Dept. of Systems Medicine and Bioengineering, Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA.
Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA.
Eur J Radiol. 2022 Aug;153:110361. doi: 10.1016/j.ejrad.2022.110361. Epub 2022 May 17.
Probability of malignancy for BI-RADS 4-designated breast lesions ranges from 2% to 95%, contributing to high false-positive biopsy rates. We compare clinical performance of digital breast tomosynthesis (DBT) versus digital mammography (2D) among our BI-RADS 4 population without prior history of breast cancer.
We extracted retrospective data i.e., clinical, mammogram reports, and biopsy data, from electronic medical records across Houston Methodist's nine hospitals for patients who underwent diagnostic examinations using both modalities (02/01/2015 - 09/30/2020). 2D and DBT cohorts were not intra-individual matched, and there was no direct mammogram evaluation. Using Student's t test, Fisher's exact test, and Chi-squared test, we evaluated the data to determine statistical significance of differences between modalities in BI-RADS 4 cases. We calculated adjusted odds-ratio between modalities for cancer detection rate (CDR) and biopsy-derived positive predictive value (PPV3).
There were 6,356 encounters (6,020 patients) in 2D and 5,896 encounters (5,637 patients) in DBT assessed as BI-RADS 4. Using Fisher's exact test, DBT mammography cases were significantly assessed as BI-RADS 4 5.66% more often than those undergoing 2D mammography, P = 0.0046 (1.0566 95% CI: 1.0169-1.0977). The CDRs were 112.65 (2D) and 120.76 (DBT), adjusted odds-ratio: 1.04 (0.93, 1.16)), P = 0.5029, while PPV3 were 14.41% (2D) and 15.99% (DBT), adjusted odds-ratio: 1.09 (0.97, 1.22), P = 0.1483; both logistic regression-adjusted for all other factors.
DBT did not achieve better performance and sensitivity in assigning BI-RADS 4 cases compared with 2D, showed no significant advantage in CDR and PPV3, and does not reduce false-positive biopsies among BI-RADS 4-assessed patients.
BI-RADS 4 级指定的乳房病变的恶性肿瘤概率为 2%至 95%，导致假阳性活检率高。我们比较了在没有乳腺癌病史的 BI-RADS 4 人群中，数字乳腺断层合成术（DBT）与数字乳腺钼靶摄影（2D）的临床性能。
我们从休斯顿卫理公会的九家医院的电子病历中提取了回顾性数据，即临床、乳房 X 光报告和活检数据，用于接受两种方式诊断检查的患者（2015 年 2 月 1 日至 2020 年 9 月 30 日）。2D 和 DBT 队列没有个体内匹配，也没有直接的乳房 X 光检查。我们使用学生 t 检验、Fisher 精确检验和卡方检验评估数据，以确定两种方式在 BI-RADS 4 病例中的差异的统计学意义。我们计算了两种方式的癌症检出率（CDR）和活检衍生阳性预测值（PPV3）的调整比值比。
在 2D 中评估了 6356 次就诊（6020 例患者），在 DBT 中评估了 5896 次就诊（5637 例患者）为 BI-RADS 4。使用 Fisher 精确检验，DBT 乳房 X 光摄影病例的 BI-RADS 4 评估率显著高于 2D 乳房 X 光摄影病例，P=0.0046（1.0566 95%CI：1.0169-1.0977）。CDR 分别为 112.65（2D）和 120.76（DBT），调整后的比值比为 1.04（0.93，1.16），P=0.5029，而 PPV3 分别为 14.41%（2D）和 15.99%（DBT），调整后的比值比为 1.09（0.97，1.22），P=0.1483；两者均为逻辑回归，调整了所有其他因素。
与 2D 相比，DBT 在分配 BI-RADS 4 病例方面并未表现出更好的性能和敏感性，在 CDR 和 PPV3 方面没有显著优势，并且不能减少 BI-RADS 4 评估患者的假阳性活检。
