Seo Mirinae, Chang Jung Min, Kim Sun Ah, Kim Won Hwa, Lim Ji He, Lee Su Hyun, Bae Min Sun, Koo Hye Ryoung, Cho Nariya, Moon Woo Kyung
Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Breast Cancer. 2016 Dec;19(4):438-446. doi: 10.4048/jbc.2016.19.4.438. Epub 2016 Dec 23.
The purpose of this study was to assess the value of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) in the diagnostic workup of breast cancer and to determine which lesion variables affect cancer detectability in the combined modality.
Between March and May 2012, paired FFDM and DBT images were obtained from 203 women as part of a diagnostic workup for breast cancer. Images from FFDM alone, DBT alone, and DBT combined with FFDM were reviewed in separate sessions by six blinded readers. Jackknife alternative free-response receiver operating characteristic (JAFROC) figure of merit (FOM), sensitivity, and specificity were compared between the modalities. Lesion characteristics affecting the cancer detection rate when using the combined modality were also analyzed.
Among the 203 women, 126 women had a total of 129 malignancies and 77 women had total of 77 benign lesions. The overall JAFROC FOM of the combined modality was higher than that of FFDM alone (0.827 vs. 0.775, <0.001) and that of DBT alone was higher than that of FFDM alone (0.807 vs. 0.775, =0.027). The overall sensitivity of the combined modality was higher than that of FFDM alone (80.0% vs. 73.2%, <0.001) and that of DBT alone was higher than that of FFDM alone (78.3% vs. 73.2%, =0.007). Compared to FFDM alone, the combined modality detected an additional 48 cancers. Using the combined modality, the presence of masses or microcalcifications was significantly associated with the cancer detection rate (<0.001).
The combination of DBT with FFDM results in a higher diagnostic yield than FFDM alone. Additionally, DBT alone performs better than FFDM alone. However, even when DBT is combined with FFDM, breast cancers with no discernible masses and those lacking calcifications are difficult to detect.
本研究旨在评估在乳腺癌诊断检查中，将数字乳腺断层合成（DBT）添加到全视野数字乳腺摄影（FFDM）中的价值，并确定哪些病变变量会影响联合模式下癌症的可检测性。
2012年3月至5月期间，作为乳腺癌诊断检查的一部分，从203名女性中获取了配对的FFDM和DBT图像。六名不知情的阅片者在不同的时间段分别查看了单独的FFDM图像、单独的DBT图像以及DBT与FFDM相结合的图像。比较了不同模式下的刀切法替代自由响应接收器操作特性（JAFROC）品质因数（FOM）、敏感性和特异性。还分析了使用联合模式时影响癌症检出率的病变特征。
在203名女性中，126名女性共有129处恶性肿瘤，77名女性共有77处良性病变。联合模式的总体JAFROC FOM高于单独的FFDM（0.827对0.775，<0.001），单独的DBT高于单独的FFDM（0.807对0.775，=0.027）。联合模式的总体敏感性高于单独的FFDM（80.0%对73.2%，<0.001），单独的DBT高于单独的FFDM（78.3%对73.2%，=0.007）。与单独的FFDM相比，联合模式额外检测出48例癌症。使用联合模式时，肿块或微钙化的存在与癌症检出率显著相关（<0.001）。
DBT与FFDM联合使用比单独使用FFDM具有更高的诊断率。此外，单独使用DBT比单独使用FFDM表现更好。然而，即使DBT与FFDM联合使用，没有明显肿块且缺乏钙化的乳腺癌也难以检测到。
