CAJ | 학술논문

目的：探讨数字乳腺断层合成（DBT）与数字乳腺X线摄影（DM）对致密型乳腺内肿块的诊断价值。方法回顾性分析经手术病理证实且行DBT及DM检查的858例乳腺疾病患者资料。参照乳腺影像报告和数据系统（BI?RADS）标准对患者DBT及DM图像的乳腺致密度及病变表现进行分类。纳入在DBT及DM图像上表现为肿块的致密型乳腺患者631例进行研究。631例术前均行双侧乳腺DM及患侧乳腺DBT检查。以组织病理结果为金标准，对采用DBT及DM图像对乳腺肿块的检出率、诊断符合率、敏感度、特异度、假阴性率、召回率、对肿块边缘的显示及BI?RADS分类进行评估。采用χ2检验比较采用2种检查方法对肿块的检出率、正确诊断率、良性病灶边缘、恶性病灶毛刺显示的差异，采用秩和检验比较2种检查方法BI?RADS分类的差异。结果 DBT与DM对致密型乳腺肿块的检出率分别为84.3%（532/631）和77.3%（488/631），对致密型乳腺肿块的诊断符合率分别为82.3%（519/631）和73.4%（463/631），差异均有统计学意义（c2值分别为27.191和36.890，P均<0.01)。DBT与DM对致密型乳腺内肿块诊断的敏感度分别为68.1%（205/301）和58.8%（177/301），特异度分别为95.2%（314/330）和86.7%（286/330），召回率分别为3.6%（23/631）和9.8%（62/631）。DBT与DM分别检出边缘清晰良性肿块172、75例，恶性肿块毛刺征182、115例，差异均有统计学意义（c2值分别为70.471和21.707，P均<0.01）。330例恶性肿块中，DM图像BI?RADS分类为0、2、3、4A、4B、4C、5类者分别为19、4、8、13、52、93、141例，DBT图像上述BI?RADS分类分别为3、1、7、5、52、83、179例，差异有统计学意义（Z=－2.235，P=0.025）；301例良性肿块中，DM图像BI?RADS分类为0、2、3、4A、4B、4C、5类者分别为43、10、60、117、58、11、2例，DBT图像上述BI?RADS分类分别为20、4、64、150、55、7、1例，差异无统计学意义（Z=－1.846，P=0.065）。结论 DBT能提高致密型乳腺内肿块的检出率，同时能更好地显示肿块边缘、病变周围结构扭曲，具有较大临床应用价值。目的：探討數字乳腺斷層閤成（DBT）與數字乳腺X線攝影（DM）對緻密型乳腺內腫塊的診斷價值。方法迴顧性分析經手術病理證實且行DBT及DM檢查的858例乳腺疾病患者資料。參照乳腺影像報告和數據繫統（BI?RADS）標準對患者DBT及DM圖像的乳腺緻密度及病變錶現進行分類。納入在DBT及DM圖像上錶現為腫塊的緻密型乳腺患者631例進行研究。631例術前均行雙側乳腺DM及患側乳腺DBT檢查。以組織病理結果為金標準，對採用DBT及DM圖像對乳腺腫塊的檢齣率、診斷符閤率、敏感度、特異度、假陰性率、召迴率、對腫塊邊緣的顯示及BI?RADS分類進行評估。採用χ2檢驗比較採用2種檢查方法對腫塊的檢齣率、正確診斷率、良性病竈邊緣、噁性病竈毛刺顯示的差異，採用秩和檢驗比較2種檢查方法BI?RADS分類的差異。結果 DBT與DM對緻密型乳腺腫塊的檢齣率分彆為84.3%（532/631）和77.3%（488/631），對緻密型乳腺腫塊的診斷符閤率分彆為82.3%（519/631）和73.4%（463/631），差異均有統計學意義（c2值分彆為27.191和36.890，P均<0.01)。DBT與DM對緻密型乳腺內腫塊診斷的敏感度分彆為68.1%（205/301）和58.8%（177/301），特異度分彆為95.2%（314/330）和86.7%（286/330），召迴率分彆為3.6%（23/631）和9.8%（62/631）。DBT與DM分彆檢齣邊緣清晰良性腫塊172、75例，噁性腫塊毛刺徵182、115例，差異均有統計學意義（c2值分彆為70.471和21.707，P均<0.01）。330例噁性腫塊中，DM圖像BI?RADS分類為0、2、3、4A、4B、4C、5類者分彆為19、4、8、13、52、93、141例，DBT圖像上述BI?RADS分類分彆為3、1、7、5、52、83、179例，差異有統計學意義（Z=－2.235，P=0.025）；301例良性腫塊中，DM圖像BI?RADS分類為0、2、3、4A、4B、4C、5類者分彆為43、10、60、117、58、11、2例，DBT圖像上述BI?RADS分類分彆為20、4、64、150、55、7、1例，差異無統計學意義（Z=－1.846，P=0.065）。結論 DBT能提高緻密型乳腺內腫塊的檢齣率，同時能更好地顯示腫塊邊緣、病變週圍結構扭麯，具有較大臨床應用價值。
목적：탐토수자유선단층합성（DBT）여수자유선X선섭영（DM）대치밀형유선내종괴적진단개치。방법회고성분석경수술병리증실차행DBT급DM검사적858례유선질병환자자료。삼조유선영상보고화수거계통（BI?RADS）표준대환자DBT급DM도상적유선치밀도급병변표현진행분류。납입재DBT급DM도상상표현위종괴적치밀형유선환자631례진행연구。631례술전균행쌍측유선DM급환측유선DBT검사。이조직병리결과위금표준，대채용DBT급DM도상대유선종괴적검출솔、진단부합솔、민감도、특이도、가음성솔、소회솔、대종괴변연적현시급BI?RADS분류진행평고。채용χ2검험비교채용2충검사방법대종괴적검출솔、정학진단솔、량성병조변연、악성병조모자현시적차이，채용질화검험비교2충검사방법BI?RADS분류적차이。결과 DBT여DM대치밀형유선종괴적검출솔분별위84.3%（532/631）화77.3%（488/631），대치밀형유선종괴적진단부합솔분별위82.3%（519/631）화73.4%（463/631），차이균유통계학의의（c2치분별위27.191화36.890，P균<0.01)。DBT여DM대치밀형유선내종괴진단적민감도분별위68.1%（205/301）화58.8%（177/301），특이도분별위95.2%（314/330）화86.7%（286/330），소회솔분별위3.6%（23/631）화9.8%（62/631）。DBT여DM분별검출변연청석량성종괴172、75례，악성종괴모자정182、115례，차이균유통계학의의（c2치분별위70.471화21.707，P균<0.01）。330례악성종괴중，DM도상BI?RADS분류위0、2、3、4A、4B、4C、5류자분별위19、4、8、13、52、93、141례，DBT도상상술BI?RADS분류분별위3、1、7、5、52、83、179례，차이유통계학의의（Z=－2.235，P=0.025）；301례량성종괴중，DM도상BI?RADS분류위0、2、3、4A、4B、4C、5류자분별위43、10、60、117、58、11、2례，DBT도상상술BI?RADS분류분별위20、4、64、150、55、7、1례，차이무통계학의의（Z=－1.846，P=0.065）。결론 DBT능제고치밀형유선내종괴적검출솔，동시능경호지현시종괴변연、병변주위결구뉴곡，구유교대림상응용개치。
Objective To compare the diagnostic value of digital breast tomosynthesis (DBT) versus digital mammography (DM) in the evaluation mass like lesions in dense breasts. Methods Eight hundred and fifty eight patients, who had DBT and DM, with breast diseases confirmed by pathology were retrospectively reviewed. The breast density and the imaging features were classified according to the standard of American College of Radiology(2013) and breast imaging reporting and data system (BI?RADS) scores. Six hundred and thirty one patients with mass lesions in dense breasts were chosen to included. All 631 patients had DM of both breasts and DBT of affected breast prior to mastectomy. Pathological results were used as the golden standard. Detection rate and diagnostic accuracy of masses, sensitivity and specificity of diagnosis, false negative and recall rates, the margins and spicules and BI?RADS category were calculated. The detection rate and diagnostic accuracy, the margins and spicules of masses were compared with Chi?square test, the BI?RADS scores were analyzed with rank test. Results With DBT, average detection rate increased from 77.3%(488/631) to 84.3% (532/631), average diagnostic accuracy rate increased from 73.4%(463/631) to 82.3%(519/631),with statistical significant difference between groups (c2=27.191,36.890,P<0.01).Sensitivity for DBT and DM were 68.1%(205/301) and 58.8%(177/301), respectively. Specificity for DBT and DM were 95.2%(314/330)and 86.7%(286/330), respectively. Recall rate for DBT and DM were 3.6%(23/631)and 9.8%(62/631), respectively. One hundred and seventy two cases and 75 cases with circumscribed masses of benign cases were detected by DBT and DM, respectively. One hundred and eighty-two cases and 115 cases with spiculated masses of malignant cases were detected by DBT and DM, respectively, with statistical significant difference between groups (c2=70.471 and 21.707, P<0.01). Of 330 malignant cases, the numbers of BI?RADS category 0, 2, 3, 4A, 4B, 4C, 5 on DM images were 19,4,8,13,52,93,141, respectively, the numbers on DBT images were 3,1,7,5,52,83,179, respectively, with statistical significant difference(Z=-2.235,P=0.025). Of 301 benign cases, the number of BI?RADS category 0, 2, 3, 4A, 4B, 4C, 5 on DM images were 43,10,60,117,58,11,2, respectively, the number on DBT images were 20,4,64,150,55,7,1, respectively, with no statistical significant difference between groups(Z=-1.846,P=0.065). Conclusion DBT significantly improves the detection of mass?like lesions in dense breasts, display of mass margin and architectural distortion of surrounding tissue.