A comparative efficacy study of diagnostic digital breast tomosynthesis and digital mammography in BI-RADS 4 breast cancer diagnosis.
A comparative efficacy study of diagnostic digital breast tomosynthesis and digital mammography in BI-RADS 4 breast cancer diagnosis.
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DOI：
10.1016/j.ejrad.2022.110361
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发表时间：
2022-08
影响因子：
3.3
通讯作者：
Wong, Stephen T. C.
中科院分区：
文献类型：
--
作者：
Ezeana, Chika F.;Puppala, Mamta;Wang, Lin;Chang, Jenny C.;Wong, Stephen T. C.
关键词：
BI-RADS 4指定的乳腺病变的恶性概率范围为2%至95%，导致高假阳性活检率。我们在没有乳腺癌既往史的BI-RADS 4人群中比较了数字乳腺断层合成摄影（DBT）与数字乳腺X射线摄影（2D）的临床性能。我们提取了回顾性数据，来自休斯顿卫理公会九家医院的电子医疗记录的临床、乳房X线照片报告和活检数据，这些患者使用两种模式进行了诊断检查（2015年2月1日至2020年9月30日）。2D和DBT队列未进行个体内匹配，也未进行直接乳房X线摄影评价。使用Student t检验、Fisher精确检验和卡方检验，我们评估了数据，以确定BI-RADS 4例病例中模式之间差异的统计学显著性。我们计算了癌症检出率（CDR）和活检得出的阳性预测值（PPV 3）之间的校正比值比。2D中有6，356次（6，020例患者），DBT中有5，896次（5，637例患者）被评估为BI-RADS 4。使用Fisher精确检验，DBT乳腺X线摄影病例被显著评估为BI-RADS 4的频率比接受2D乳腺X线摄影的病例高5.66%，P = 0.0046（1.0566 95% CI：1.0169-1.0977）。CDRs分别为112.65（2D）和120.76（DBT），校正比值比为1.04（0.93，1.16）），P = 0.5029，PPV 3分别为14.41%（2D）和15.99%（DBT），校正比值比：1.09（0.97，1.22），P = 0.1483;两个logistic回归校正所有其他因素。与2D相比，DBT在分配BI-RADS 4例病例时没有实现更好的性能和灵敏度，在CDR和PPV 3中没有显示出显著优势，并且在BI-RADS 4评估的患者中没有减少假阳性活检。
Probability of malignancy for BI-RADS 4-designated breast lesions ranges from 2% to 95%, contributing to high false-positive biopsy rates. We compare clinical performance of digital breast tomosynthesis (DBT) versus digital mammography (2D) among our BI-RADS 4 population without prior history of breast cancer. We extracted retrospective data i.e., clinical, mammogram reports, and biopsy data, from electronic medical records across Houston Methodist’s nine hospitals for patients who underwent diagnostic examinations using both modalities (02/01/2015 – 09/30/2020). 2D and DBT cohorts were not intra-individual matched, and there was no direct mammogram evaluation. Using Student’s t test, Fisher’s exact test, and Chi-squared test, we evaluated the data to determine statistical significance of differences between modalities in BI-RADS 4 cases. We calculated adjusted odds-ratio between modalities for cancer detection rate (CDR) and biopsy-derived positive predictive value (PPV3). There were 6,356 encounters (6,020 patients) in 2D and 5,896 encounters (5,637 patients) in DBT assessed as BI-RADS 4. Using Fisher’s exact test, DBT mammography cases were significantly assessed as BI-RADS 4 5.66% more often than those undergoing 2D mammography, P = 0.0046 (1.0566 95% CI: 1.0169–1.0977). The CDRs were 112.65 (2D) and 120.76 (DBT), adjusted odds-ratio: 1.04 (0.93, 1.16)), P = 0.5029, while PPV3 were 14.41% (2D) and 15.99% (DBT), adjusted odds-ratio: 1.09 (0.97, 1.22), P = 0.1483; both logistic regression-adjusted for all other factors. DBT did not achieve better performance and sensitivity in assigning BI-RADS 4 cases compared with 2D, showed no significant advantage in CDR and PPV3, and does not reduce false-positive biopsies among BI-RADS 4-assessed patients.
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