Analysis of the diagnostic efficacy of digital breast tomosynthesis in patients with early-stage breast cancer
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摘要:
目的 探究数字乳腺断层摄影技术(DBT)对早期乳腺癌患者的诊断效能并与磁共振检查技术(MRI)进行比较。 方法 回顾性分析2023年1—12月在江苏省肿瘤医院诊断为早期乳腺癌的50例患者资料，所有患者在接受病理学检查前均接受了影像学检查且影像学资料清晰完整。以病理学检查结果作为金标准，比较不同影像检查技术的检出准确率、灵敏度、特异度，并对比乳腺癌类型的分型结果与病理诊断结果。 结果 DBT诊断乳腺病变的漏诊率、误诊率和准确率分别为4.00%(2/50)、6.00%(3/50)和90.00%(45/50)，与MRI比较[2.00%(1/50)、4.00%(2/50)、94.00%(47/50)]差异均无统计学意义；以病理检查结果为金标准进行比较，DBT对乳腺癌类型的诊断结果差异无统计学意义；50例早期乳腺癌患者中共发现87处肿块(恶性54处，良性33处)，DBT诊断的灵敏度和阴性预测值低于MRI，但特异度和阳性预测值高于MRI，且两者准确率相当；DBT和MRI的成本效益比(CER)分别为3.25和12.17，以DBT为基准，MRI的增量成本效益比(ICER)为713.91。 结论 数字乳腺断层摄影技术诊断乳腺癌患者的准确率和效益均较高，值得推广。 -
关键词:
- 乳腺癌 /
- 数字乳腺断层摄影技术 /
- 诊断
Abstract:Objective To investigate the diagnostic efficacy of digital breast tomosynthesis (DBT) in detecting early-stage breast cancer and compare its efficacy with that of magnetic resonance imaging (MRI). Methods A retrospective analysis was conducted on 50 patients diagnosed with early-stage breast cancer between January 2023 and December 2023. All patients underwent imaging examination, with complete and high-quality imaging data prior to pathological examination. The pathological findings were used as the gold standard to compare detection accuracy, sensitivity, and specificity DBT and MRI, as well as breast cancer staging consistency between imaging and pathology. Results The rates of missed diagnoses, misdiagnosis, and accuracy in detecting breast lesions for DBT were 4.00% (2/50), 6.00% (3/50), and 90.00% (45/50), respectively. Compared with MRI [2.00% (1/50), 4.00% (2/50), and 94.00% (47/50)], these differences were not statistically significant. Based on the pathological examination results as the gold standard, there was no statistically significant difference in the diagnostic results of DBT for breast cancer type classification. A total of 87 breast masses (54 malignant and 33 benign) were identified in 50 patients with early-stage breast cancer. DBT demonstrated lower diagnostic sensitivity and negative predictive value than MRI, it exhibited higher specificity and positive predictive value. Overall diagnostic accuracy was comparable between the two modalities. The cost-benefit ratio (CER) for DBT and MRI were 3.25 and 12.17, respectively, and the incremental cost-benefit ratio (ICER) for MRI relative to DBT was 713.91. Conclusion Digital breast tomosynthesis offers high accuracy and favorable cost-effectiveness in the diagnosis of patients with breast cancer, making it a valuable tool worthy of broader clinical application. -
Key words:
- Breast cancer /
- Digital breast tomosynthesis /
- Diagnosis
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图 1 1例乳腺癌患者的DBT、磁共振和病理检查结果
注：A、B分别为右乳MLO位和CC位图像；C、E分别为右乳磁共振增强图像和经过处理后的时间-信号强度曲线图；D为病变处的常规病理切片，免疫组化结果显示，P63基底细胞(+)；CK5/6基底细胞(+)；CD10肌上皮(+)；CK14基底细胞(+)；Calponin肌上皮(+)；ER(+，95%)；PR(+，热点区90%)；AR(+，95%)；Ki-67(+，热点区10%)；P53野生型；EGFR(-)。红圈内为病变组织。
Figure 1. DBT, magnetic resonance and pathologic findings of one patient with breast cancer
表 1 2种影像检查方法对乳腺癌患者的检出情况比较(%)
Table 1. Comparison of the detection situations of breast cancer patients by two imaging examination methods (%)
检查方法 例数 漏诊率 误诊率 准确率 DBT 50 4.00(2/50) 6.00(3/50) 90.00(45/50) MRI 50 2.00(1/50) 4.00(2/50) 94.00(47/50) χ2值 < 0.001 < 0.001 0.136 P值 0.999 0.999 0.712 
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表 2 DBT检查技术与病理诊断对乳腺癌类型的诊断结果比较[例(%)]
Table 2. Comparison of the detection situations of breast cancer patients by two imaging examination methods (%)
检查方法 例数 原位癌 导管内癌 黏液腺癌 DBT 50 9(18.00) 30(60.00) 11(22.00) 病理诊断 50 8(16.00) 31(62.00) 11(22.00) 注：2组乳腺癌类型比较，χ2=0.075，P=0.963。
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表 3 DBT对乳腺肿块的检查结果(处)
Table 3. The examination results of breast masses by DBT (cases)
DBT 病理结果 合计 阳性 阴性 阳性 48 3 51 阴性 6 30 36 合计 54 33 87
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表 4 磁共振对乳腺肿块的检查结果(处)
Table 4. The examination results of breast masses by MRI (cases)
MRI 病理结果 合计 阳性 阴性 阳性 51 5 56 阴性 3 28 31 合计 54 33 87
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表 5 2种检查方法对乳腺肿块的诊断效能(%)
Table 5. The diagnostic efficacy of two examination methods for breast masses (%)
检查方法 灵敏度 特异度 阳性预测值 阴性预测值 准确率 DBT 88.89 90.91 94.12 83.33 89.66 MRI 94.44 84.85 91.07 90.32 90.80
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表 6 2种检查方法诊断乳腺疾病的成本效益比较
Table 6. Cost-benefit comparison of two examination methods in the diagnosis of breast diseases
检查方法 成本(元) 效果(%) 时间(min) CER ICER DBT 291.50 89.66 12.50 3.25 MRI 1 105.36 90.80 27.30 12.17 713.91
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