Gharaibeh Maha, Alfwares Ahmad Abu, Elobeid Eyhab, Khasawneh Ruba, Rousan Liqa, El-Heis Mwaffaq, Al-Jarrah Mooath, Haj Hussein Ahmed A, Altalhi Maryam, Abualigah Laith
Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Department of Radiation Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Front Med (Lausanne). 2023 Nov 21;10:1276434. doi: 10.3389/fmed.2023.1276434. eCollection 2023.
To assess the diagnostic performance of digital breast tomosynthesis (DBT) in older women across varying breast densities and to compare its effectiveness for cancer detection with 2D mammography and ultrasound (U/S) for different breast density categories. Furthermore, our study aimed to predict the potential reduction in unnecessary additional examinations among older women due to DBT.
This study encompassed a cohort of 224 older women. Each participant underwent both 2D mammography and digital breast tomosynthesis examinations. Supplementary views were conducted when necessary, including spot compression and magnification, ultrasound, and recommended biopsies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated for 2D mammography, DBT, and ultrasound. The impact of DBT on diminishing the need for supplementary imaging procedures was predicted through binary logistic regression.
In dense breast tissue, DBT exhibited notably heightened sensitivity and NPV for lesion detection compared to non-dense breasts (61.9% vs. 49.3%, < 0.001) and (72.9% vs. 67.9%, < 0.001), respectively. However, the AUC value of DBT in dense breasts was lower compared with non-dense breasts (0.425 vs. 0.670). Regarding the ability to detect calcifications, DBT demonstrated significantly improved sensitivity and NPV in dense breasts compared to non-dense breasts (100% vs. 99.2%, < 0.001) and (100% vs. 94.7%, < 0.001), respectively. On the other hand, the AUC value of DBT was slightly lower in dense breasts compared with non-dense (0.682 vs. 0.711). Regarding lesion detection for all cases between imaging examinations, the highest sensitivity was observed in 2D mammography (91.7%, < 0.001), followed by DBT (83.7%, < 0.001), and then ultrasound (60.6%, < 0.001). In dense breasts, sensitivity for lesion detection was highest in 2D mammography (92.9%, < 0.001), followed by ultrasound (76.2%, < 0.001), and the last one was DBT. In non-dense breasts, sensitivities were 91% ( < 0.001) for 2D mammography, 50.7% ( < 0.001) for ultrasound, and 49.3% ( < 0.001) for DBT. In terms of calcification detection, DBT displayed significantly superior sensitivity compared to 2D mammography in both dense and non-dense breasts (100% vs. 91.4%, < 0.001) and (99.2% vs. 78.5%, < 0.001), respectively. However, the logistic regression model did not identify any statistically significant relationship ( > 0.05) between DBT and the four dependent variables.
Our findings indicate that among older women, DBT does not significantly decrease the requirement for further medical examinations.
评估数字乳腺断层合成（DBT）在不同乳腺密度的老年女性中的诊断性能，并比较其与二维乳腺X线摄影和超声（U/S）在不同乳腺密度类别中检测癌症的有效性。此外，我们的研究旨在预测DBT可能减少老年女性不必要的额外检查。
本研究纳入了224名老年女性队列。每位参与者均接受了二维乳腺X线摄影和数字乳腺断层合成检查。必要时进行补充检查，包括点压和放大、超声检查以及建议的活检。计算二维乳腺X线摄影、DBT和超声的灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。通过二元逻辑回归预测DBT对减少补充成像程序需求的影响。
在致密乳腺组织中，与非致密乳腺相比，DBT在病变检测方面表现出显著更高的灵敏度和NPV（分别为61.9%对49.3%，<0.001）和（72.9%对67.9%，<0.001）。然而，致密乳腺中DBT的AUC值低于非致密乳腺（0.425对0.670）。关于钙化检测能力，与非致密乳腺相比，DBT在致密乳腺中表现出显著提高的灵敏度和NPV（分别为100%对99.2%，<0.001）和（100%对94.7%，<0.001）。另一方面，致密乳腺中DBT的AUC值略低于非致密乳腺（0.682对0.711）。关于所有病例在成像检查之间的病变检测，二维乳腺X线摄影的灵敏度最高（91.7%，<0.001），其次是DBT（83.7%，<0.001），然后是超声（60.6%，<0.001）。在致密乳腺中，病变检测的灵敏度二维乳腺X线摄影最高（92.9%，<0.001），其次是超声（76.2%，<0.001），最后是DBT。在非致密乳腺中，二维乳腺X线摄影的灵敏度为91%（<0.001），超声为50.7%（<0.001），DBT为49.3%（<0.001）。在钙化检测方面，DBT在致密和非致密乳腺中均显示出比二维乳腺X线摄影显著更高的灵敏度（分别为100%对91.4%，<0.001）和（99.2%对78.5%，<0.001）。然而，逻辑回归模型未发现DBT与四个因变量之间存在任何统计学显著关系（>0.05）。
我们的研究结果表明，在老年女性中，DBT并未显著降低进一步医学检查的需求。
