全数字化乳腺摄影、数字乳腺断层摄影与DCE-MRI对乳腺肿物诊断效能的比较
Comparison of the Diagnostic Efficacy of Full-field Digital Mammography, Digital Breast Tomography and DCE-MRI for Breast Tumors
- 中山大学学报（医学科学版） 2020年41卷第4期 页码：603-610
- 作者机构：
中山大学孙逸仙纪念医院放射科，广东 广州 510120
- 作者简介：
王智慧，学士，研究方向：磁共振成像技术，E-mail: wangzhh57@mail.sysu.edu.cn
- 基金信息：国家自然科学基金(81801756)
DOI：
中图分类号： R445.2纸质出版日期：2020-07-15，
收稿日期：2020-02-24，
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王智慧,卢国雄,颜卓恒等.全数字化乳腺摄影、数字乳腺断层摄影与DCE-MRI对乳腺肿物诊断效能的比较[J].中山大学学报（医学科学版）,2020,41(04):603-610.
WANG Zhi-hui,LU Guo-xiong,YAN Zhuo-heng,et al.Comparison of the Diagnostic Efficacy of Full-field Digital Mammography, Digital Breast Tomography and DCE-MRI for Breast Tumors[J].Journal of Sun Yat-sen University(Medical Sciences),2020,41(04):603-610.
王智慧,卢国雄,颜卓恒等.全数字化乳腺摄影、数字乳腺断层摄影与DCE-MRI对乳腺肿物诊断效能的比较[J].中山大学学报（医学科学版）,2020,41(04):603-610. DOI：
WANG Zhi-hui,LU Guo-xiong,YAN Zhuo-heng,et al.Comparison of the Diagnostic Efficacy of Full-field Digital Mammography, Digital Breast Tomography and DCE-MRI for Breast Tumors[J].Journal of Sun Yat-sen University(Medical Sciences),2020,41(04):603-610. DOI：
摘要
目的
2
本文旨在对比全数字化乳腺摄影（FFDM），数字乳腺断层摄影（DBT）及动态增强磁共振成像（DCE-MRI）对不同腺体中乳腺肿物的诊断效能。
方法
2
回顾性分析49例同时行FFDM、DBT及MRI检查的乳腺病变患者的56个病灶，依据FFDM将乳腺分为非致密型与致密型，分别依据FFDM、DBT及MRI对乳腺病变进行BI-RADS分级，4a级及以下定义为良性，4b级及以上定义为恶性。所有病人均行手术或活检获取病理诊断作为金标准。采用
kappa
一致性检验与受试者工作特征（ROC）曲线对比FFDM、DBT与MRI在不同腺体类型中对乳腺肿物的诊断效能。
结果
2
在全部乳腺腺体中，MRI诊断（
kappa
= 0.66）与病理诊断一致性高于DBT（
kappa
= 0.44），而FFDM诊断与病理无显著一致性（
kappa
= 0.14），在非致密型乳腺中，MRI诊断（
kappa
= 0.88）与病理诊断一致性高于DBT（
kappa
= 0.51），而FFDM诊断与病理无显著一致性（
kappa
= 0.18）。在致密型乳腺中，MRI诊断（
kappa
= 0.54）与病理诊断一致性高于DBT（
kappa
= 0.37），而FFDM诊断与病理诊断无显著一致性（
kappa
= 0.10）。在全部乳腺腺体中，MRI、DBT与FFDM对乳腺肿物的诊断效能逐渐减低（AUC = 0.83、 0.73、 0.58）。具体表现为MRI、DBT与FFDM诊断乳腺肿物的特异度依次升高（77%、 82%、 86%），灵敏度依次降低（88%、 65%、 29%）。在非致密型乳腺中，MRI、DBT与FFDM对乳腺肿物的诊断效能逐渐减低（AUC = 0.97、 0.84、 0.66）。具体表现为，MRI诊断乳腺肿物的灵敏度（94%）高于DBT（69%）高于FFDM（31%）。在致密型乳腺中，MRI、DBT与FFDM对乳腺肿物的诊断效能逐渐减低（AUC = 0.77、 0.69、 0.55）。具体表现为，MRI、DBT与FFDM诊断乳腺肿物的特异度依次升高（71%、 76%、 82%），灵敏度依次降低（83%、 61%、 28%）。
结论
2
无论在致密型还是非致密型乳腺中，FFDM的诊断效能均最低。在非致密型乳腺中，MRI的诊断效能高于DBT。在致密型乳腺中，DBT诊断特异度高于MRI，具有一定的优势。
Abstract
Objective
2
To compare the diagnostic efficacy of full-field digital mammography (FFDM)
digital breast mammography (DBT) and dynamic enhanced magnetic resonance imaging (DCE-MRI) for breast tumors in different gland types.
Methods
2
Retrospective analyses of 56 breast lesions in 49 patients who underwent FFDM
DBT and MRI in the Department of Radiology
Sun Yat-sen Memorial Hospital
Sun Yat-sen University from October 2018 to December 2019 were performed. The breasts were divided into the non-dense or dense pattern
according to FFDM images. The breast lesions were diagnosed as benign (BI-RADS grade 4a and below) or malignant (BI-RADS grade 4b and above)
based on the images of FFDM
DBT and MRI
respectively. All patients underwent surgery or biopsy to get a pathological diagnosis. The kappa consistency tests and receiver operating characteristics (ROC) analyses were used to compare the efficacy of FFDM
DBT and MRI in the diagnosis of breast tumor in different gland patterns.
Results
2
In all breasts
MRI (
kappa =
0.66) was moderately consistent with pathological diagnosis
which was higher than DBT (
kappa =
0.44)
while there was no significant difference between FFDM
(kappa =
0.14) and pathological diagnosis. In non-dense breasts
MRI (
kappa =
0.88) was moderately consistent with pathological diagnosis
which was higher than DBT (
kappa =
0.51)
while there was no significant difference between FFDM (
kappa =
0.18) and pathological diagnosis. In dense breasts
MRI (
kappa =
0.54) was moderately consistent with pathological diagnosis
which was higher than DBT (
kappa =
0.37)
while there was no significant difference between FFDM (
kappa =
0.10) and pathological diagnosis. In all breasts
the diagnostic efficacy of MRI
DBT and FFDM for breast tumor decreased gradually (AUC = 0.83; 0.73; 0.58). Specifically
the specificity of MRI
DBT and FFDM increased sequentially (77%
82%
86%)
but the sensitivity decreased (88%
65%
29%). In non-dense breasts
the diagnostic efficacy of MRI
DBT and FFDM for breast tumor decreased gradually (AUC = 0.97; 0.84; 0.66). Specifically
the sensitivity of MRI (94%) was higher than that of DBT (69%) and FFDM (31%). In dense breasts
the diagnostic efficacy of MRI
DBT and FFDM for breast tumor decreased gradually (AUC = 0.77; 0.69; 0.55). Specifically
the specificity of MRI
DBT and FFDM increased sequentially (71%
76%
82%)
but the sensitivity decreased (83%
61%
28%).
Conclusions
2
In both dense and non-dense breasts
FFDM has the lowest diagnostic ability. In non-dense breasts
the diagnostic efficacy of MRI is higher than DBT. DBT shows its advantage over MRI in dense breasts
as it has a higher diagnostic specificity.
关键词
全数字化乳腺摄影数字乳腺断层摄影磁共振成像乳腺肿物
Keywords
full-field digital mammographydigital breast tomographymagnetic resonance imagingbreast tumor
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