数字乳腺断层摄影诊断乳腺癌现状

乳腺癌严重威胁女性健康,乳腺摄影是早期检出肿瘤的方法之一。数字乳腺断层摄影(DBT)能够克服全数字化乳腺摄影(FFDM)因组织重叠而影响病变观察的问题,降低复检率,减少不必要的活检,提高癌灶的检出率。对于致密型乳腺,DBT可以减少"假阳性"的检出,降低乳腺癌筛查的成本,提高诊断的准确性。     

数字乳腺断层摄影诊断乳腺癌现状

乳腺癌严重威胁女性健康,乳腺摄影是早期检出肿瘤的方法之一。数字乳腺断层摄影（DBT）能够克服全数字化乳腺摄影（FFDM）因组织重叠而影响病变观察的问题,降低复检率,减少不必要的活检,提高癌灶的检出率。对于致密型乳腺,DBT可以减少＂假阳性＂的检出,降低乳腺癌筛查的成本,提高诊断的准确性。     

数字乳腺断层摄影在乳腺筛查中的应用进展

目前全数字化乳腺摄影（full-field digital mammography, FFDM）仍是乳腺癌早期发现、早期诊断的首选检查方法。而数字乳腺断层摄影技术能够克服常规FFDM中重叠纤维腺体组织干扰诊断这一主要局限性,增强对乳腺病变的可见性,显著提高诊断的敏感性和特异性,有效地降低了召回率。本文重点对于DBT在乳腺筛查中的优势及局限性进行综述。     

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...     

数字乳腺断层合成摄影诊断乳腺放射状病变的价值

目的:评估数字乳腺断层合成摄影（DBT）、数字乳腺X线摄影（DM）对放射状病变的诊断价值。方法:回顾性分析2016年12月至2020年5月青岛大学附属医院收治的、在DBT上表现为放射状病变并经手术病理证实的76例患者（共78个病灶）的资料。以病理结果为金标准,将78个病变分为良性放射状病变（46个）和恶性放射状病变（3...     

数字乳腺断层X线成像技术在乳腺癌筛查中的应用

【摘要】乳腺影像检查是降低乳腺癌死亡率的有效方法,数字乳腺断层融合X 线成像（DBT）作为近年来新出现的影像成像技术,大大提高了乳腺癌筛查的敏感度和特异度。本文就DBT与传统乳腺X线摄影检查的对比研究、在致密型与非致密型乳腺中的应用、诊断早期与浸润性乳腺癌的效能以及其目前存在的局限性等方面进行综述,旨在提高对乳腺癌的诊断,为DBT技术的发展实践提供策略。     

数字乳腺X线摄影技术的研究进展

随着数字化乳腺X线检查技术的发展,屏/片系统乳腺X线摄影(SFM)技术已逐步被取代,一些技术改进的优势已在致密型乳腺的女性中得到证实。比较数字乳腺体层摄影(DBT)技术、对比增强双能数字乳腺X线摄影(CEDM)技术及常规数字乳腺X线摄影(DM)技术,并综述数字乳腺摄影技术发展中一些新技术的特点,分析其优势、局限性及对病人的潜在影响等,从而预测它们的发展前景。     

数字乳腺X线摄影与断层摄影联合应用对乳腺癌的诊断价值

目的 探讨分析不同分子亚型乳腺癌的影像学特征,探讨数字乳腺X线摄影(DM)结合断层摄影(DBT)在乳腺癌分子分型中的应用价值,从而对乳腺癌的临床个体化治疗及预后评估提供可靠依据.方法 选取我院临床检查乳腺发现可疑病灶,且经穿刺活检或手术病理证实的230例女性乳腺癌患者.所有患者活检或术前均行DM和DBT检查,根据雌激素...     

Breast cancer detection: Comparison of digital mammography and digital breast tomosynthesis across non-dense and dense breasts

IntroductionBreast density is associated with an increase in breast cancer risk and limits early detection of the disease. This study assesses the diagnostic performance of mammogram readers in digital mammography (DM) and digital breast tomosynthesis (DBT).MethodsEleven breast readers with 1–39 years of experience reading mammograms and 0–4 years of experience reading DBT participated in the study. All readers independently interpreted 60 DM cases (40 normal/20 abnormal) and 35 DBT cases (20 normal/15 abnormal). Sensitivity, specificity, ROC AUC, and diagnostic confidence were calculated and compared between DM and DBT.ResultsDBT significantly improved diagnostic confidence in both dense breasts (p = 0.03) and non-dense breasts (p = 0.003) but not in other diagnostic performance metrics. Specificity was higher in DM for readers with >7 years' experience (p = 0.03) in reading mammography, non-radiologists (p = 0.04), readers who had completed a 3–6 months training fellowship in breast imaging (p = 0.04), and those with ≤2 years’ experience in reading DBT (p = 0.02), particularly in non-dense breasts.ConclusionDiagnostic confidence was higher in DBT when compared to DM. In contrast, other performance metrics appeared to be similar or better with DM and may be influenced by the lack of experience of the reader cohort in reading DBT.Implications for practiceThe benefits of DBT may not be entirely accrued until radiologists attain expertise in DBT interpretation. Specificity of DBT varied according to reader characteristics, and these characteristics may be useful for optimising pairing strategies in independent double reading of DBT as practiced in Australia to reduce false positive diagnostic errors.     

Breast tomosynthesis: A diagnostic addition to screening digital mammography

Objectives

Comparison between digital mammography alone and with adding digital breast tomosynthesis in breast cancer screening.

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women

IntroductionDigital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening.Materials and methodsAsymptomatic women aged 40–49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre.Results1227 women were recruited. 1221 first screens (604 2D, 617 2D + DBT) and 1124 second screens (558 2D + DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D + DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D + DBT (p = 0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D + DBT than 2D (p = 0.023).ConclusionThe addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.     

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.

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。     

全数字化乳腺摄影与MRI对乳腺恶性病变诊断的对比分析

目的 探讨乳腺癌全数字化乳腺摄影(full-field digital mammography,FFDM)与乳腺MRI的影像学表现,评价其对乳腺癌的诊断价值.方法 收集68例经穿刺或手术病理证实的乳腺癌病例,对比分析其X线摄影及MRI表现.全数字化乳腺摄影采用常规方法摄片,MRI采用自旋回波T1WI,T2WI序列及动态增强扫描等.结果 68例乳腺恶性肿瘤中,浸润性导管癌57例,浸润性小叶癌3例,叶状囊肉瘤1例,血管肉瘤1例,导管内癌2例,炎性乳癌2例,印戒细胞癌1例,Paget's病1例.乳腺X线摄影诊断正确61例,诊断准确率89.7％.MRI诊断正确66例,诊断准确率97.1％.结论 乳腺X线摄影是乳腺恶性病变的首选检查方法,MRI能更多的显示乳腺病灶的内部特征,二者联合应用对乳腺癌的临床诊断具有重要意义.     

数字化乳腺摄影与普通钼靶摄影在小乳癌诊断中的对比分析

目的：探讨数字化乳腺摄影在小乳癌诊断中的优越性。方法：经手术病理证实的小乳癌57例，采用数字化乳腺摄影及普通钼靶摄影方法。结果：数字化乳腺摄影诊断51例，其敏感性、特异性、准确性分别为89．4％、95．O％、90.9％；普通钼靶摄影术前诊断46例，其敏感性、特异性、准确性分别为80．7％、85．O％、81．8％。结论：在小乳癌诊断中。数字化乳腺摄影在敏感性、特异性、准确性方面均优于普通钼靶摄影。     

全数字化乳腺X线摄影对乳腺炎性疾病的诊断价值

目的:分析乳腺炎性疾病的全数字化乳腺X线摄影(FFDM)表现,提高该病与乳腺癌的鉴别诊断水平。方法:回顾性分析39例经穿刺或手术病理证实的乳腺炎性疾病的FFDM表现。结果:39例患者中,26例为慢性乳腺炎,5例为浆细胞性乳腺炎,8例为肉芽肿性乳腺炎。X线表现为肿块影17例,局部腺体非对称性致密影20例,结构扭曲2例。伴同侧腋下淋巴结致密影7例,局部或乳晕区皮肤增厚12例,乳头凹陷7例。结论:结合临床资料并细致分析乳腺炎性疾病的FFDM表现,有助于提高该病诊断与鉴别诊断水平。