乳腺三维断层摄影与全数字化乳腺摄影#br# 在乳腺疾病诊断中的效能对比

目的：研究数字乳腺三维断层摄影(digital breast tomosynthesis，DBT)对于乳腺影像报告数据系统(breast imaging-reporting and data system，BI-RADS)分类的影响及意义。方法：选取2013年5月至2013年11月来福建医科大学第二临床医学院就诊的乳腺疾病患者832例，入选病人全部双体位拍摄并进行COMBO模式检查包括DBT和全数字化乳腺摄影(full-field digital mammography，FFDM)]。分别对COMBO及FFDM检查进行BI-RADS分类，并比较COMBO模式和FFDM检查模式在同一患者图像中腺体含量的判断、肿块特征的显示以及间接征象的显示；对832例进行Wilcoxon配对秩和检验，判断两种检查方法是否存在差异，同时对有病理结果的79例患者采用受试者工作特征曲线(receiver operator characteristic curve，ROC)分析。结果：本组乳腺疾病患者中，多量腺体者(包括c类及d类)占87.6%，少量腺体者(包括a类及b类)占11.7%。判断腺体含量时，COMBO模式可以观察到更细致的腺体分布状况；秩和检验结果显示：COMBO模式及FFDM检查模式对乳腺 BI-RADS分类诊断分布差异有统计学意义(P<0.05)，COMBO整体分类级别高于FFDM；诊断效能的比较以病理结果作为金标准，FFDM ROC曲线下面积是0.805，COMBO模式ROC曲线下面积为0.941，COMBO模式最佳截点值的敏感度为82.9%，高于FFDM的敏感度(60%)，二者的特异度相同，均为93.2%。结论：DBT在乳腺X线检查进行BI-RADS分类时具有很高的临床价值。

Comparison of the diagnostic efficiency between digital breast tomosynthesis and full-field digital mammography

Objective: To explore the effect of digital breast tomosynthesis (DBT) on the classification of breast imaging-reporting and data system (BI-RADS) and its significance. Methods: A total of 832 patients with breast diseases, who came from Second Clinical College of Fujian Medical University from May 2013 to November 2013, were collected. The patients were examined by double position radiography (including craniocaudol and mediolateral oblique) and COMBO mode including DBT and full-field digital mammography (FFDM)]. Meanwhile, the results of FFDM and DBT were classified. The number of glands, the characteristics of mass and other indirect signs were compared by COMBO and FFDM modes. Paired Wilcoxon rank sum text was adopted to investigate the differences between COMBO mode and FFDM mode in the 832 patients, and receiver operator characteristic curve (ROC) was applied to analyze the 79 patients with the pathological results. Results: The patients with large amount of glands (including Class c and Class d) accounted for 87.6% in the 832 patients, while the patients with small amounts of glands (including Class a and Class b) accounted for 11.7%. In estimating the content of glands, more details about the distribution of glands were found in the COMBO mode compared with those in the FFDM mode. According to the results of paired Wilcoxon rank sum test, there was significant statistical difference in BI-RADS classcification in breast masses between the COMBO mode and the FFDM mode (P<0.05), though the overall classification of the COMBO mode is higher than that of the FFDM mode. The pathology was served as a standard to estimate the diagnostic efficiency. The area under ROC curve was 0.805 in the FFDM mode, while that in the COMBO mode was 0.941. The optimal sensibility in the COMBO mode was 82.9%, which was higher than that in the FFDM mode. However, the specificity was 93.2% in both COMBO mode and the FFDM mode. Conclusion: DBT has a high clinical significance in BI-RADS classification for breast X-ray examination.