Butler Reni, Conant Emily F, Philpotts Liane
Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT.
University of Pennsylvania Medical Center, Department of Radiology, Philadelphia, PA.
J Breast Imaging. 2019 Mar 13;1(1):9-22. doi: 10.1093/jbi/wby008.
Digital breast tomosynthesis (DBT) is increasingly recognized as a superior breast imaging technology compared with 2D digital mammography (DM) alone. Accumulating data confirm increased sensitivity and specificity in the screening setting, resulting in higher cancer detection rates and lower abnormal interpretation (recall) rates. In the diagnostic environment, DBT simplifies the diagnostic work-up and improves diagnostic accuracy. Initial concern about increased radiation exposure resulting from the DBT acquisition added onto a 2D mammogram has been largely alleviated by the development of synthesized 2D mammography (SM). Continued research is underway to reduce artifacts associated with SM, and improve its comparability to DM. Breast cancers detected with DBT are most often small invasive carcinomas with a preponderance for grade 1 histology and luminal A molecular characteristics. Recent data suggest that higher-grade cancers are also more often node negative when detected with DBT. A meta-analysis of early single-institution studies of the effect of DBT on interval cancers has shown a modest decrease when multiple data sets are combined. Because of the greater conspicuity of lesions on DBT imaging, detection of subtle architectural distortion is increased. Such findings include both spiculated invasive carcinomas and benign etiologies such as radial scars. The diagnostic evaluation of architectural distortion seen only with DBT can pose a challenge. When no sonographic correlate can be identified, DBT-guided biopsy and/or localization capability is essential. Initial experience with DBT-guided procedures suggests that DBT biopsy equipment may improve the efficiency of percutaneous breast biopsy with less radiation.
与单纯的二维数字乳腺摄影（DM）相比，数字乳腺断层合成（DBT）越来越被认为是一种更优越的乳腺成像技术。越来越多的数据证实，在筛查中其敏感性和特异性有所提高，从而提高了癌症检出率并降低了异常解读（召回）率。在诊断环境中，DBT简化了诊断流程并提高了诊断准确性。最初对在二维乳腺摄影基础上进行DBT采集导致辐射暴露增加的担忧，已因合成二维乳腺摄影（SM）的发展而在很大程度上得到缓解。目前正在继续开展研究以减少与SM相关的伪影，并提高其与DM的可比性。通过DBT检测出的乳腺癌大多是小的浸润性癌，以1级组织学和管腔A型分子特征为主。最近的数据表明，用DBT检测到的高级别癌症也更常为无淋巴结转移。一项对DBT对间期癌影响的早期单机构研究的荟萃分析表明，合并多个数据集时，间期癌有适度减少。由于DBT成像上病变的辨识度更高，细微结构扭曲的检出率增加。这些发现包括毛刺状浸润性癌和诸如放射状瘢痕等良性病因。仅在DBT上看到的结构扭曲的诊断评估可能具有挑战性。当无法识别超声相关表现时，DBT引导下的活检和/或定位能力至关重要。DBT引导下操作的初步经验表明，DBT活检设备可以在减少辐射的情况下提高经皮乳腺活检的效率。
