Bahrs Sonja D, Otto Vanessa, Hattermann Valerie, Klumpp Bernhard, Hahn Markus, Nikolaou Konstantin, Siegmann-Luz Katja
1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.
2 Department of Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany.
Acta Radiol. 2018 Oct;59(10):1176-1183. doi: 10.1177/0284185118756458. Epub 2018 Feb 16.
Background The limited sensitivity of mammography in case of a high breast density often produces unclear or false-positive findings, so-called BI-RADS 3 lesions, which have to be followed up to prove benignity. Digital breast tomosynthesis (DBT) was developed to reduce such summation effects. Purpose To evaluate the influence of an additional DBT on the management of mammographic BI-RADS 3 findings and whether DBT can decrease the time to definitive diagnosis or not. Material and Methods We analyzed 87 patients with a mammographic non-calcified BI-RADS 3 lesion who underwent an additional DBT of the affected breast. A follow-up two-dimensional (2D) examination or a histological result of the lesion had to be available. The images were analyzed especially for the BI-RADS category and incremental diagnostic accuracy. Moreover, the inter-reader reliability and the radiation dose were evaluated. Results The BI-RADS category has been changed by the addition of DBT: 57.1% were assessed as BI-RADS 1 or 2, 4.6% as BI-RADS 4, and only 38.3% remained as BI-RADS 3. The intraclass correlation coefficient for the three readers showed a good agreement for inter-reader reliability. No false-negative examination was found in the follow-ups. Nine lesions were biopsied (seven benign, two malignant). Both malignant lesions were suspicious in the DBT (BI-RADS 4). A significant higher glandular dose was necessary for the DBT. Conclusion DBT has the potential to reduce the recall-rate of BI-RADS 3 lesions and to find and diagnose malignant lesions earlier than 2D mammography alone.
在乳腺密度较高的情况下，乳腺钼靶检查的敏感性有限，常常会产生不清晰或假阳性结果，即所谓的BI-RADS 3类病变，必须对其进行随访以证明为良性。数字乳腺断层合成（DBT）技术的发展是为了减少这种叠加效应。目的：评估额外的DBT对乳腺钼靶BI-RADS 3类结果管理的影响，以及DBT是否能缩短明确诊断所需时间。材料与方法：我们分析了87例乳腺钼靶检查发现非钙化BI-RADS 3类病变且对患侧乳房进行了额外DBT检查的患者。必须有病变的二维（2D）随访检查结果或组织学结果。对图像进行了特别分析，以确定BI-RADS分类和增量诊断准确性。此外，还评估了阅片者间的可靠性和辐射剂量。结果：增加DBT后，BI-RADS分类发生了变化：57.1%被评估为BI-RADS 1或2类，4.6%为BI-RADS 4类，只有38.3%仍为BI-RADS 3类。三位阅片者的组内相关系数显示阅片者间可靠性具有良好的一致性。随访中未发现假阴性检查结果。对9个病变进行了活检（7个良性，2个恶性）。两个恶性病变在DBT检查中均可疑（BI-RADS 4类）。DBT检查需要更高的腺体剂量。结论：DBT有可能降低BI-RADS 3类病变的召回率，并比单纯二维乳腺钼靶检查更早地发现和诊断恶性病变。
