Dou Eda, Ksepka Martha, Dodelzon Katerina, Shingala Prapti Y, Katzen Janine T
NewYork-Presbyterian Hospital/Weill Cornell Medical College, Department of Radiology, New York, NY.
Medical Imaging of Lehigh Valley, Allentown, PA.
J Breast Imaging. 2020 Nov 21;2(6):552-560. doi: 10.1093/jbi/wbaa078.
The purpose of this study was to evaluate the positive predictive value of biopsy (PPV3) of architectural distortion (AD) detected on digital breast tomosynthesis (DBT) in BI-RADS 4 cases, where suspicion for malignancy remains broad.
This Institutional Review Board-approved, retrospective study included screening and diagnostic mammograms performed from August 2015 to December 2017 with DBT and digital mammography (DM) revealing suspicious AD with a BI-RADS 4 assessment. Medical records were reviewed for clinical data, imaging, and pathology results. Malignancy rate was assessed by lesion visibility on DM and DBT. Multivariate analysis was performed to assess the odds ratio (OR) of malignancy.
A total of 63/179 cases were malignant, yielding a PPV3 of 35%. No significant difference in PPV3 was found by race, personal or family history of breast cancer, presence of microcalcifications, or mammogram type. Architectural distortion was more likely to be malignant when an US correlate was present (PPV3 49% vs 19%; P < 0.0001). Multivariate analysis demonstrated a 3-fold increased OR for malignancy with an US correlate present (P = 0.005). Lesion visibility analysis revealed a higher PPV3 for AD visible on DM-DBT compared with DBT alone (44% vs 26%; P = 0.01) and when an US correlate was present (DM-DBT 54% vs 30%, P = 0.02; DBT-only 43% vs 11%, P < 0.001).
Tomosynthesis-detected BI-RADS 4 AD are malignant in 35% of cases and are more likely to be malignant if an US correlate is present and if visible on both DM and DBT.
本研究旨在评估在乳腺影像报告和数据系统（BI-RADS）4类病例中，数字乳腺断层合成（DBT）检测到的结构扭曲（AD）活检的阳性预测值（PPV3），此类病例中恶性肿瘤的可疑程度仍较高。
这项经机构审查委员会批准的回顾性研究纳入了2015年8月至2017年12月期间进行的筛查和诊断性乳房X线摄影，这些检查采用DBT和数字乳腺摄影（DM），显示出可疑的AD并进行了BI-RADS 4级评估。查阅病历以获取临床数据、影像资料和病理结果。通过DM和DBT上病变的可见性评估恶性率。进行多变量分析以评估恶性肿瘤的优势比（OR）。
总共63/179例为恶性，PPV3为35%。在种族、个人或家族乳腺癌病史、微钙化的存在或乳房X线摄影类型方面，未发现PPV3有显著差异。当存在超声相关表现时，结构扭曲更有可能是恶性的（PPV3为49%对vs 19%；P < 0.0001）。多变量分析显示，存在超声相关表现时，恶性肿瘤的OR增加了3倍（P = 0.005）。病变可见性分析显示，与单独的DBT相比，在DM-DBT上可见的AD的PPV3更高（44%对vs 26%；P = 0.01），并且当存在超声相关表现时（DM-DBT为54%对vs 30%，P = 0.02；仅DBT为43%对vs 11%，P < 0.001）。
DBT检测到的BI-RADS 4级AD在35%的病例中为恶性，如果存在超声相关表现并且在DM和DBT上均可见，则更有可能是恶性的。
