Santos Aragon Lourdes Noemi, Soto-Trujillo Dafne
Radiology, ABC Medical Center IAP, Mexico City, MEX.
Cureus. 2021 Mar 11;13(3):e13838. doi: 10.7759/cureus.13838.
Introduction The most frequent malignant tumor in women is breast cancer. A dense breast may mask lesions within the tissue. The constant improvement in diagnosis techniques has made the diagnosis more accurate. Digital mammography loses sensitivity in dense breasts as lesions may be masked by the over-position of tissue. Tomosynthesis increases sensitivity and specificity over diagnostic mammography. In this study, we examine the effectiveness of tomosynthesis versus digital mammography in asymptomatic patients. Materials and methods A cohort study of 1,499 Mexican patients that came for screening at a private health service from January to December 2015. A Breast Imaging Reporting and Database System (BI-RADS) classification was given by a breast radiologist with the digital mammography reading. Later, a second breast radiologist reviewed the same patients with tomosynthesis and assigned a second BI-RADS category. Results Patients were divided into three age groups. The one with the most had patients between 40-49 years (51.3%), where re-staging to a higher BI-RADS occurred in 40 patients. Re-staging to a lower category was most common in the group of age above 50, where 30 patients were assigned BI-RADS 2 after tomosynthesis. Dense breast (C and D) represented 38%. After tomosynthesis, 28 patients were classified as BI-RADS 4 or 5. The prevalence of diseases in groups BI-RADS 4 and BI-RADS 5 after re-staging and a breast cancer result was 0.024, with a sensitivity of 54% and a specificity of 88%. When re-staging 2D mammography with 3D tomosynthesis for suspicious lesions classified BI-RADS 3, 4, or 5, the prevalence was 0.23, with a sensitivity of 45% and a specificity of 98%. In this study, patients were asymptomatic, yet 20 breast cancers were detected, with a sensitivity of 54% and a specificity of 88%, exceeding the specificity of diagnostic mammography. Moreover, when re-staging to a BI-RADS of suspicious findings, the sensitivity was 45%, with a specificity of as high as 98%.
引言 女性中最常见的恶性肿瘤是乳腺癌。致密型乳腺可能会掩盖组织内的病变。诊断技术的不断进步使诊断更加准确。数字乳腺摄影在致密型乳腺中会降低敏感性，因为病变可能会被过多的组织遮挡。断层合成技术比诊断性乳腺摄影提高了敏感性和特异性。在本研究中，我们检验了断层合成技术与数字乳腺摄影在无症状患者中的有效性。
材料与方法 对2015年1月至12月在一家私立医疗服务机构进行筛查的1499名墨西哥患者进行队列研究。由一名乳腺放射科医生对数字乳腺摄影图像进行解读并给出乳腺影像报告和数据系统（BI-RADS）分类。随后，另一名乳腺放射科医生用断层合成技术对相同患者进行复查并给出第二个BI-RADS分类。
结果 患者被分为三个年龄组。40 - 49岁组患者最多（51.3%），其中40名患者的BI-RADS分级上调。在50岁以上组，分级下调最为常见，有30名患者在断层合成检查后被评为BI-RADS 2级。致密型乳腺（C级和D级）占38%。断层合成检查后，28名患者被分类为BI-RADS 4级或5级。重新分级后BI-RADS 4级和BI-RADS 5级组中疾病的患病率及乳腺癌诊断结果为0.024，敏感性为54%，特异性为88%。当对分类为BI-RADS 3、4或5级的可疑病变进行从二维乳腺摄影到三维断层合成的重新分级时，患病率为0.23，敏感性为45%，特异性为98%。在本研究中，患者无症状，但检测出20例乳腺癌，敏感性为54%，特异性为88%，超过了诊断性乳腺摄影的特异性。此外，当对可疑发现重新分级为BI-RADS时，敏感性为45%，特异性高达98%。
