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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 25 -30. doi: 10.3877/cma.j.issn.1674-0807.2024.01.004

论著

数字乳腺体层合成和全视野数字乳腺X线摄影技术在不同体位组合下的诊断效能
陈穹1,†(), 潘鑫1, 应伟峰1, 侯羽宇1, 路明1, 安冬清1, 顾佳瑶1, 彭卫军2   
  1. 1. 200237　上海市徐汇区大华医院放射科
    2. 200231　上海，复旦大学附属肿瘤医院影像中心
  • 收稿日期:2023-10-10 出版日期:2024-02-01
  • 通信作者: 陈穹
  • 基金资助:
    上海市卫生健康委员会临床研究面上项目(202140074); 上海市徐汇区卫生健康委员会面上项目(SHXH202207)

Diagnostic efficiency of digital breast tomosynthesis and full-field digital mammography under different position combinations

Qiong Chen1,†(), Xing Pan1, Weifeng Ying1, Yuyu Hou1, Ming Lu1, Dongqin An1, Jayao Gu1, Weijun Peng2   

  1. 1. Department of Radiology, Dahua Hospital of Xuhui District, Shanghai 200237, China
    2. Department of Radiology, Affiliated Cancer Hospital of Fudan University, Shanghai 200231, China.
  • Received:2023-10-10 Published:2024-02-01
  • Corresponding author: Qiong Chen
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引用本文：

陈穹, 潘鑫, 应伟峰, 侯羽宇, 路明, 安冬清, 顾佳瑶, 彭卫军. 数字乳腺体层合成和全视野数字乳腺X线摄影技术在不同体位组合下的诊断效能[J]. 中华乳腺病杂志(电子版), 2024, 18(01): 25-30.

Qiong Chen, Xing Pan, Weifeng Ying, Yuyu Hou, Ming Lu, Dongqin An, Jayao Gu, Weijun Peng. Diagnostic efficiency of digital breast tomosynthesis and full-field digital mammography under different position combinations[J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(01): 25-30.

目的

对比分析数字乳腺体层合成(DBT)和全视野数字乳腺X线摄影(FFDM)2种不同乳腺摄影方法在不同体位组合下的辐射剂量和诊断效能。

方法

回顾性分析2018年5月至2022年1月在上海市徐汇区大华医院外科门诊就诊的419例(共837个乳房)同时行乳腺DBT与FFDM检查的患者资料，按照不同摄影组合分为：A组，FFDM头尾位(CC)＋内外侧斜位(MLO)；B组，FFDM(CC)＋DBT(MLO)；C组，FFDM(MLO)＋DBT(CC)；D组，DBT(CC＋MLO)；F组，FFDM(CC＋MLO)＋DBT(CC＋MLO)。以最终病理结果为诊断依据。采用单因素方差分析与事后检验比较5组的乳腺辐射吸收剂量和影像学特征检出率，分别绘制5组恶性病变诊断的受试者操作特征曲线(ROC)，曲线下面积的组间比较采用非参数检验，两两比较采用Delong检验。

结果

5组患者的辐射吸收量比较差异有统计学意义[ A组为(1.975±0.752)mGy，B组为(3.039±1.173)mGy，C组为(2.998±1.059)mGy，D组为(4.023±1.482)mGy，F组为(6.037±2.154)mGy，F＝996.373，P<0.001)]。组间两两比较除了B组与C组间差异无统计学意义外，余各组间比较，差异均有统计学意义(P均<0.001)。837个乳房行X线摄影共发现乳腺恶性病变45个，各组诊断ROC曲线下面积分别为：0.913(95%CI：0.892～0.931)、0.979(95%CI：0.966～0.987)、0.983(95%CI：0.972～0.991)、0.982(95%CI：0.970～0.990)和0.986(95%CI：0.976～0.993)，组间比较差异有统计学意义(Z＝114.744，P<0.001)。A组与B、C、D、F组ROC曲线下面积比较，差异均有统计学意义(Z＝2.358、2.497、2.442、2.607，P＝0.018、0.013、0.015、0.009)；B组与C、F组比较，差异也有统计学意义(Z＝2.287、2.338，P＝0.022、0.019)；D组与F组比较，差异也有统计学意义(Z＝3.096，P＝0.002)。5种组合的诊断敏感度与特异度分别为：A组75.56%、96.46%；B组91.11%、95.45%；C组91.11%、96.21%；D组93.33%、95.58%；F组93.33%、95.71%。

结论

FFDM(MLO)＋ DBT(CC)的联合使乳腺X线摄影在兼顾低辐射剂量的同时，不损失诊断效能。

关键词: 辐射吸收剂量, 诊断, 乳腺X线摄影
Objective

To compare the radiation dose and diagnostic efficiency of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) under different position combinations.

Methods

A retrospective analysis was performed in 419 patients (837 breasts) who underwent both DBT and FFDM in the surgical clinic of Dahua Hospital, Xuhui District, Shanghai from May 2018 to January 2022. According to different photographic combinations, the patients were divided into five groups: group A, FFDM [(craniocaudal, CC) + (mediolateral oblique, MLO)]; group B, FFDM (CC) + DBT (MLO); group C, FFDM (MLO) + DBT (CC); group D, DBT (CC + MLO); group F, FFDM (CC + MLO) + DBT (CC + MLO). The final pathological results were used as the diagnostic basis. One-way analysis of variance and post-hoc test were used to compare the radiation dose and detection rate of different imaging features among five groups. The receiver operating characteristic (ROC) curves of the five groups were drawn for the diagnostic efficiency of malignant lesions, the non-parametric test was used for the comparison of the area under the curve between groups, and the Delong test was used for pairwise comparison.

Results

There was a significant difference in the radiation dose among the five groups [group A: (1.975±0.752) mGy; group B: (3.039±1.173) mGy; group C: (2.998±1.059) mGy; group D: (4.023±1.482) mGy; group F: (6.037±2.154) mGy; F=996.373, P<0.001]. Except no significant difference between group B and group C, pairwise comparison showed a significant difference between groups (all P<0.001). A total of 45 malignant lesions were found in 837 breasts. The areas under the ROC curve were 0.913 (95%CI: 0.892-0.931), 0.979 (95%CI: 0.966-0.987), 0.983 (95%CI: 0.972-0.991), 0.982 (95%CI: 0.970-0.990) and 0.986 (95%CI: 0.976-0.993) in groups A-F, respectively, indicating a significant differences between groups (Z=114.744, P<0.001). There were significant differences in the area under the ROC curve between group A and group B/C/D/F (Z=2.358, 2.497, 2.442, 2.607, P=0.018, 0.013, 0.015, 0.009), between group B and group C/F (Z=2.287, 2.338, P=0.022, 0.019), between group D and group F (Z=3.096, P=0.002). The diagnostic sensitivity and specificity were 75.56% and 6.46% in group A, 91.11% and 95.45% in group B, 91.11% and 96.21% in group C, 93.33% and 95.58% in group D, 93.33% and 95.71% in group F.

Conclusion

The combination of FFDM (MLO) + DBT (CC) shows the advantage of low radiation dose without compromising diagnostic performance.

Key words: Radiation absorbed dose, Diagnosis, Mammography
图1 1例浸润性导管癌女性患者乳腺X线摄影结果　a、b图分别为全视野数字乳腺X线摄影(内外侧斜位)和数字乳腺体层合成图像(内外侧斜位)，均可见左侧乳腺中央区域出现结构扭曲；c图为全视野数字乳腺X线摄影(头尾位)，表现为肿块伴有微钙化；d图为数字乳腺体层合成图像(头尾位)显示为结构扭曲
图2 1例导管原位癌女性患者乳腺X线摄影结果　a图为全视野数字乳腺X线摄影(头尾位)，未见明显钙化；b图为数字乳腺体层合成图像(头尾位)，圆圈处可见成簇分布不定形微钙化；c图为数字乳腺断面合成技术(内外侧斜位)，圆圈处可见成簇分布不定形微钙化；d图为数字乳腺体层合成图像(内外侧斜位)，未见明显钙化
表1 837个乳房病变影像学特征检出情况[个(%)]
影像学特征 A组 B组 C组 D组 F组 χ2值 P值
肿块 101(12.1) 122(14.6) 136(16.3) 138(16.5) 140(16.7) 9.918 0.042
钙化 340(40.6) 333(39.8) 336(40.1) 338(40.4) 358(42.8) 1.920 0.750
结构扭曲 23(2.7) 27(3.2) 28(3.3) 28(3.3) 28(3.3) 0.725 0.948
不对称致密 15(1.8) 17(2.0) 17(2.0) 17(2.0) 17(2.0) 0.197 0.995
图3 5种摄影体位组合的辐射吸收剂量比较注：5组比较，F＝996.373，P<0.001；A组为FFDM(CC＋MLO)，B组为FDM(CC)＋DBT(MLO)，C组为FFDM(MLO)＋DBT(CC)，D组为DBT(CC＋MLO)，F组为FFDM(CC＋MLO)＋DBT(CC＋MLO)；FFDM为全视野数字乳腺X线摄影；CC为头尾位；MLO为内外侧斜位；DBT为数字乳腺体层合成
图4 5种摄影体位组合恶性病变诊断的受试者操作特征曲线比较注：A组为FFDM(CC＋MLO)，B组为FDM(CC)＋DBT(MLO)，C组为FFDM(MLO)＋DBT(CC)，D组为DBT(CC＋MLO)，F组为FFDM(CC＋MLO)＋DBT(CC＋MLO)；FFDM为全视野数字乳腺X线摄影；CC为头尾位；MLO为内外侧斜位；DBT为数字乳腺体层合成
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