Tang Wei, Hu Fei-Xiang, Zhu Hui, Wang Qi-Feng, Gu Ya-Jia, Peng Wei-Jun
Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Clin Hemorheol Microcirc. 2017;66(2):105-116. doi: 10.3233/CH-16242.
To compare the diagnostic efficiency of digital breast tomosynthesis (DBT) plus digital mammography (DM) and magnetic resonance imaging (MRI) plus DM in symptomatic women.
The protocol used in our study was accepted by the ethics committee at our hospital, and informed consent was obtained from all patients. Between June and December 2014, 197 patients with 238 histologically proven lesions all underwent DM, DBT and MRI. Two radiologists were responsible for interpreting all images according to the Breast Imaging Reporting and Data System (BI-RADS). The diagnostic performance of each method was assessed by receiver-operating characteristic (ROC) curve. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were compared using McNemar's test and Fisher's exact test. A Kappa test was used to assess the interobserver agreement.
The area under the ROC curve (AUC) was lower in the group that underwent DM alone (Radiologist1 [R1], 0.849; Radiologist2 [R2], 0.850) than in the group that underwent DBT plus DM (R1, 0.907, P = 0.0204; R2, 0.900, P = 0.0239) and MRI plus DM (R1, 0.939, P = 0.0006; R2, 0.935, P = 0.0009). However, the difference between the group that received DBT plus DM and the group that received MRI plus DM was not significant (R1, P = 0.1262; R2, P = 0.0843). The accuracy (R1, 71.8%; R2, 71.4%) and sensitivity (R1, 71.9%; R2, 71.2%) of DM were lower than those of DBT ((accuracy: R1, 85.3%, P = 0.001; R2, 83.6%, P < 0.001; sensitivity: R1,92.1%, P < 0.001; R2, 90.8%, P < 0.001) and MRI combined with DM (accuracy: R1, 90.3%, P = 0.001; R2, 90.7%, P < 0.001; sensitivity: R1, 94.7%, P < 0.001; R2, 95.4%, P < 0.001). In contrast, no significant difference was observed between DBT and MRI combined with DM (accuracy: R1, P = 0.644; R2, P = 0.360; sensitivity: R1, P = 0.502; R2, P = 0.359). The interobserver agreement of each method was excellent (k = 0.894 0.919 and 0.882 for DM, DBT and MRI combined with DM, respectively).
The diagnostic performance of DBT and MRI combined with DM is superior to that of DM alone in symptomatic women; MRI plus DM is slightly better than that of DBT plus DM, but this difference was not statistically significant.
比较数字乳腺断层合成（DBT）联合数字乳腺钼靶摄影（DM）与磁共振成像（MRI）联合DM对有症状女性的诊断效率。
我们研究中使用的方案已获我院伦理委员会批准，并获得了所有患者的知情同意。2014年6月至12月期间，197例有238个经组织学证实病变的患者均接受了DM、DBT和MRI检查。两名放射科医生负责根据乳腺影像报告和数据系统（BI-RADS）解读所有图像。通过受试者操作特征（ROC）曲线评估每种方法的诊断性能。使用McNemar检验和Fisher精确检验比较敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。采用Kappa检验评估观察者间的一致性。
仅接受DM检查的组（放射科医生1[R1]，0.849；放射科医生2[R2]，0.850）的ROC曲线下面积（AUC）低于接受DBT联合DM检查的组（R1，0.907，P = 0.0204；R2，0.900，P = 0.0239）和接受MRI联合DM检查的组（R1，0.939，P = 0.0006；R2，0.935，P = 0.0009）。然而，接受DBT联合DM检查的组与接受MRI联合DM检查的组之间的差异不显著（R1，P = 0.1262；R2，P = 0.0843）。DM的准确性（R1，71.8%；R2，71.4%）和敏感性（R1，71.9%；R2，71.2%）低于DBT联合DM（准确性：R1，85.3%，P = 0.001；R2，83.6%，P < 0.001；敏感性：R1，92.1%，P < 0.001；R2，90.8%，P < 0.001）以及MRI联合DM（准确性：R1，90.3%，P = 0.001；R2，90.7%，P < 0.001；敏感性：R1，94.7%，P < 0.001；R2，95.4%，P < 0.001）。相比之下，DBT与MRI联合DM之间未观察到显著差异（准确性：R1，P = 0.644；R2，P = 0.360；敏感性：R1，P = 0.502；R2，P = 0.359）。每种方法的观察者间一致性都很好（DM、DBT和MRI联合DM的k值分别为0.894、0.919和0.882）。
在有症状女性中，DBT和MRI联合DM的诊断性能优于单独使用DM；MRI联合DM略优于DBT联合DM，但这种差异无统计学意义。
