中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (11): 813-818.doi: 10.19401/j.cnki.1007-3639.2018.11.003

• 论著 • 上一篇    下一篇

数字乳腺断层融合X线摄影术前评估乳腺癌肿块大小的效能对比研究

汤 伟1,杨 孟1,高 毅2,王奇峰3,沈茜刚1,顾雅佳1,彭卫军1   

  1. 1. 复旦大学附属肿瘤医院放射诊断科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    2. 复旦大学附属肿瘤医院超声诊断科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    3. 复旦大学附属肿瘤医院病理科,复旦大学上海医学院肿瘤学系,上海 200032
  • 出版日期:2018-11-30 发布日期:2018-12-14
  • 通信作者: 彭卫军 E-mail: cjr.pengweijun@vip.163.com
  • 基金资助:
    科技部国家重点研发计划数字诊疗装备研发(2017YFC0109403);2017上海卫生和计划生育委员会青年基金项目(20174Y0242);复旦大学附属肿瘤医院影像专项基金(YX-1702)。

Accuracy of tumour size assessment in the preoperative staging of breast lesions: a comparative study between digital breast tomosynthesis and conventional imaging methods

TANG Wei1, YANG Meng1, GAO Yi2, WANG Qifeng3, SHEN Xigang1, GU Yajia1, PENG Weijun1   

  1. 1. Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 2. Department of Diagnostic Sonography, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3. Department of Pathology, Fudan University, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University Shanghai 200032, China
  • Published:2018-11-30 Online:2018-12-14
  • Contact: PENG Weijun E-mail: cjr.pengweijun@vip.163.com

摘要: 背景与目的:全数字化乳腺摄影(full-field digital mammography,FFDM)的大规模使用可显著降低乳腺癌的死亡率,但对于致密型乳腺患者,其诊断灵敏度和特异度明显减低。本研究旨在对比数字乳腺断层融合X线摄影(digital breast tomosynthesis,DBT)与常规影像学检查术前评估乳腺癌肿块大小的效能。方法:回顾性分析2015年3月—2015年12月在复旦大学附属肿瘤医院就诊并经病理学检查证实为乳腺癌的136例患者,所有患者均行超声、FFDM、DBT和磁共振成像(magnetic resonance imaging,MRI)检查。选取每种检查均可测量最大径的肿块纳入本研究。由3名高年资放射诊断科医师分别测量可见肿块最大径,利用方差分析比较DBT、超声、FFDM及MRI与术后大体标本测量值之间的差异;利用Pearson相关系数分析各种检查与大体标本测量值之间的相关性,并应用配对t检验评价DBT术前评估肿块大小的能力。结果:136例患者共发现140枚肿块,排除26例患者选择先辅助化疗后再行手术,最后纳入研究的为114枚肿块。DBT及MRI测得肿瘤最大径与病理测量值之间差异无统计学意义(P均>0.05);FFDM和超声与病理测量值相比差异有统计学意义(与FFDM相比:t=3.30,P=0.013 4;与超声相比:t=2.58,P=0.021 5)。DBT(r=0.81)、MRI测量值(r=0.84)与病理测量值的相关性显著高于超声(r=0.68)和FFDM组(r=0.69)。结论:DBT术前评估乳腺癌肿块大小的能力显著优于超声和FFDM,与MRI相似;DBT作为乳腺X线摄影新技术,在乳腺癌术前分期中有良好的应用前景。

关键词: 乳腺肿块, 全数字化乳腺摄影, 磁共振成像, 数字乳腺断层融合X线摄影, 超声成像

Abstract: Background and purpose: The large-scale use of full-field digital mammography (FFDM) can significantly reduce the mortality rate of breast cancer. However, the sensitivity and specificity of diagnosis were significantly reduced in patients with dense breast. This study aimed to compare the efficacy of digital breast tomosynthesis (DBT) with conventional imaging methods in assessing the tumor size before surgery. Methods: One hundred and thirty-six patients diagonosed as having breast cancer by pathology were enrolled in this study. All patients underwent FFDM, DBT and breast magnetic resonance imagining (MRI) examinations between Mar. 2015 and Dec. 2015. The maximum tumour size was measured by 3 experienced radiologists and compared to the gross specimen using Pearson analysis. The results were compared between any two methods using paired t test. Results: One hundred and forty masses were found in 136 patients, and 26 masses were excluded from the patients who received operation after adjuvant chemotherapy. One hundred and fourteen masses with measurable tumour size were included for further research. There was no significant difference in the maximum tumour size between DBT or MRI group and gross specimen group (both P>0.05), while there was remarkable difference between the gross specimen group and FFDM (t=3.30, P=0.013 4), or the sonography (t=2.58, P=0.021 5) group. The coefficients of correlation with pathological data of DBT (r=0.81) and MRI (r=0.84) were significantly higher than those of sonography (r=0.68) and FFDM (r=0.69). Conclusion: DBT and MRI are superior to FFDM and sonography in the preoperative assessment of breast tumor size. As a new mammography technology, DBT has good clinical application prospect in preoperative staging of breast cancer.

Key words: Breast tumor, Full-field digital mammography, Magnetic resonance imaging, Digital breast tomosynthesis, Sonography