采用数字乳腺断层结合合成二维图像对乳腺病变的鉴别诊断价值

摘要

目的 探讨采用数字乳腺断层合成X线成像(DBT)结合合成二维(2D)图像对乳腺病变的鉴别诊断价值.方法 前瞻性收集2016年3月至5月复旦大学附属肿瘤医院和四川大学华西医院经临床检查乳腺发现可疑病灶,年龄≥18岁,且诊断经穿刺活检或手术病理或临床证实的167例(177个病灶)女性乳腺疾病患者.行全屏数字化乳腺X线成像(FFDM)和DBT检查,重组DBT检查获得合成2D图像(V-preview图像).对FFDM图像、V-preview图像、DBT结合FFDM图像、DBT结合V-preview图像进行分析,对病灶进行乳腺影像报告和数据系统(BI-RADS)分类,诊断病灶的良、恶性.记录患者FFDM和DBT两种检查方法中每个体位的平均腺体剂量.采用非参数Z检验比较4种类型图像上病灶BI-RADS分类诊断的差异;以病理和临床诊断结果为标准,采用ROC评价采用不同类型图像鉴别乳腺良、恶性病变的效能;采用独立样本t检验比较FFDM和DBT检查中平均腺体剂量的差异.结果 良性病灶103个、恶性病灶74个.FFDM与V-preview图像、DBT结合FFDM与DBT结合V-preview图像的BI-RADS分类差异无统计学意义(Z值分别为0.187、0.226,P值分别为0.851和0.821);DBT结合V-preview与V-preview图像的BI-RADS分类差异有统计学意义(Z值为3.546,P<0.01).DBT结合FFDM、DBT结合V-preview鉴别诊断乳腺良、恶性病变的ROC下面积均为0.899,诊断敏感度、特异度和准确度均为90.5%、89.3%和89.3%,优于FFDM和V-preview的ROC下面积(分别为0.822和0.817).FFDM和DBT的单个体位平均腺体剂量分别为(1.48±0.52)、(1.56±0.39)mGy,差异无统计学意义(t=1.714,P=0.087).结论 DBT合成的2D图像可代替常规FFDM图像,结合DBT诊断在不增加辐射剂量的前提下,可提高鉴别诊断良、恶性病变的效能.%Objective To investigate the diagnostic value and characteristics of breast lesion in digital breast tomosynthesis (DBT) in combination with synthesized two-dimensional (2D) images. Methods The prospective study enrolled women older than 18 years with clinically suspected breast lesion.One hundred and sixty seven patients with 177 lesions confirmed by biopsy or surgery were included. All the patients underwent full-field digital mammography(FFDM)and DBT examinations,and synthesized 2D images(V-preview)were reconstructed from DBT.The images of FFDM,V-preview images and DBT plus FFDM, V-preview images were analyzed. The breast imaging reporting and data system (BI-RADS) and characteristic for predicting benign and malignant lesion were also evaluated.The average glandular dose for a single mammographic view between FFDM and DBT was recorded.The Nonparametric Z test was used to compare the differences among four different mammographic images in BI-RADS.The differential diagnostic performance among different mammography was evaluated by ROC analysis.Independent t test was used to compare the average glandular dose between FFDM and DBT.Results One hundred three benign lesions and 74 malignant lesions were confirmed. Compared with FFDM images alone or plus DBT,the diagnostic values of V-preview images alone/or plus DBT were not significantly different(Z=0.187 and 0.226,P=0.851 and 0.821), but compared with V-preview, the diagnostic values of V-preview images plus DBT revealed significant difference(Z=3.546,P<0.01).The area under ROC for V-preview plus DBT were 0.899,and the sensitivity,specificity,and accuracy were 90.5%,89.3%,and 89.3%,separately.For the average glandular dose, there was no significant difference between FFDM (1.48 ± 0.52) mGy and DBT (1.56 ± 0.39) mGy examination(t=1.714,P=0.087).Conclusion Synthesized 2D images from DBT,which may eliminate the need for FFDM,in combination with DBT can improve the diagnostic efficiency.