Digital breast tomosynthesis (DBT): initial experience in a clinical setting
Digital breast tomosynthesis (DBT): initial experience in a clinical setting
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DOI：
10.1258/ar.2012.120062
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发表时间：
2012-06-01
期刊：
影响因子：
1.3
通讯作者：
Kreger, Mona
中科院分区：
文献类型：
--
作者：
Skaane, Per;Gullien, Randi;Kreger, Mona
背景：数字乳腺断层合成（DBT）是一项很有前途的新技术。一些实验性临床研究已经显示出积极的结果，但这项新技术的未来作用和适应症，无论是在筛查还是临床环境中，都需要评估。目的：比较数字乳房x线摄影和DBT对癌症显著性的并排特征分析，并评估DBT在检测其他恶性肿瘤方面是否有标准的最先进的常规影像学检查的潜在附加价值。材料和方法：该研究已获得伦理委员会的批准。共有129名妇女接受了2D数字乳房x光检查，包括补充锥形和放大视图，如果有必要，还进行了乳房超声检查，以及数字乳房断层合成检查。临床常规影像学的指征包括30例（23%）可触及的肿块，54例（42%）乳房x线检查发现异常，45例（35%）妇女接受监测。这些妇女根据目前的指导方针进行检查，包括斑点放大视图、超声检查和针活检，如果有必要的话。在不知道常规影像学结果的情况下，在常规影像学检查后几周进行DBT检查。在随后的会议中，三名放射科医生对50例样本中的癌症显著性进行了并排特征分析。结果：采用最先进的常规影像学检查对45例乳房进行了穿刺活检，其中20例为良性病变，共诊断出25例癌症。其余84名妇女因发现正常/绝对良性且无穿刺活检指征而出院。随后的DBT解释在这84名女性中发现了4名可疑的发现，这4名女性必须被召回进行反复检查，以了解断层合成结果。这些延迟的检查导致了两例癌症（癌症检出率提高了8%）和两例假阳性结果。并排特征分析显示，对于表现为针状肿块和扭曲的癌症，断层合成的显著性评分高于常规的20分。结论：层析合成技术是一种很有前途的新技术。我们的初步临床经验表明，使用这种新技术有可能提高灵敏度，特别是对于表现为针状肿块和扭曲的癌症。
Background: Digital breast tomosynthesis (DBT) is a promising new technology. Some experimental clinical studies have shown positive results, but the future role and indications of this new technique, whether in a screening or clinical setting, need to be evaluated.Purpose: To compare digital mammography and DBT in a side-by-side feature analysis for cancer conspicuity, and to assess whether there is a potential additional value of DBT to standard state-of-the-art conventional imaging work-up with respect to detection of additional malignancies.Material and Methods: The study had ethics committee approval. A total of 129 women underwent 2D digital mammography including supplementary cone-down and magnification views and breast ultrasonography if indicated, as well as digital breast tomosynthesis. The indication for conventional imaging in the clinical setting included a palpable lump in 30 (23%), abnormal mammographic screening findings in 54 (42%), and surveillance in 45 (35%) of the women. The women were examined according to present guidelines, including spot-magnification views, ultrasonography, and needle biopsies, if indicated. The DBT examinations were interpreted several weeks after the conventional imaging without knowledge of the conventional imaging findings. In a later session, three radiologists performed a side-by-side feature analysis for cancer conspicuity in a sample of 50 cases.Results: State-of-the-art conventional imaging resulted in needle biopsy of 45 breasts, of which 20 lesions were benign and a total of 25 cancers were diagnosed. The remaining 84 women were dismissed with a normal/definitely benign finding and without indication for needle biopsy. The subsequent DBT interpretation found suspicious findings in four of these 84 women, and these four women had to be called back for repeated work-up with knowledge of the tomosynthesis findings. These delayed work-ups resulted in two cancers (increasing the cancer detection by 8%) and two false-positive findings. The side-by-side feature analysis showed higher conspicuity scores for tomosynthesis compared to conventional 20 for cancers presenting as spiculated masses and distortions.Conclusion: Tomosynthesis is a promising new technique. Our preliminary clinical experience shows that there is a potential for increasing the sensitivity using this new technique, especially for cancers manifesting as spiculated masses and distortions.