姜金杰, 韩海林, 付焕杰, 杜群, 李丹, 肖纪涛. 低剂量DBT成像技术和FFDM在早期乳腺癌筛查中的价值研究[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202304023-00397
引用本文: 姜金杰, 韩海林, 付焕杰, 杜群, 李丹, 肖纪涛. 低剂量DBT成像技术和FFDM在早期乳腺癌筛查中的价值研究[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202304023-00397
Jinjie Jiang, Hailin Han, Huanjie Fu, Qun Du, Dan Li, Jitao Xiao. Value research of low-dose DBT and FFDM in screening early breast cancer[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202304023-00397
Citation: Jinjie Jiang, Hailin Han, Huanjie Fu, Qun Du, Dan Li, Jitao Xiao. Value research of low-dose DBT and FFDM in screening early breast cancer[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202304023-00397

低剂量DBT成像技术和FFDM在早期乳腺癌筛查中的价值研究

Value research of low-dose DBT and FFDM in screening early breast cancer

  • 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、低剂量DBT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、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诊断为早期乳腺癌154例、乳腺良性病变92例;经低剂量DBT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诊断早期乳腺癌的灵敏度(86.98%)、特异度(96.30%)、准确率(89.02%)、阳性预测值(98.82%)和阴性预测值(67.53%)均高于FFDM(75.00%、81.48%、76.42%、93.51%、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(90.63%)、特异度(94.44%)、准确率(91.46%)、阳性预测值(98.31%)和阴性预测值(73.91%)均高于FFDM,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诊断早期乳腺癌结果与组织病理学检查结果具有良好的一致性(Kappa值=0.655),低剂量DBT诊断早期乳腺癌结果与组织病理学检查结果具有良好的一致性(Kappa值=0.722),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具有良好的一致性(Kappa值=0.792)。FFDM(1.03±0.18)mGy、低剂量DBT(1.04±0.19)mGy及二者联合检查(1.06±0.21)mGy的腺体剂量的差异无统计学意义(F=1.529,P>0.05),FFDM检查时间(6.25±0.52)min与低剂量DBT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 246 female patients (age (47.3±6.2) years old, ranging from 28 to 65 years old) with breast lumps and breast swelling pain treated in the Second People's Hospital of Liaocheng from January 2020 to April 2022 were prospectively selected. All patients underwent routine FFDM and low-dose DBT examinations, and underwent ultrasound-guided puncture biopsy. The pathological examination results of biopsy tissue was taken as the "gold standard", and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FFDM, low-dose DBT and combination of the two in screening early breast cancer were compared and analyzed, and the consistency (Kappa value) between FFDM, low-dose DBT, alone and combination examination of the two and histopathological examination results were analyzed and compared. The average glandular dose and examination time of different examination methods were compared. The intergroup comparison of quantitative data adopted t test or one-way analysis of variance, while the intergroup comparison of counting data adopted χ2 test, and analysis of consistency between different examination methods and histopathological examination results adoptedKappa test.
    Results Of the 246 patients included in the study, 192 cases were diagnosed as early breast cancer and 54 cases were diagnosed as benign breast lesions by histopathological examination. 154 cases of early breast cancer and 92 cases of benign breast lesions were diagnosed by FFDM. 169 cases of early breast cancer and 77 cases of benign breast lesions were diagnosed by low-dose DBT. 177 cases of early breast cancer and 69 cases of benign breast lesions were diagnosed by FFDM combined with low-dose DBT. The sensitivity (86.98%), specificity (96.30%), accuracy (89.02%), positive predictive value (98.82%) and negative predictive value (67.53%) of low-dose DBT in the diagnosis of early breast cancer were higher than those of FFDM (75.00%, 81.48%, 76.42%, 93.51% and 47.83%), and the differences were statistically significant (χ2=6.000~13.677, all P<0.05). The sensitivity (90.63%), specificity (94.44%), accuracy (91.46%), positive predictive value (98.31%) and negative predictive value (73.91%) of FFDM combined with low-dose DBT in the diagnosis of early breast cancer were higher than those of FFDM, and the differences were statistically significant (χ2 =4.285~20.644, all P<0.05). There was no significant difference in the sensitivity, specificity, accuracy, positive predictive value and negative predictive value between low-dose DBT alone and FFDM combined with low-dose DBT in diagnosing early breast cancer (χ2=0.159~1.283, all P>0.05). The results of FFDM in the diagnosis of early breast cancer has good consistency with the histopathological examination results (Kappa value=0.655), and the results of low-dose DBT in the diagnosis of early breast cancer has good consistency with the histopathological examination results (Kappa value=0.722), and the combination diagnostic results of the two has good consistency with the histopathological examination results (Kappa value=0.792).. There was no statistically significant difference in the average glandular dose among FFDM (1.03±0.18)mGy, low-dose DBT (1.04±0.19) mGyand combined examination of the two (1.06±0.21) mGy (F=1.529, P>0.05), and there was no statistically significant difference between FFDM examination time (6.25±0.52) min and low-dose DBT examination time (6.33±0.57) min (t=1.626, P>0.05).
    Conclusions Compared with FFDM, low-dose DBT has higher application value in screening early breast cancer, and it has good consistency with histopathological examination results, which can be used as an important examination method for clinical screening of early breast cancer.

     

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