超声下数字乳腺三维断层摄影技术联合全视野数字化乳腺摄影与单独DBT在乳腺癌诊断中的价值对比

doi:10.3969/j.issn.1006-6233.2020.07.016

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摘要 目的:探讨超声下数字乳腺三维断层摄影技术(DBT)联合全视野数字化乳腺摄影技术(FFDM)与单独DBT在乳腺癌诊断中的价值,为乳腺癌的临床诊断提供理论与实践依据。方法:以病理诊断为金标准选取哈励逊国际和平医院于2017年10月至2018年12月收治的乳腺癌(均为女性)患者300例进行前瞻性研究,在准确获取所有受试者乳腺密度类型、病灶大小、钙化灶及组织类型等指标的基础上采用COMBO模式获得FFDM及DBT图像,并对DBT联合FFDM与单独DBT诊断的两种图像进行判断,并将其各项数据纳入SPSS19.0和Medcalc12.0软件处理,分析两种诊断方法的灵敏度、特异度和准确度和评价(受试者工作特征ROC曲线)这两种检测方法在乳腺肿物中的诊断准确度。结果:经统计分析发现,A、B、C、D组中的DBT＋FFDM检测结果与单纯的DBT检测相比A组(ACR1、ACR2)、B组(≤10mm和>30mm)无显著差异(P>0.05),其他指标相比DBT＋FFDM检测结果均显著优于单纯DBT检测,差异显著(P<0.05)。统计发现,≤40岁、>50岁和已绝经者的DBT＋FFDM检测与单纯DBT诊断结果均无显著差异(P>0.05),而40~50岁和未绝经者的DBT＋FFDM检测结果显著优于单纯DBT诊断,差异显著(P<0.05)。将表1、表2中P<0.05的各项指标纳入Medcalc12.0软件处理和绘制其ROC曲线下面积(AUC)来看,DBT＋FFDM诊断的AUC=0.937,95%CI为0.878~1.024,而单纯DBT诊断的AUC=0.781,95%CI为0.715~0.843,两者相比DBT＋FFDM诊断准确性更高(P<0.05)。结论:在乳腺癌的临床诊断中科学、合理的予以DBT联合FFDM诊断的准确率与单纯DBT诊断效果相比更高,能更好的应用于临床检测,是乳腺癌检查及相关乳腺疾病诊断的首选检查方法,可为临床该病的临床诊治提供更准确的影像诊断结果、缩短病患检测时间和降低临床诊断费用,临床应用价值较好。

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	赵鹏
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	李红蕊

关键词 ：乳腺癌, 超声下数字乳腺三维断层摄影技术, 全视野数字化乳腺摄影技术

Abstract：Objective: To explore the value of three-dimensional ultrasound mammography (DBT) combined with full field digital mammography (FFDM) and single DBT in the diagnosis of breast cancer, so as to provide theoretical and practical basis for the clinical diagnosis of breast cancer. Methods: Based on the gold standard of pathological diagnosis, 300 cases of breast cancer (all female) admitted by Harrison International Peace Hospital from October 2017 to December 2018 were selected for prospective study. FFDM and DBT images were obtained by combo mode on the basis of accurately obtaining breast density type, focus size, calcification focus and tissue type of all subjects. The images of DBT diagnosis were judged, and their data were included in spss19.0 and medcalc12.0 software processing. The sensitivity, specificity and accuracy of the two diagnostic methods and the diagnostic accuracy of evaluation (ROC curve of working characteristics of subjects) were analyzed. Results: 1) By statistical analysis, the results of DBT+FFDM in group A, B, C and D showed no significant difference (P＞0.05) compared with that in group A (ACR1, ACR2) and group B (< 10 mm and > 30 mm), and the results of DBT + FFDM in other indicators were significantly better than that of DBT alone (P＜0.05). 2). Statistical results showed that there was no significant difference between the DBT+FFDM detection of patients under 40 years old, over 50 years old and postmenopausal patients and that of patients with simple DBT diagnosis (P＞0.05), while the DBT+FFDM detection of patients between 40-50 years old and postmenopausal patients was significantly better than that of patients with simple DBT diagnosis (P＜0.05). 3). The AUC of DBT+FFDM was 0.937, 95% CI was 0.878~1.024, while that of DBT+FFDM was 0.781, 95% CI was 0.715~0.843, which was more accurate than that of DBT+FFDM (P＜0.05). Conclusion: In the clinical diagnosis of breast cancer, the diagnostic accuracy of DBT combined with FFDM is higher than that of DBT alone, which can be better used in clinical detection. It is the first choice for breast cancer examination and diagnosis of related breast diseases. It can provide more accurate image diagnosis results for clinical diagnosis and treatment of the disease, shorten the detection time of patients and reduce the clinical diagnosis cost. It has good clinical application value.

Key words： Breast cancer Digital three-dimensional mammography under ultrasound Full field digital mammography

基金资助:2017衡水市科技创新局科研项目课题,(编号:2017014013C-20)

引用本文:

赵鹏, 肖杨, 李红蕊. 超声下数字乳腺三维断层摄影技术联合全视野数字化乳腺摄影与单独DBT在乳腺癌诊断中的价值对比[J]. 河北医学, 2020, 26(7): 1119-1124.
ZHAO Peng, XIAO Yang, LI Hongrui. Comparison of the Diagnostic Value of Three-dimensional Ultrasound Mammography Combined with Full Field Digital Mammography and DBT Alone in Breast Cancer Diagnosis. HeBei Med, 2020, 26(7): 1119-1124.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.07.016 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I7/1119

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