CAJ | 학술논문

目的：探讨数字乳腺断层合成X线成像（DBT）结合全屏数字化乳腺X线成像（FFDM）诊断乳腺良、恶性病变的价值。方法前瞻性收集经临床或超声检查乳腺发现可疑肿块，最终诊断经病理证实，且术前或穿刺活检前均行FFDM、DBT和乳腺专用MRI（DB-MRI）检查的46例患者的图像资料。观察各检查图像上乳腺病变表现，对3种检查图像上病变进行乳腺影像报告和数据系统（BI-RADS）分类，并对DBT结合FFDM、单独FFDM图像中病灶的可见性进行分级评估。以病理结果为金标准，采用ROC曲线分析FFDM、FFDM结合DBT及DB-MRI的诊断效能，并采用Z检验比较FFDM结合DBT与其他2种检查方法的差异。结果46例中，良性病灶14例，恶性病灶32例。DBT结合FFDM与单独FFDM图像相比，35例采用DBT结合FFDM可见性分级提高，其中恶性病变27例，23例表现为肿块伴毛刺及结构扭曲；良性病变8例，6例伴晕征。11例DBT结合FFDM与单独FFDM图像可见性分级无变化。FFDM检查中，BI-RADS 0类病灶为23.9%（11/46），在其他2种检查中也均为0；BI-RADS 3类病灶在DBT结合FFDM检查中显示率最低（6.5%，3/46）。病灶在DBT结合FFDM图像上表现为肿块或结构扭曲时，MRI上表现为类似的肿块样或非肿块样强化。以病理结果为金标准，剔除FFDM中BI-RADS 0类的11例，35例患者DBT结合FFDM、FFDM诊断乳腺良、恶性病变的ROC曲线下面积分别为0.955、0.878，差异有统计学意义（Z=2.132，P=0.033）。46例患者DBT结合FFDM、MRI诊断乳腺良、恶性病变的ROC曲线下面积分别为0.887、0.908，差异无统计学意义（Z=0.502，P=0.616）。结论 DBT结合FFDM较常规FFDM检查能够提高乳腺病灶的显示及诊断效能，而DBT与MRI两种检查的诊断效能相当。
목적：탐토수자유선단층합성X선성상（DBT）결합전병수자화유선X선성상（FFDM）진단유선량、악성병변적개치。방법전첨성수집경림상혹초성검사유선발현가의종괴，최종진단경병리증실，차술전혹천자활검전균행FFDM、DBT화유선전용MRI（DB-MRI）검사적46례환자적도상자료。관찰각검사도상상유선병변표현，대3충검사도상상병변진행유선영상보고화수거계통（BI-RADS）분류，병대DBT결합FFDM、단독FFDM도상중병조적가견성진행분급평고。이병리결과위금표준，채용ROC곡선분석FFDM、FFDM결합DBT급DB-MRI적진단효능，병채용Z검험비교FFDM결합DBT여기타2충검사방법적차이。결과46례중，량성병조14례，악성병조32례。DBT결합FFDM여단독FFDM도상상비，35례채용DBT결합FFDM가견성분급제고，기중악성병변27례，23례표현위종괴반모자급결구뉴곡；량성병변8례，6례반훈정。11례DBT결합FFDM여단독FFDM도상가견성분급무변화。FFDM검사중，BI-RADS 0류병조위23.9%（11/46），재기타2충검사중야균위0；BI-RADS 3류병조재DBT결합FFDM검사중현시솔최저（6.5%，3/46）。병조재DBT결합FFDM도상상표현위종괴혹결구뉴곡시，MRI상표현위유사적종괴양혹비종괴양강화。이병리결과위금표준，척제FFDM중BI-RADS 0류적11례，35례환자DBT결합FFDM、FFDM진단유선량、악성병변적ROC곡선하면적분별위0.955、0.878，차이유통계학의의（Z=2.132，P=0.033）。46례환자DBT결합FFDM、MRI진단유선량、악성병변적ROC곡선하면적분별위0.887、0.908，차이무통계학의의（Z=0.502，P=0.616）。결론 DBT결합FFDM교상규FFDM검사능구제고유선병조적현시급진단효능，이DBT여MRI량충검사적진단효능상당。
Objective To investigate the diagnostic value of digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) in benign and malignant breast disease.Methods The prospective study enrolled 46 consenting women with a clinical suspicious of breast lesion confirmed by pathology. All the patients underwent DBT, FFDM and dedicated breast magnetic resonance image (DB-MRI) examinations before surgery or biopsy. To observe the manifestation of breast disease in different examinations according to breast imaging reporting and data system (BI-RADS), and to evaluate the visibility grade of disease between DBT plus FFDM and FFDM alone. Using receiving operating characteristic(ROC) and Z test to analysis the diagnostic efficiency of three examinations.Results Forty-six cases included 14 benign cases and 32 malignant cases. Compared with FFDM, 35 cases showed increased visibility in DBT plus FFDM, that the malignant lesion manifested mass with speculated and architectural distortion(23/27) and the benign lesion manifested mass with halo sign(6/8). Eleven cases didn't show increase visibility in both DBT plus FFDM and FFDM alone. The ration of BI-RADS 0 in FFDM was 23.9%(11/46), meanwhile in other two examination were 0. The ration of BI-RADS 3 in DBT plus FFDM was the lowest(6.5%, 3/46). When the lesion in DBT plus FFDM showed mass or speculated, in MRI showed similar morphology with mass or mass-like enhancement. According pathology as the gold standard, excluded 11 cases with BI-RADS 0 in FFDM, there was significant statistical difference between DBT plus FFDM and FFDM alone in 35 cases (Z=2.132, P=0.033) to differentiate benign and malignant breast disease, the area of ROC curve were respectively 0.955, 0.878. There is no statistical difference between DBT plus FFDM and MRI in 46 cases (Z=0.502, P=0.616), the area of ROC curve were respectively 0.887, 0.908.Conclusion DBT combined with FFDM can improve both detection of breast lesion and diagnostic efficiency, while the performance value between DBT and MRI are equal.