statistically significant difference in CAD performance for the detection of mass cancers versus calcification cancers ( P =0.547 ).There was a significant difference in the CAD performance for the detection of mass cancer cases in non-dense versus dense breasts (P =0.001 ),but no significant difference in the CAD for the detection of calcification cancers in non-deuse versus dense breasts (P =0.216).In the controls,the distribution of mass false-positive marks did not differ significantly between non-dense and dense breast tissue cases ( P =0.207 ),but the distribution of calcification false-positive marks differed significantly between non-dense and dense breast tissue cases ( P =0.001 ).There was a statistically significant difference of false-positive marks in non-dense versus dense breasts (P =0.043 ).Conclusions The sensitivity of CAD in the detection of breast cancers is impacted by breast density.There is a statistically significant difference in the CAD performance for the detection of cancer cases in non-dense versus dense breasts.The false-positive rate of CAD is lower in dense versus non-dense breasts.It appears difficult for CAD in the early detection of breast cancer in the absence of microcalcifications,particularly in dense breasts.