1 Department of Radiology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242.
2 Present address: Department of Radiology, University of Cincinnati, Cincinnati, OH.
AJR Am J Roentgenol. 2018 Dec;211(6):1397-1404. doi: 10.2214/AJR.18.19658. Epub 2018 Sep 21.
The objective of our study was to determine the ability of tomosynthesis (3D) to detect nonmalignant and malignant architectural distortion (AD) on 3D screening mammograms compared with digital mammography (2D) only and to correlate the 3D imaging features of nonmalignant and malignant AD with pathology findings.
For this single-institution retrospective study, screening mammography reports from October 1, 2012, to December 1, 2016, that included AD as a finding were reviewed. Associated additional imaging studies and pathology results were also reviewed.
Three-dimensional mammography showed statistically significant increased detection of both nonmalignant and malignant AD compared with 2D only (0.10% [24/24,902 examinations] vs 0.01% [1/9470 examinations], p < 0.05; and 0.21% [52/24,902 examinations] vs 0.07% [7/9470 examinations], p < 0.05, respectively). Higher percentages of nonmalignant AD (16%) were occult on ultrasound compared with malignant AD (3%). The pathologic diagnoses of nonmalignant AD included radial scar (42%), sclerosing adenosis (16%), stromal or dense fibrosis (16%), and other miscellaneous benign causes (25%). Morphologically, nonmalignant AD was more likely to show symmetric or spoke-wheel spiculation appearance (58% vs 2%, p < 0.05) and central lucency (25% vs 0%, p < 0.05) than malignant AD, whereas malignant AD was more likely to show asymmetric spiculation (98% vs 42%, p < 0.05) and central mass 60% vs 0%, p < 0.05) than nonmalignant AD.
Malignant AD and nonmalignant AD are more readily detected by 3D mammography than 2D mammography. Three-dimensional imaging features of AD can help to distinguish nonmalignant types in which symmetric or spoke-wheel spiculation with central lucency are more often seen and are more often occult on ultrasound.
本研究的目的是确定三维断层合成（3D）检测与数字乳腺摄影（2D）相比，在三维筛查乳房 X 光片中检测非恶性和恶性结构扭曲（AD）的能力，并将非恶性和恶性 AD 的 3D 成像特征与病理结果相关联。
本单机构回顾性研究回顾了 2012 年 10 月 1 日至 2016 年 12 月 1 日的筛查性乳腺 X 光片报告，这些报告均将 AD 作为发现。还回顾了相关的附加成像研究和病理结果。
与仅 2D 相比，3D 乳房 X 光摄影术显示出对非恶性和恶性 AD 的检测均有统计学上的显著增加（0.10%[24/24902 次检查]与 0.01%[1/9470 次检查]，p<0.05；0.21%[52/24902 次检查]与 0.07%[7/9470 次检查]，p<0.05）。与恶性 AD（3%）相比，更多的非恶性 AD（16%）在超声检查中为隐匿性。非恶性 AD 的病理诊断包括放射状瘢痕（42%）、硬化性腺病（16%）、基质或致密纤维化（16%）和其他各种良性原因（25%）。形态上，非恶性 AD 更可能表现为对称或轮辐样刺突（58%与 2%，p<0.05）和中央透亮（25%与 0%，p<0.05），而非恶性 AD 更可能表现为不对称性刺突（98%与 42%，p<0.05）和中央肿块（60%与 0%，p<0.05）。
与 2D 乳房 X 光摄影术相比，恶性 AD 和非恶性 AD 更易通过 3D 乳房 X 光摄影术检测。AD 的 3D 成像特征有助于区分对称或轮辐样刺突伴中央透亮的非恶性类型，这些类型在超声检查中更常为隐匿性。
