阅片者间应用数字乳腺断层合成X线成像诊断乳腺疾病的可靠性分析

目的：比较阅片者间应用全屏数字化乳腺 X 线成像(FFDM)和数字乳腺断层合成 X 线成像(DBT)对乳腺疾病诊断及BI-RADS 分类的差异,评价 DBT 在诊断乳腺肿瘤方面的应用价值。方法收集疑似乳腺疾病病例300例,所有病例均经手术病理证实,其中良性118例,恶性182例,所有患者术前均行 FFDM 及 DBT 检查。分别由4名不同年资医师独立阅片进行诊断,以病理为金标准,比较阅片者间对乳腺病变诊断的差异。采用χ2及受试者工作特征(ROC)曲线分析方法进行统计。结果高年资医师阅读 FFDM 和 DBT 的诊断正确率分别为90%和91%,曲线下面积(AUC)分别为0.891和0.899；低年资医师阅读 FFDM 和DBT 影像的诊断正确率分别为82%和90%,AUC 分别为0.801和0.891。118例良性病变中 DBT 相比 FFDM,高、低年资医师分类为 BI-RADS 4a 类及以下的病例分别由82例提高到96例、41例提高到98例,分类为 BI-RADS 4b-5类的病例分别由19例降至16例、30例降至16例。182例恶性病变中 DBT 相比 FFDM,分类为 BI-RADS 4a-5类的病例高、低年资医师分别由167例提高到169例、152例提高到167例；BI-RADS 4a 类及以下的病例分别由12例降至10例、24例降至15例。高、低年资医师阅读 FFDM 分类为 BI-RADS 0类的病例分别为22例和53例,而阅读 DBT 后二者分别降至7例和4例。结论不同年资医师阅读 DBT 可以提高诊断的准确性,BI-RADS 分类与病理结果的一致性亦更高,以低年资医师提高更为显著。DBT 对提高乳腺肿瘤的检出率及诊断准确性具有很大的潜能。

Intraobserver reliability for diagnosing breast diseases on digital breast tomosynthesis

Objective To evaluate the diagnostic accuracy and BI-RADS classification with full-field digital mammography (FFDM)and digital breast tomosynthesis (DBT)among different experience doctors,to estimate the value of using DBT in breast disease diagnosis.Methods 300 patients with symptoms were imaged with FFDM and DBT.Pathology results were available for all patients,118 cases were benign,and 182 cases were malignant.Four doctors with different experience made diagnosis independently,the results would be compared and analyzed among different readers.The results would be compared and analyzed among different readers by using Chi-squared test and ROC.Results Comparing with pathology,the accuracy rate of experienced doctor was 90% by FFDM,while it was increased to 91%by DBT,and area under curve(AUC)was increased from 0.891 to 0.899.82% of the cases were accurately diagnosed on FFDM by inexperienced doctor,while it was increased to 90% by DBT,the AUC was increased from 0.801 to 0.891.Comparing with FFDM, the number of benign cases in BI-RADS 1-4a was increased from 82 to 96,and decreased from 1 9 to 1 6 in BI-RADS 4b-5 on DBT by experienced doctor,and it was increased from 41 to 98 in BI-RADS 1-4a,and decreased from 30 to 16 in BI-RADS 4b-5 by inexperienced doctor.For malignant cases,experienced doctor made classification as BI-RADS 1-4a was 12 by FFDM,and 10 by DBT;while the number increased from 167 to 169 in BI-RADS 4b-5.Comparing with FFDM,the number of cases in BI-RADS 1-4a was decreased from 24 to 15,and increased from 152 to 167 in BI-RADS 4b-5 by inexperienced doctor on DBT.The number in BI-RADS 0 was decreased from 22 to 7 by experienced doctor when using DBT,and from 53 to 4 by inexperienced doctor.Conclusion DBT can improve the diagnostic accuracy of breast lesions for different experience doctors,especially for inexperienced doctor. The BI-RADS classification based on DBT is more consistent with the pathology.