P.L. SHUPYK NATIONAL MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE.
SI, ''INSTITUTE OF NUCLEAR MEDICINE AND DIAGNOSTIC RADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCE OF UKRAINE'', KYIV, UKRAINE; MEDICAL CENTER «VERUM EXPERT», KYIV, UKRAINE.
Wiad Lek. 2021;74(7):1674-1679.
The aim: The aim of our study was to determine if digital breast tomosynthesis improves breast cancer detection associated with architectural distortion in comparison with full-field digital mammography in the absence of appropriate history of trauma or surgery.
Materials and methods: The overall rate of breast cancer involvement for the 34 patients with architectural distortion was 15 cases (44,1%) (invasive breast cancers, n=12 (36,4%); ductal cancer in situ, n= 3 (8,8%)) other findings associated with architectural distortion were high-risk lesions and benign findings (radial scar, n=5 (14,7%); sclerosing adenosis, n=9 (26,5%); typical lobular hyperplasia, n=3 (8,8%); typical ductal hyperplasia, n=2 cases (5,9%)).
Results: Overall of 17/34 (50.0%) architectural distortions were identified at digital breast tomosynthesis that were missed at full-field digital mammography what was statistically significant difference ([95% CI, 2.56-7.45]; p=0.00001). Analysis of the results showed that sensitivity of full-field digital mammography for digital breast tomosynthesis detected breast cancers associated with architectural distortion was 53.3% [95% CI, 26.59% to 78.73%] and specificity was 52.63% [95% CI, 28.86% to 75.55%].
Conclusions: Our study suggests that digital breast tomosynthesis detects more breast cancers represented as architectural distortion which are occult on full-field digital mammography. Presence of microcalcifications within architectural distortion, in the absence of appropriate history of trauma or surgery, has a high likelihood of malignancy and obligatorily requires biopsy.
本研究旨在确定与全数字化乳腺摄影相比，数字乳腺断层合成技术在无适当外伤或手术史的情况下是否能提高伴有结构扭曲的乳腺癌检出率。
材料和方法：34 例结构扭曲患者的乳腺癌总体受累率为 15 例（44.1%）（浸润性乳腺癌 12 例（36.4%）；导管原位癌 3 例（8.8%））。与结构扭曲相关的其他发现为高危病变和良性发现（放射状瘢痕 5 例（14.7%）；硬化性腺病 9 例（26.5%）；典型小叶增生 3 例（8.8%）；典型导管增生 2 例（5.9%））。
17/34（50.0%）的结构扭曲在数字乳腺断层合成术中被识别，而在全数字化乳腺摄影中漏诊，这具有统计学显著差异（[95%置信区间，2.56-7.45]；p=0.00001）。结果分析表明，全数字化乳腺摄影对数字乳腺断层合成术检测到的与结构扭曲相关的乳腺癌的敏感性为 53.3%（[95%置信区间，26.59%至 78.73%]），特异性为 52.63%（[95%置信区间，28.86%至 75.55%]）。
本研究表明，数字乳腺断层合成术能更准确地检测出全数字化乳腺摄影中隐匿性的结构扭曲型乳腺癌。在无适当外伤或手术史的情况下，结构扭曲中存在微钙化，高度提示恶性肿瘤，必须进行活检。
