X-ray Phase Imaging In The Diagnosis Of Breast Cancer Value

Part one The comparison research of the image quality between the phase-contrast mammography and full-fieid digital mammographyObjective To investigate and compare the image quality of phase-contrast mammography and full-field digital mammography. Methods ACR RMI-156 phantom and CDMAM (contrast detail mammography) phantom were selected and were exposured at PCM and FFDM. The exposured condition was the same in two groups except in automaticexposure. Three radiologisits evaluate the phantom X-ray imagings which were printed to film respectively. The method of evaluating RMI-156 was scoring(according to minute structure inside phantom). Compare the difference of scoring between the PCM and FFDM. One method of evaluating CDMAM was recording the minimum diameter (mm) of every row (thicknessμm), and drawing CDC (contrast detail curve). Another method of evaluating CDMAM was calculating IQF (Imaging Quality Figure), Compare the difference of CDC and IQF between the PCM and FFDM. The method was test using paried t test and one way ANOVA . Statistic software was Stata 7.0. Results 1. The results of using RMI-156: In all three exposured condition, the scoring of every radiologist between two groups is approximate, there were no statistically diffenrence between PCM and FFDM (P>0.05) . No matter which group there were no statistically diffenrence among three radiologists (P>0.05). The scoring of two groups surpass the accepted criterion(10 score) of ACR . 2. The results of using CDMAM: The minimum thickness which was observed by both PCM and FFDM was 0.08μm. the minimum diameter which was observed by both PCM and FFDM was 0.13mm( on the level of 2.00μm thickness). In all three exposured condition, two CDC were blended, there were no statistically diffenrence of the average IQF between PCM and FFDM (t =2.0840 P > 0.05 ) . Conclusion The capability of displaying simulated calcification , fiber and simulated mass which inside the RMI-156 phantom is the same between PCM and FFDM. The capability of discriminating detail inside the CDMAM is the same also. Two mammography have the higher image quality. Part two The diagnostic value of phase-contrast mammography for breast carcinoma: A experimental studyObjective To study diagnostic ability for detecting breast cancer using phase-contrast mammography(PCM) technology. Methods Nine excising specimens of breast were expose at PCM and FFDM (full field digital mammography) machine using automatic exposure and different other exposure. To compare the ability of displaying inner structure and margin of lesion using scoring method. To compare the difference of exposure condition(kV,mAs ) between two groups which using automatic exposure. AGD( Average Gland Dose) between two groups was compared indirectly also. Results In displaying lesions using automatic exposure, the average score of PCM and FFDM were 4.89±1.17 and 4.67±1.12 respectively (t=1.5119, P>0.05),there was no statistical difference between two groups; Whether lower exposure condition(20 mAs) or higher exposure condition(50 mAs), there was no statistical difference between two groups (t_20mAs=2.000, P_20mAs =0.0805, t_50mAs =1.0000, P_20mAs =0.3436) . Using automatic exposure, the average kV of PCM and FFDM were 26.78±1.20 and 26.00±0.70 respectively (t=1.6783, P>0.05), there was no statistical difference between two groups. The average mAs of PCM and FFDM were 31.82±4.52 and 69.33±36.68 respectively (z=2.666, P<0.01), there was statistical difference between two groups. The average AGD of PCM and FFDM were 0.55±0.06 and 1.00±0.13 respectively , there was statistical difference between two groups (z =2.201, P<0.05), the AGD of PCM is lower than that of FFDM using indirect method. Conclusion PCM has the same ability as FFDM in displaying inner structure and margin of breast cancer. Exposuring time of PCM is shorter than that of FFDM. The AGD of PCM may be lower than that of FFDM. Part three Comparison research of clinical diagnostic value between phase-contrast mammography and full-field digital mammography for breast carcinomaObjective To evaluate the clinical diagnostic value of phase-contrast mammography and full-field digital mammography for breast diseases. Methods From Jan. to Aug. 2008, 451 patients of breast diseases were reviewed and their clinical data and mammograms were collected. 23 of 451 patients were surgeried for bilateral breast, so 474 cases were studied. Craniocaudal(CC) view and midiolateral oblique(MLO) were conducted for every patients before surgery( 236 cases were exposured by PCM and 238 cases were exposured by FFDM). Three radiologists who are expert in breast imaging assessed and classified mammograms in all patients according to BI-RADS. Breasts were classified according to density. Evaluate sensitivity,specificity and accuracy of PCM and FFDM at diagnosing breast carcinoma. The method was test using Kappa,Youden Index and ROC. Discuss the possibility of false-negative and false-positive. Results 1. In PCM group, there were 117 breast maligant tumors (100 of them were invasive duct carcinoma) and 119 breast benign lesions(51 of them were fibroadenoma). In FFDM group, there were 130 breast maligant tumors (109 of them were invasive duct carcinoma) and 108 breast benign lesions (57 of them were breast adenosis). 2. Masses was the most common signs of the maligant tumors, account for 46%(PCM) and 41%(FFDM) respectively. Masses with microcalcification was another common sings of the maligant tumors, account for 24%(PCM) and 21%(FFDM). 3. The sensitivity,specificity and accuracy of PCM at diagnosing breast carcinoma were 92.3%,87.4%,and 89.8%, respectively; those of FFDM,90.8%,87%,and 89.1%,respectively. 4. There were high agreement between mammographic diagnostic activity and pathologic results ( k_pcm=0.7967, k_ffdm=0.7793). There was no statistical differences between two groups in diagnositic validity(u=0.6, P>0.5). The areas under the ROC curves in PCM and FFDM were 0.9581 and 0.9281 respectively. 5. The key factors of false-negative were negative X-ray findings(3 cases in PCM group and 5 cases in FFDM group) and demonstrating focal asymmetric densities(4 cases in both group ); The key factors of false-positive were interpretating the massse with the spiculated,indistinct and lobular margins as maligant tumors(8 cases in PCM group and 7 cases in FFDM group). Conclusion There were higher sensitivity,specificity and accuracy of PCM and FFDM at diagnosing breast carcinoma in women with signs and symptoms. No significant difference in cancer detection was observed between PCM and FFDM. Both methods has clinical value in detecting breast carcinoma. It is necessary that accurate outcome should be according to population-based mammography screening.