Liu Aidi, Ma Yue, Yin Lu, Zhu Yueqiang, Lu Hong, Li Haijie, Ye Zhaoxiang
Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China.
Acta Radiol. 2023 Mar;64(3):962-970. doi: 10.1177/02841851221112562. Epub 2022 Jul 11.
Calcifications are important abnormal findings in breast imaging and help in the diagnosis of breast cancer.
To compare breast cone-beam computed tomography (CBCT) with digital mammography (DM) in terms of the ability to identify malignant calcifications.
In total, 115 paired examinations were performed utilizing breast CBCT and DM; 86 pathology-proven malignant lesions with calcifications detected on DM and 29 randomly selected breasts without calcifications were reviewed by three radiologists. The ability to detect calcifications was assessed on CBCT images. The characterization agreement of two imaging modalities was evaluated by the kappa coefficient. For breast CBCT images, the parameters for the display of calcifications were recorded. The Kruskal-Wallis test was used to compare the preferred slice thickness chosen by each of the three radiologists. The degree of calcification clarity was compared between two modalities using the Mann-Whitney -test.
The combined sensitivity and specificity of three radiologists in 85 DM-detected calcifications detection on breast CBCT images were 98.43% (251/255) and 98.85% (86/87), respectively. CBCT images showed substantial agreement with mammograms in terms of the characterization of calcifications morphology (k = 0.703; < 0.05) and distribution (k = 0.629; < 0.05). CBCT images with a slice thickness of 0.273 mm and three-dimensional maximum-intensity projection (3D-MIP) were more beneficial for calcifications identification. No statistically significant difference was found between standard DM views and CBCT images for three radiologists on calcification display clarity.
CBCT images were comparable to mammograms in calcification identification and may be sufficient for malignant calcifications detection and characterization.
钙化是乳腺成像中的重要异常表现，有助于乳腺癌的诊断。
比较乳腺锥束计算机断层扫描（CBCT）与数字乳腺摄影（DM）识别恶性钙化的能力。
总共对115例患者进行了乳腺CBCT和DM的配对检查；三位放射科医生对86例经病理证实有钙化的恶性病变（这些钙化在DM上被检测到）以及29例随机选择的无钙化乳房进行了回顾。在CBCT图像上评估检测钙化的能力。通过kappa系数评估两种成像方式的特征一致性。对于乳腺CBCT图像，记录钙化显示的参数。使用Kruskal-Wallis检验比较三位放射科医生各自选择的首选层厚。使用Mann-Whitney检验比较两种成像方式之间钙化清晰度的程度。
三位放射科医生在乳腺CBCT图像上检测85例DM发现的钙化的联合敏感度和特异度分别为98.43%（251/255）和98.85%（86/87）。CBCT图像在钙化形态特征（k = 0.703；P < 0.05）和分布特征（k = 0.629；P < 0.05）方面与乳腺X线摄影显示出高度一致性。层厚为0.273 mm的CBCT图像和三维最大强度投影（3D-MIP）对钙化识别更有益。三位放射科医生在钙化显示清晰度方面，标准DM视图与CBCT图像之间未发现统计学显著差异。
CBCT图像在钙化识别方面与乳腺X线摄影相当，可能足以用于恶性钙化的检测和特征描述。
