Department of Radiology, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA.
AJR Am J Roentgenol. 2013 Feb;200(2):291-8. doi: 10.2214/AJR.12.8881.
This study evaluated digital breast tomosynthesis (DBT) as an alternative to conventional diagnostic mammography in the workup of noncalcified findings recalled from screening mammography in a simulated clinical setting that incorporated comparison mammograms and breast ultrasound results.
One hundred forty-six women, with 158 abnormalities, underwent diagnostic mammography and two-view DBT. Three radiologists viewed the abnormal screening mammograms, comparison mammograms, and DBT images and recorded a DBT BI-RADS category and confidence score for each finding. Readers did not view the diagnostic mammograms. A final DBT BI-RADS category, incorporating ultrasound results in some cases, was determined and compared with the diagnostic mammography BI-RADS category using kappa statistics. Sensitivity and specificity were calculated for DBT and diagnostic mammography.
Agreement between DBT and diagnostic mammography BI-RADS categories was excellent for readers 1 and 2 (κ = 0.91 and κ = 0.84) and good for reader 3 (κ = 0.68). For readers 1, 2, and 3, sensitivity and specificity of DBT for breast abnormalities were 100%, 100%, and 88% and 94%, 93%, and 89%, respectively. The clinical workup averaged three diagnostic views per abnormality and ultrasound was requested in 49% of the cases. DBT was adequate mammographic evaluation for 93-99% of the findings and ultrasound was requested in 33-55% of the cases.
The results of this study suggest that DBT can replace conventional diagnostic mammography views for the evaluation of noncalcified findings recalled from screening mammography and achieve similar sensitivity and specificity. Two-view DBT was considered adequate mammographic evaluation for more than 90% of the findings. There was minimal change in the use of ultrasound with DBT compared with diagnostic mammography.
本研究通过对比筛查性乳房 X 光摄影中召回的非钙化病灶的比较乳房 X 光摄影和乳房超声检查结果，评估数字乳腺断层合成术（DBT）在常规诊断性乳房 X 光摄影中的替代作用，该研究是在模拟临床环境中进行的。
146 名女性，共 158 处病变，接受了诊断性乳房 X 光摄影和双能 X 线乳房断层摄影检查。3 名放射科医生分别观察异常的筛查性乳房 X 光摄影片、对比乳房 X 光摄影片和 DBT 图像，并对每一处病灶记录 DBT BI-RADS 分类和置信评分。读者不查看诊断性乳房 X 光摄影片。在某些情况下，结合超声检查结果，最终确定 DBT BI-RADS 分类，并与诊断性乳房 X 光摄影 BI-RADS 分类进行比较，采用 Kappa 统计。计算 DBT 和诊断性乳房 X 光摄影的灵敏度和特异性。
对于读者 1 和 2（κ=0.91 和 κ=0.84），DBT 与诊断性乳房 X 光摄影 BI-RADS 分类的一致性极好，读者 3 的一致性较好（κ=0.68）。对于读者 1、2 和 3，DBT 对乳腺病变的灵敏度和特异性分别为 100%、100%和 88%，94%、93%和 89%。平均每处病变的临床检查有 3 个诊断视图，49%的病例要求进行超声检查。93%-99%的病灶的 DBT 检查结果足以进行乳腺评估，33%-55%的病例要求进行超声检查。
本研究结果表明，DBT 可替代常规诊断性乳房 X 光摄影来评估筛查性乳房 X 光摄影中召回的非钙化病灶，且具有相似的灵敏度和特异性。超过 90%的病灶的双能 X 线乳房断层摄影检查被认为足以进行乳腺评估。与诊断性乳房 X 光摄影相比，DBT 检查时使用超声检查的变化很小。
