比较数字乳腺断层合成术(DBT)和MRI作为全视野数字乳腺X线摄影(FFDM)的辅助手段,用于基于乳腺密度的乳腺癌女性术前评估。
这项回顾性研究纳入了280名接受FFDM的乳腺癌患者,DBT,和MRI术前局部肿瘤分期。三位放射科医生单独使用FFDM来寻找癌症和其他同侧和对侧乳腺癌的指标,DBT加FFDM,或MRI加FFDM。根据乳房X线摄影密度,在所有患者和乳腺致密(n=186)和乳腺非致密(n=94)亚组的阅读模式中比较了三位放射科医生的诊断表现。
280名患者中,除索引癌症外,46例(16.4%)还有48例(同侧39例和对侧9例)癌症。对于索引癌症,在非致密组中,DBT加FFDM和MRI加FFDM的敏感性均为100%.在密集的群体中,DBT加FFDM的敏感性低于MRI加FFDM(94.6%vs.99.6%,p<0.001)。对于其他同侧癌症,DBT加FFDM在非致密组中表现出100%的特异性和阳性预测值(PPV),但敏感性和阴性预测值(NPV)与MRI加FFDM无统计学差异(p>0.05)。在密集的群体中,DBT加FFDM显示更高的特异性(98.2%vs.94.1%,p=0.005)和PPV(83.1%vs.65.4%;p=0.036)比MRI+FFDM高,但灵敏度较低(59.9%与75.3%;p=0.049)。对于对侧癌症,DBT加FFDM比MRI加FFDM显示更高的特异性(99.0%vs.96.7%,p=0.014),然而,其他值在致密组中没有差异(所有p>0.05)。
无论乳腺密度如何,DBT加FFDM的总体特异性均高于MRI加FFDM,在其他癌症的诊断中,敏感性和NPV可能没有实质性损失。因此,DBT可能有可能用作术前乳腺癌分期工具。
To compare digital breast tomosynthesis (DBT) and MRI as an adjunct to full-field digital mammography (FFDM) for the preoperative evaluation of women with breast cancer based on mammographic density.
This retrospective study enrolled 280 patients with breast cancer who had undergone FFDM, DBT, and MRI for preoperative local tumor staging. Three radiologists independently sought the index cancer and additional ipsilateral and contralateral breast cancers using either FFDM alone, DBT plus FFDM, or MRI plus FFDM. Diagnostic performances across the three radiologists were compared among the reading modes in all patients and subgroups with dense (n = 186) and non-dense breasts (n = 94) according to mammographic density.
Of 280 patients, 46 (16.4%) had 48 additional (39 ipsilateral and nine contralateral) cancers in addition to the index cancer. For index cancers, both DBT plus FFDM and MRI plus FFDM showed sensitivities of 100% in the non-dense group. In the dense group, DBT plus FFDM showed lower sensitivity than that of MRI plus FFDM (94.6% vs. 99.6%, p < 0.001). For additional ipsilateral cancers, DBT plus FFDM showed specificity and positive predictive value (PPV) of 100% in the non-dense group, but sensitivity and negative predictive value (NPV) were not statistically different from those of MRI plus FFDM (p > 0.05). In the dense group, DBT plus FFDM showed higher specificity (98.2% vs. 94.1%, p = 0.005) and PPV (83.1% vs. 65.4%; p = 0.036) than those of MRI plus FFDM, but lower sensitivity (59.9% vs. 75.3%; p = 0.049). For contralateral cancers, DBT plus FFDM showed higher specificity than that of MRI plus FFDM (99.0% vs. 96.7%, p = 0.014), however, the other values did not differ (all p > 0.05) in the dense group.
DBT plus FFDM showed an overall higher specificity than that of MRI plus FFDM regardless of breast density, perhaps without substantial loss in sensitivity and NPV in the diagnosis of additional cancers. Thus, DBT may have the potential to be used as a preoperative breast cancer staging tool.