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.