From the Departments of Radiology and Medical Imaging (T.I.A., J.V.N., C.M.R., B.T.N., J.A.H.) and Biostatistics (J.T.P.), University of Virginia Health System, Box 800170, Charlottesville, VA 22908.
Radiology. 2018 Jul;288(1):38-46. doi: 10.1148/radiol.2018171159. Epub 2018 Mar 27.
Purpose To compare the outcome of architectural distortion (AD) without associated mass only on digital breast tomosynthesis (DBT) with AD seen at two-dimensional (2D) mammography and to evaluate if the incidence of malignancy is influenced by the presence of a correlate at ultrasonography (US). Materials and Methods This retrospective study had institutional review board approval and was HIPAA compliant. All consecutive cases in which patients with AD were ultimately assigned Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 categories from 2009 to 2016 were reviewed by three readers for visibility (2D vs DBT). The level of suspicion was assigned using a Likert scale. Pathologic results were compared between 2D-detected and DBT-detected AD. Frequencies were compared by using the McNemar and Pearson χ exact tests. Results One hundred eighty-one AD lesions were included; 122 (67.4%) were 2D visible while 59 (32.6%) were DBT detected. Forty-two women (with 43 lesions) underwent 2D mammography prior to initiation of DBT. In 117 women with 121 AD lesions who underwent 2D mammography plus DBT, 59 lesions (48.8%) were detected only with DBT. The malignancy rate based on final pathology was significantly higher for 2D-detected AD (53 [43.4%] of 122) compared with DBT (six [10.2%] of 59) (P < .001). A US correlate was more frequent with 2D-detected AD (103 [84.4%] of 122) than DBT (33 [55.9%] of 59) (P < .001). Malignancy rate was not different for DBT-detected AD with (four [12.1%] of 33; 95% confidence interval [CI]: 3.4%, 28.2%]) or without (two [7.7%] of 26; 95% CI: 0.9%, 25.1%]) a US correlate. NPV based on radiologists' level of suspicion was high (91.8%-98.0%) but not sufficient enough to forgo biopsy. Conclusion DBT-detected suspicious AD has a lower malignancy outcome compared with 2D mammography-detected suspicious AD, although still high enough to warrant biopsy. RSNA, 2018 Online supplemental material is available for this article.
目的 比较单纯数字乳腺断层摄影术（DBT）上的仅表现为结构扭曲（AD）而无相关肿块与二维（2D）乳腺钼靶摄影上 AD 的表现，并评估超声（US）上是否存在相关病变是否会影响恶性肿瘤的发生率。
材料与方法 本回顾性研究获得了机构审查委员会的批准，并符合 HIPAA 规定。对 2009 年至 2016 年期间所有因 AD 最终被分配到乳腺影像报告和数据系统（BI-RADS）4 或 5 类的患者的病例进行了三位读者的回顾性分析，以评估其在 2D 和 DBT 上的可见性。使用李克特量表评估可疑程度。比较 2D 与 DBT 检出的 AD 的病理结果。使用 McNemar 和 Pearson χ 精确检验比较频率。
结果 共纳入 181 例 AD 病变；122 例（67.4%）在 2D 上可见，59 例（32.6%）在 DBT 上可见。42 例女性（43 例病变）在开始进行 DBT 之前先进行了 2D 乳腺钼靶检查。在 117 例同时进行了 2D 乳腺钼靶和 DBT 的女性中，59 例（48.8%）病变仅在 DBT 上被检出。基于最终病理，与 DBT 检出的 AD（6 例[10.2%]）相比，2D 检出的 AD（53 例[43.4%]）的恶性率显著更高（P <.001）。与 DBT 检出的 AD（33 例[55.9%]）相比，2D 检出的 AD（103 例[84.4%]）更常伴有 US 相关病变（P <.001）。对于 DBT 检出的 AD，有（4 例[12.1%]）或无（2 例[7.7%]）US 相关病变时，恶性率均无差异（95%置信区间：3.4%，28.2%）。基于放射科医生可疑程度的阴性预测值（NPV）很高（91.8%-98.0%），但仍不足以排除活检。
结论 与 2D 乳腺钼靶摄影术检出的可疑 AD 相比，DBT 检出的可疑 AD 的恶性结局较低，但仍足以进行活检。RSNA，2018 在线补充材料可用于本文。
