低剂量DBT和FFDM在早期乳腺癌筛查中的价值研究

Value research of low-dose digital breast tomosynthesis and full-field digital mammography in screening early breast cancer

    摘要
  • 摘要:
    目的  探讨低剂量数字乳腺断层融合X射线成像（DBT）和全数字化乳腺X射线摄影（FFDM）在早期乳腺癌筛查中的价值。
    方法  前瞻性选取2020年1月至2022年4月在聊城市第二人民医院就诊的以乳腺肿块、乳腺胀痛为主要表现的246例女性患者，年龄（47.3±6.2）岁，范围28~65岁，均进行常规FFDM及低剂量DBT检查，并在超声引导下行穿刺活检。将活检组织病理学检查结果作为“金标准”，对比分析FFDM单独检查、低剂量DBT单独检查及二者联合筛查早期乳腺癌的灵敏度、特异度、准确率、阳性预测值、阴性预测值，并分析比较FFDM单独检查、低剂量DBT单独检查及二者联合检查与组织病理学检查结果的一致性。比较不同检查方法的腺体剂量和检查时间。计量资料的组间比较采用t检验或单因素方差分析，计数资料的组间比较采用χ2检验，不同检查方法与组织病理学检查结果的一致性分析采用Kappa检验。
    结果 纳入研究的246例患者中，经组织病理学检查确诊为早期乳腺癌192例、乳腺良性病变54例；经FFDM单独检查诊断为早期乳腺癌154例、乳腺良性病变92例；经低剂量DBT单独检查诊断为早期乳腺癌169例、乳腺良性病变77例；经FFDM联合低剂量DBT诊断为早期乳腺癌177例、乳腺良性病变69例。低剂量DBT单独检查诊断早期乳腺癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值均高于FFDM单独检查（86.98%对75.00%、96.30%对81.48%、89.02%对76.42%、98.82%对93.51%、67.53%对47.83%），且差异均有统计学意义（χ2=6.000~13.677，均P<0.05）；FFDM联合低剂量DBT诊断早期乳腺癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值均高于FFDM单独检查（90.63%对75.00%、94.44%对81.48%、91.46%对76.42%、98.31%对93.51%、73.91%对47.83%），且差异均有统计学意义（χ2=4.285~20.644，均P<0.05）；与FFDM联合低剂量DBT相比，低剂量DBT单独检查诊断早期乳腺癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值的差异均无统计学意义（χ2=0.159~1.283，均P>0.05）。FFDM单独检查、低剂量DBT单独检查及FFDM联合低剂量DBT诊断早期乳腺癌结果与组织病理学检查结果均具有良好的一致性（Kappa值=0.655、0.722、0.792）。FFDM单独检查（1.03±0.18） mGy、低剂量DBT单独检查（1.04±0.19） mGy及二者联合检查的腺体剂量（1.06±0.21） mGy的差异无统计学意义（F=1.529，P>0.05），FFDM单独检查时间（6.25±0.52） min与低剂量DBT单独检查时间（6.33±0.57） min的差异无统计学意义（t=1.626，P>0.05）。
    结论 相较于FFDM，低剂量DBT在早期乳腺癌筛查中的应用价值更高，且与组织病理学检查结果的一致性良好，可作为临床对早期乳腺癌进行筛查的重要检查手段。

     

    Abstract:
    Objective  To explore the value of low-dose digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in screening early breast cancer.
    Methods  A prospective selection was conducted on 246 female patients who received routine FFDM and low-dose DBT examinations at the Second People's Hospital of Liaocheng from January 2020 to April 2022. The age of the patients was 47.3±6.2 years, ranging from 28 to 65 years old, and breast masses and breast pain were the main manifestations. All patients underwent ultrasound-guided puncture biopsy. The results of histopathological examination on biopsy tissues were considered as the "gold standard", and the sensitivity, specificity, accuracy, and positive and negative predictive value of FFDM alone, low-dose DBT alone, and their combination in the screening of early breast cancer were compared and analyzed. Then, the consistency among the results of different examination methods and histopathological examination results were explored, and the glandular doses and examination times of the examination methods were compared. The intergroup comparison of quantitative data was conducted using t-test or one-way analysis of variance, whereas the intergroup comparison of counting data was conducted using χ2 test. Consistency analysis between different examination methods and histopathological examination were conducted using Kappa test.
    Results  Only 192 of the 246 patients included in the study were diagnosed with early breast cancer, and 54 cases were diagnosed with benign breast lesions through histopathological examination; 154 cases of early breast cancer and 92 cases of benign breast lesions were diagnosed by FFDM alone; 169 cases of early breast cancer and 77 cases of benign breast lesions were diagnosed by low-dose DBT alone; 177 cases of early breast cancer and 69 cases of benign breast lesions were diagnosed by FFDM combined with low-dose DBT. The sensitivity, specificity, accuracy, and positive and negative predictive value of low-dose DBT alone in the diagnosis of early breast cancer were higher than those of FFDM alone (86.98% vs. 75.00%, 96.30% vs. 81.48%, 89.02% vs. 76.42%, 98.82% vs. 93.51%, 67.53% vs. 47.83%), and the differences were statistically significant (χ2=6.000–13.677, all P<0.05); The sensitivity, specificity, accuracy, and positive and negative predictive value of FFDM combined with low-dose DBT in the diagnosis of early breast cancer were higher than those of FFDM alone (90.63% vs. 75.00%, 94.44% vs. 81.48%, 91.46% vs. 76.42%, 98.31% vs. 93.51%, 73.91% vs. 47.83%), and the differences were statistically significant (χ2=4.285–20.644, all P<0.05). The sensitivity, specificity, accuracy, and positive and negative predictive value of low-dose DBT alone in the diagnosis of early breast cancer had no statistically significant difference from those of FFDM combined with low-dose DBT (χ2=0.159–1.283, all P>0.05). The results of FFDM alone, low-dose DBT alone, and their combination in the diagnosis of early breast cancer all showed good consistency with the histopathological examination results (Kappa value=0.655, 0.722, 0.792). No statistically significant difference in glandular dose was found among FFDM alone ((1.03±0.18) mGy), low-dose DBT alone ((1.04±0.19) mGy), and their combination ((1.06±0.21) mGy; F=1.529, P>0.05), and no statistically significant difference was found between examination time of FFDM alone ((6.25±0.52) min) and examination time of low-dose DBT alone ((6.33±0.57) min; t=1.626, P>0.05).
    Conclusion Compared with FFDM, low-dose DBT has higher application value in screening early breast cancer and has good consistency with histopathological examination results, emerging as an important examination method for the clinical screening of early breast cancer.

     

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