数字乳腺X线摄影:男性乳腺疾病诊断的推荐检查可行性分析

目的 基于敏感性、特异性等指标的评价,探讨数字乳腺X线摄影及超声对男性乳腺病变的诊断价值.方法 选取79例行乳腺X线摄影检查的男性乳腺肿块病例,部分病例同时行超声检查(62例).乳腺病灶评价依据2013版BI-RADS,通过2位高年资乳腺放射医师对征象进行分析后作出BI-RADS分类,并将BI-RADS 4a类以上定义...     

多模态X线影像组学模型对乳腺BI-RADS4类肿块良恶性的辅助诊断价值

目的 探讨多模态X线影像组学模型在鉴别乳腺BI-RADS 4类肿块型病变良恶性方面的价值.方法 回顾性分析山东省千佛山医院2017年8月至2020年4月,经全屏数字化乳腺X线摄影(FFDM)和数字乳腺断层合成摄影(DBT)检查诊断为BI-RADS 4类乳腺病变并经病理证实的120例女性患者(4A 41例,良性34例、恶...     

基于乳腺X线摄影的深度学习技术鉴别乳腺影像报告和数据系统3类与4类疾病的价值

目的探讨基于乳腺X线摄影的深度学习技术鉴别乳腺影像报告和数据系统(BI-RADS)3类与4类疾病的价值。方法回顾性分析2020年1至12月在深圳市人民医院及深圳市罗湖区人民医院乳腺X线摄影评估为BI-RADS 3类及4类305例患者的临床及影像资料。305例患者共314个病灶, 均为女性, 年龄21～83(47±12)岁。按1∶1比例交叉、简单随机分配给2名工作经验分别为5年及6年普通影像诊断医师(普通医师A、普通医师B)和2名工作经验均为21年且经过专业乳腺影像培训的乳腺影像诊断医师(专业医师A、专业医师B)单独阅片, 之后分别结合深度学习系统再次阅片, 最终将乳腺病变重新分为BI-RADS 3类或4类。采用受试者操作特征曲线及曲线下面积(AUC)评价诊断效能, 以DeLong法比较AUC的差异。结果普通医师A结合深度学习系统重新分类BI-RADS 3类与4类乳腺病灶的AUC较普通医师A单独诊断明显提高(AUC分别为0.79、0.63, Z=2.82、P=0.005);普通医师B结合深度学习系统重新分类BI-RADS 3类与4类乳腺病灶的AUC较普通医师B明显提高(AUC分别为0.8...     

国产数字乳腺断层摄影在乳腺癌筛查中的初步研究

目的 初步探讨国产低剂量数字乳腺断层摄影(DBT)在女性体检乳腺癌筛查中的应用价值。方法 前瞻性搜集行乳腺DBT筛查患者的基本资料近600例,由两名高年资放射科医师观察其既往常规全数字化乳腺X线摄影(FFDM)图像和DBT及融合二维(SM)图像,记录图像分型、病灶分类及数据系统(BI-RADS)分类结果。结果 共纳入573例患者资料。DBT+SM图像与常规FFDM图像的BI-RADS分级诊断比较,差异无统计学意义(P>0.0125)。DBT+SM图像与常规FFDM图像的病灶筛查检出率比较,在肿块及结构扭曲方面,病灶检出率差异有统计学意义(P<0.0125),在钙化、腋窝淋巴结、非对称性改变、相关征象等方面,二者检出率差异无统计学意义(P>0.0125)。DBT+SM图像与常规FFDM图像对于肿块边缘及形态的检出差异无统计学意义(P>0.0125),对钙化形态的检出差异有统计学意义(P<0.0125)。结论 低剂量DBT+SM在女性乳腺癌筛查中对乳腺病变的总体诊断效能与常规FFDM相当,在显示肿块病变、结构扭曲、钙化形态及分布方面的效能优于常规FFDM,且辐...     

数字乳腺断层成像与磁共振成像对乳腺肿瘤的诊断价值

【摘要】目的：通过对比全数字化乳腺摄影（FFDM）、数字乳腺三维成像（DBT）与MRI对乳腺肿瘤的鉴别诊断能力,评价不同影像检查方法对乳腺癌的诊断价值。方法：回顾性分析253例临床经病理证实为乳腺病变的女性患者的病例资料,均采用FFDM、DBT及MRI检查。观察肿瘤大小、形态、边缘、有无钙化等,强化方式、早期强化率（EER）、时间-信号强度曲线（TIC）及表观扩散系数（ADC）,根据乳腺影像报告数据系统（BI-RADS）进行分类,以病理结果为金标准,采用受试者操作特性曲线（ROC）分析不同检查方法对乳腺癌的诊断效能,评价单纯的FFDM、DBT、MRI对乳腺癌的诊断准确性。结果：253例乳腺病变患者中良性病灶112例,恶性病灶141例。FFDM、DBT及MRI诊断乳腺癌的ROC 曲线下面积分别是0.826、0.897、0.884;诊断其敏感度分别为84.2%、92.3%、95.6%;特异度分别为82.5%、85.5%、84.5%。DBT及MRI 诊断乳腺癌的曲线下面积大于FFDM,差异有统计学意义（P<0.001）,DBT与MRI诊断乳腺癌的曲线下面积差异无统计学意义（P>0.05）。结论：DBT及MRI较FFDM检查能够提高乳腺癌的诊断效能,DBT和MRI 对乳腺病灶的检出及诊断效能相近,但DBT更为经济适用,且禁忌证相对较少。     

基于EMPIRE算法的数字乳腺断层合成X线成像结合重建二维及三维图像对乳腺良恶性病灶的鉴别诊断价值

【摘要】目的：探讨基于EMPIRE算法的数字乳腺断层合成X线成像（DBT）结合重建二维（s2D）及重建三维（s3D）图像对乳腺良恶性病灶的鉴别诊断价值。方法：前瞻性纳入经超声诊断为乳腺影像报告和数据系统（BI-RADS）分类为4类及以上、拟行手术或穿刺活检的126例患者，所有患者均行全屏数字乳腺X线成像（FFDM）和DBT检查，通过DBT图像后处理获得s2D、s3D图像。分别对FFDM、DBT结合s2D、DBT结合s3D、DBT结合FFDM图像进行分析，记录腺体的平均辐射剂量，对病灶的可见性进行分级，同时对病灶进行BI-RADS分类；对穿刺及手术标本进行病理分析，获得病变的组织类型。采用单因素方差分析比较四种不同组合图像的平均腺体辐射剂量，采用配对符号秩和检验比较四种组合图像的可见性评级，以病理学为金标准，采用受试者工作特征（ROC）曲线比较四种组合图像的诊断效能。结果：4例为穿刺病理证实，122例为手术病理证实。良性病灶61例，恶性病灶65例。FFDM、DBT-FFDM、DBT-s2D、DBT-s3D图像的单个体位平均腺体辐射剂量分别为（1.72±0.48）、（4.81±1.12）、（3.28±0.79）和（3.28±0.79）mGy，其差异具有统计学意义（P＜0.0001）。DBT-FFDM（116/126）、DBT-s2D（116/126）及DBT-s3D（117/126）较单独FFDM(98/126）显著提高病灶的可见性，其中DBT-s3D对病灶的可见性最高（93%）。FFDM、DBT-FFDM、DBT-s2D及DBT-s3D对乳腺良恶性病灶诊断的ROC曲线下面积分别为0.749，0.804，0.832，0.864。结论：基于EMPIRE迭代算法的DBT结合重建二维及三维图像能在一定程度上增加乳腺病灶的可见性，并提高乳腺良恶性病灶的鉴别诊断效能。     

乳腺低危团簇状分布钙化的BI-RADS分类建议及临床处理策略

【摘要】目的：探讨全数字化乳腺X线摄影（FFDM）筛查性检查中低危团簇状钙化灶的合理BI-RADS归类,提出相应的临床处理策略。方法：回顾性研究本院FFDM筛查性检查发现的99例低危团簇状钙化患者资料,患者1周内进行针对性第二眼超声检查,1个月内行穿刺活检或手术明确病理诊断。以病理学检查结果为标准,比较单纯FFDM和FFDM联合第二眼超声在诊断乳腺良恶性病灶上的差异。结果：99例患者经FFDM发现团簇状钙化灶共114处,其中乳腺良性病变94例,乳腺癌5例,恶性病变占5.05%。针对FFDM发现的低危团簇状分布钙化灶病例,本研究提出“BI-RADS 4F”分类类别,并在FFDM检查完成1周内进行第二眼超声检查,与单纯FFDM相比,FFDM联合第二眼超声检查检出了所有乳腺癌的病例,阳性似然比从2.91升至3.3,降低假阳性率,减少不必要的穿刺活检,两者比较差异有统计学意义（P=0.027）。结论：FFDM筛查性检查联合针对性第二眼超声检查,可显著提高低危团簇状钙化灶的乳腺癌检出率,降低假阳性率,避免不必要的有创活检。基于本研究结果的“乳腺团簇状分布钙化灶处理流程图”及增设“BI-RADS 4F”类别的建议对临床工作有参考意义。     

探究不同乳腺实质区域的全视野数字化乳腺摄影影像组学对BI-RADS 4类病变鉴别的价值

目的 探究基于全视野数字化乳腺摄影(FFDM)的瘤内、瘤周以及对侧实质区域的影像组学模型鉴别乳腺BI-RADS 4类病灶良恶性的价值。方法 回顾性分析2020年11月至2021年8月行FFDM检查被诊断为BI-RADS 4类的117例患者。分别勾画病灶的瘤内ROI、瘤周ROI和对侧乳腺实质ROI,提取并筛选影像组学特征,运用支持向量机建立3个不同区域的影像组学模型,选取性能较好的模型用于构建多区域影像组学联合模型。同时对常见的临床数据进行筛选并建立临床模型,最后构建临床-影像组学联合模型。模型的性能由AUC和准确率等指标评估。结果 共51例良性、66例恶性病例,在3个不同区域构建了单区域影像组学模型,除了对侧实质模型,其他均可以有效鉴别BI-RADS 4类病灶的性质,其中联合模型优于单区域影像组学模型和临床模型,并且优于放射科医师。瘤内模型、瘤周模型、对侧实质模型和临床-影像组学联合模型在测试集的AUC分别为0.80、0.74、0.52、0.87。结论 基于FFDM的瘤内、瘤周影像组学模型可以鉴别乳腺BI-RADS 4类病变的性质,由其构成的联合模型可以进一步提高对BI-RADS 4类...     

使用乳腺影像报告和数据系统诊断乳腺疾病的体会

目的探讨乳腺影像报告和数据系统(BI-RADS)在有症状乳腺病变X线诊断中的使用价值.方法高、低年资两组医生回顾分析307例乳腺病变的X线片并作BI-RADS分级,用操作者特征曲线(ROC)、Kappa分析两组医生判读情况,并与病理对照分析.结果 307例中乳腺癌159例,良性病变148例.高、低年资两组医生对乳腺病变的BI-RADS判读分级ROC曲线下面积(Az)分别为Az1=0.946,Az2=0.845,U检验差异无显著性意义 (U=0.526,P>0.05),总符合率有中至高度一致性,K=0.435,其中Ⅰ级(0.511)、Ⅴ级(0.679)为中至高度符合,Ⅱ级(0.373)、Ⅲ级(0.179)、Ⅳ级(0.276)符合较差.高年资组与低年资组各分级中乳腺癌的阳性率分别为Ⅰ级(12.5%、22.5%)、Ⅱ级(3.7%、12.5%)、Ⅲ级(20.83%、19.61%)、Ⅳ级(68.63%、60.34%)和Ⅴ级(100%、89.91%).两组医生判读均错误23例(7.49%).结论 BI-RADS在有症状乳腺病变的X线诊断中有价值.合理应用0级、结合临床检查能降低漏诊率.对有症状的乳腺病变,Ⅱ、Ⅲ级诊断域值可提高,Ⅳ级域值可降低.BI-RADS有其局限性,使用者应根据自己单位的实际情况订出相应的分级标准.     

全视野数字化乳腺摄影对乳腺导管原位癌的诊断价值

目的 :探讨全视野数字化乳腺摄影(full-field digital mammography,FFDM)对乳腺导管原位癌(ductal carcinoma in situ,DCIS)的诊断价值。方法 :选择经手术病理证实的DCIS患者36例,分析其X线表现。患者术前均行FFDM检查。诊断标准采用美国放射学院(ACR)推荐的乳腺影像报告和数据系统(BI-RADS)。结果:病灶出现钙化23例;肿块16例,其中肿块伴钙化5例;局灶性致密伴钙化11例;结构扭曲伴钙化7例;阴性1例;致密乳腺建议其他检查1例。BI-RADS诊断:5类11例,4类19例,3类3例,2类、1类、0类各1例。FFDM诊断的敏感性91.67%,符合率83.33%。结论:DCIS的常见X线表现为恶性钙化、肿块,FFDM对乳腺DCIS有重要的诊断价值。     

The added benefit of digital breast tomosynthesis in second breast cancer detection among treated breast cancer patients

Objectives

We aimed to compare the recall rate (RR) and the cancer detection rate (CDR) of combined full field digital mammography and digital breast tomosynthesis (FFDM?+?DBT) to those of full field digital mammography (FFDM) alone in breast cancer survivors.

Digital Breast Tomosynthesis Complements Two-Dimensional Synthetic Mammography for Secondary Examination of Breast Cancer

Objective:To compare the performance of two-dimensional synthetic mammography (SM) combined with digital breast tomosynthesis (DBT) (SM/DBT) and full-field digital mammography (FFDM) including women with DBT (FFDM/DBT) undergoing secondary examination for breast cancer.Material and Methods:Out of 186 breasts, including 52 with breast cancers; FFDM/DBT and SM/DBT findings were interpreted by four expert clinicians. Radiation doses of FFDM, SM/DBT, and FFDM/DBT were determined. Inter-rater reliabilities were analyzed between readers and between FFDM/DBT and SM/DBT by Cohen’s Kappa coefficients. Diagnostic accuracy was compared between SM/DBT and FFDM/DBT by Fisher’s exact tests. Two representative cancer cases were examined for differences in the interpretation between FFDM and SM.Results:A higher radiation dose was required in FFDM/DBT than in SM/DBT (median: 1.50 mGy vs. 2.95 mGy). Inter-rater reliabilities were similar between both readers and modalities. Both sensitivity and specificity were equivalent in FFDM/DBT and SM/DBT (p = 0.874–1.00). Compared with FFDM, SM did not clearly show abnormalities with subtle margins in the two representative cancer cases.Conclusion:SM/DBT had a similar performance to FFDM/DBT in detecting breast abnormalities but requires less radiation. DBT complements SM to improve accuracy to a level equivalent to that of FFDM. Taken together, SM/DBT may be a good substitute for FFDM/DBT for the secondary examination of breast cancer.     

两种摄影模式下的乳腺X射线摄影的剂量比较

目的 对比分析数字乳腺X射线断层融合成像和全数字化乳腺X射线摄影两种模式下乳腺X射线摄影剂量比较,以及平均腺体剂量与乳腺密度、压迫厚度的关系。方法 回顾性收集2020年10月至2022年5月在昆明医科大学第一附属医院行数字乳腺X射线断层融合成像（DBT）的乳腺疾病患者以及同时期在本院行全数字化乳腺X射线摄影（FFDM）的体检人群的乳腺X射线摄影资料,记录压迫厚度、压迫力度及平均腺体剂量（AGD）,由两名从事乳腺影像诊断的高年资医师依照2013年ACR BI-RADS MAMMOGRAPHY对乳腺腺体密度进行分型,分为a （腺体组织<25%）、b （腺体组织约25%~50%）、c （腺体组织约50%~75%）、d （腺体组织>75%）4型,分析在FFDM、DBT模式下,不同腺体密度、不同压迫厚度与AGD的关系。结果 无论是FFDM还是DBT模式,随着乳腺腺体密度增加AGD逐渐增加,AGD_a型b_型c_型d_型,差异有统计学意义（F=861.63、617.83、330.33、451.45、290.47,P<0.001）。行FFDM的c、d型乳腺,压迫厚度为31~40 mm时AGD较低。在相同压迫厚度下,a、b、c、d型乳腺AGD_DBT均高于AGD_FFDM,差异有统计学意义（a型：t=-17.88、-42.19、-29.90、-28.14、-24.95,P<0.001;b型：t=-49.18、-35.94、-27.25、-28.37、-24.10,P<0.001;c型：t=-11.78、-32.90、-23.13、-20.51、-18.24,P<0.001;d型：t=-7.94、-26.24、-17.24、-15.44、-13.81,P<0.001）,乳腺厚度为61~70 mm的d型乳腺AGD两者差异最大,为1.07 mGy （95%CI：0.92~1.22）。AGD与乳腺密度、压迫厚度正相关,且FFDM的相关性强于DBT。结论 乳腺X射线摄影AGD与乳腺密度、压迫厚度正相关,与FFDM相比,DBT会增加AGD,但AGD增幅在安全范围内,临床工作中行DBT检查对乳腺疾病患者有益。     

Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories

Objective:

To compare breast density estimated from two-dimensional full-field digital mammography (2D FFDM) and from digital breast tomosynthesis (DBT) according to different Breast Imaging–Reporting and Data System (BI-RADS) categories, using automated software.

Methods:

Institutional review board approval and written informed patient consent were obtained. DBT and 2D FFDM were performed in the same patients to allow within-patient comparison. A total of 160 consecutive patients (mean age: 50±14 years; mean body mass index: 22±3) were included to create paired data sets of 40 patients for each BI-RADS category. Automatic software (MedDensity^©, developed by Giulio Tagliafico) was used to compare the percentage breast density between DBT and 2D FFDM. The estimated breast percentage density obtained using DBT and 2D FFDM was examined for correlation with the radiologists'' visual BI-RADS density classification.

Results:

The 2D FFDM differed from DBT by 16.0% in BI-RADS Category 1, by 11.9% in Category 2, by 3.5% in Category 3 and by 18.1% in Category 4. These differences were highly significant (p<0.0001). There was a good correlation between the BI-RADS categories and the density evaluated using 2D FFDM and DBT (r=0.56, p<0.01 and r=0.48, p<0.01, respectively).

Conclusion:

Using DBT, breast density values were lower than those obtained using 2D FFDM, with a non-linear relationship across the BI-RADS categories. These data are relevant for clinical practice and research studies using density in determining the risk.

Advances in knowledge:

On DBT, breast density values were lower than with 2D FFDM, with a non-linear relationship across the classical BI-RADS categories.To tailor screening and diagnosis protocols, it is important to identify females with an increased risk of breast cancer [1–3]. It has been estimated that females with dense breasts (breast densities of >75%) have 4–6 times higher risk of breast cancer than females with low breast densities [4] and that breast density is increasingly recognised as an independent determinant of breast cancer risk and possibly in prognosis [5]. Assessment of breast density is becoming crucial in epidemiological studies, including the estimation of breast cancer risk and assessing breast density-related risk over time, radiation dose monitoring and monitoring drug-related response [6,7].Different methods and classifications have been reported to assess breast density: the Tabar classification [8], Wolfe''s parenchymal patterns [9], and both semi-quantitative and quantitative computer-aided techniques [10–16]. The Breast Imaging–Reporting and Data System (BI-RADS) classification, considered as the additional quantitative scheme, is routinely used in the USA and was introduced to standardise reporting. Initially, it was based on four qualitative categories but an additional quantitative scheme was added in 2003, based on the extent of fibroglandular tissue [17]. Mammographic breast density estimation may be limited by the two-dimensional (2D) nature of the imaging technique, whereas a three-dimensional (3D) imaging modality, such as digital breast tomosynthesis (DBT), reduces the appearance of the overlapping parenchymal tissue and may therefore influence or alter density assessments [13,14]. In DBT, high-spatial-resolution tomographic images of the breast are reconstructed from multiple low-dose projection images acquired within a limited range of X-ray tube angles [15]. It has been demonstrated in a few studies that the automated estimation of breast density eliminates subjectivity between comparisons of full-field digital mammography (2D FFDM) and DBT and is more reproducible than a quantitative BI-RADS evaluation [14,16]. However, previous research mainly considered patients with relatively high breast density, with the possibility of the results not being applicable across all density categories and showing whether published percentage breast density differences between 2D FFDM and DBT apply to less dense or non-dense breasts. The purpose of our study was to compare the breast tissue density estimated using 2D FFDM and DBT among patients in a balanced data set of the four BI-RADS categories, using fully automated software.     

Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening

PurposeTo evaluate the impact of double reading automated breast ultrasound (ABUS) when added to full field digital mammography (FFDM) or digital breast tomosynthesis (DBT) for breast cancer screening.MethodsFrom April 2014 to June 2015, 124 women with dense breasts and intermediate to high breast cancer risk were recruited for screening with FFDM, DBT, and ABUS. Readers used FFDM and DBT in clinical practice and received ABUS training prior to study initiation. FFDM or DBT were first interpreted alone by two independent readers and then with ABUS. All recalled women underwent diagnostic workup with at least one year of follow-up. Recall rates were compared using the sign test; differences in outcomes were evaluated using Fisher's exact test.ResultsOf 121 women with complete follow-up, all had family (35.5%) or personal (20.7%) history of breast cancer, or both (43.8%). Twenty-four women (19.8%) were recalled by at least one modality. Recalls increased from 5.0% to 13.2% (p = 0.002) when ABUS was added to FFDM and from 3.3% to 10.7% (p = 0.004) when ABUS was added to DBT. Findings recalled by both readers were more likely to result in a recommendation for short term follow-up imaging or tissue biopsy compared to findings recalled by only one reader (100% vs. 42.1%, p = 0.041). The cancer detection rate was 8.3 per 1000 screens (1/121); mode of detection: FFDM and DBT.ConclusionsAdding ABUS significantly increased the recall rate of both FFDM and DBT screening. Double reading of ABUS during early phase adoption may reduce false positive recalls.     

数字乳腺断层摄影及其合成二维影像技术在乳腺癌筛查中的研究进展

目前乳腺X线检查仍是乳腺癌早期诊断的有效检查方法之一,主要包括全视野数字化乳腺摄影（FFDM）、数字乳腺断层摄影（DBT）、合成乳腺X线摄影（SM）以及3种技术的联合应用（FFDM联合DBT、SM联合DBT）。对DBT、SM和SM联合DBT在乳腺筛查中诊断效能、影像质量及辐射剂量等进行比较。SM联合DBT可有效平衡辐射剂量和诊断效能,但仍然在判读时间、信息的存储与传输和检查成本方面存在局限性。就以上3种检查技术在乳腺癌筛查中的研究进展予以综述。     

Digital breast tomosynthesis versus full-field digital mammography—Which modality provides more accurate prediction of margin status in specimen radiography?

ObjectivesTo evaluate the reliability of tumor margin assessment in specimen radiography (SR) using digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in comparison to postoperative histopathology margin status as the gold standard.MethodsAfter ethics committee approval, 102 consecutive patients who underwent breast conservative surgery for nonpalpable proven breast cancer were prospectively included. All patients underwent ultrasound/mammography-guided wire localization of their lesions. After excision, each specimen was marked for orientation and imaged using FFDM and DBT. Two blinded radiologists (R1, R2) independently analyzed images acquired with both modalities. Readers identified in which direction the lesion was closest to the specimen margin and to measure the margin width. Their findings were compared with the final histopathological analysis. True positive margin status was defined as a margin measuring <1 mm for invasive cancer and 5 mm for ductal carcinoma in situ (DCIS) at imaging and pathology.ResultsFor FFDM, correct margin direction was identified in 45 cases (44%) by R1 and in 37 cases (36%) by R2. For DBT, 69 cases (68%) were correctly identified by R1 and 70 cases (69%) by R2. Overall accuracy was 40% for FFDM and 69% for DBT; the difference was statistically significant (p < 0.0001). Sensitivity in terms of correct assessment of margin status was significantly better for DBT than FFDM (77% versus 62%).ConclusionSR using DBT is significantly superior to FFDM regarding identification of the closest margin and sensitivity in assessment of margin status.     

Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software

Objective

To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software.

Methods

Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM.

Results

Fifty consecutive patients (mean age, 51?years; range, 35–83?years) underwent both FFDM and DBT. Using a method based on the integral curve, breast density showed higher results on FFDM (68.1?±?12.1 for FFDM and 51.9?±?6.5 for DBT). FFDM overestimated breast density in 16.2% (P?P?r?=?0.54, P?r?=?0.44, P?Conclusion Breast density appeared to be significantly underestimated on digital breast tomosynthesis.

Key Points

• Breast density is considered to be an independent risk factor for cancer
• Density can be assessed on full-field digital mammography and digital breast tomosynthesis
• Objective automated estimation of breast density eliminates subjectivity
• Automated estimation is more accurate than BI-RADS quantitative evaluation
• Breast density may be significantly underestimated on digital breast tomosynthesis

     

乳腺导管癌的乳腺钼靶与磁共振增强扫描的对比研究

目的比较全数字化乳腺摄影(full-field digital mammography,FFDM)、磁共振(MRI)增强扫描对乳腺导管癌的诊断价值。方法回顾性分析经手术病理证实的30例乳腺导管癌,所有病例均行FFDM、MRI增强检查。观察X线特征,根据美国放射学会乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)进行分级,3级及以下的级别考虑为良性,4A级及以上的为恶性;MRI根据病灶增强表现,绘制时间-信号强度曲线诊断病灶的良、恶性。影像诊断与病理结果对照,比较二者对导管癌的检出情况及诊断准确率。结果 30例乳腺导管癌中,FFDM检出13例肿瘤呈单纯结节或肿块,肿块伴有的钙化12例,5例病灶表现为单纯簇状钙化,同侧腋下淋巴结肿大7例。FFDM诊断4A以上病例26例,3级及以下的病例4例;MRI增强扫描检出肿块或结节27例,发现钙化5例,同侧腋下淋巴结肿大10例。时间-信号强度曲线8例呈Ⅱ型曲线,22例呈Ⅲ型曲线。FFDM正确诊断乳腺导管癌24例,MRI增强扫描正确诊断为26例,二者结合正确诊断27例。FFDM、增强MRI及FFDM+增强MRI对导管癌的诊断符合率分别为80%、86.7%、90%。结论 FFDM操作简单,对导管癌的簇状钙化检出率高于增强MRI,诊断敏感性较高,是筛查乳腺导管癌,尤其导管原位癌的首选,增强MRI对乳腺导管癌肿块及同侧腋下淋巴结检出情况高于FFDM,在乳腺导管癌定性方面有重要作用,是乳腺导管癌进行术前评价的有效方法。二者结合应用可以提高乳腺导管癌的诊断正确率。