The Value Of Digital Breast Tomosynthesis Combined With Magnetic Resonance Imaging For Diagnosing Breast Cancers In Dense Breast

Objective: To evaluate the diagnostic performance of digital breast tomosynthesis(DBT),magnetic resonance imaging(MRI)and DBT combined MRI in a large series of dense breast population/breast lesions(n?=?486).Methods: a total of 486 patients who underwent 3.0-T DCE-MRI and DBT examinations at the Department of Radiology,Xin Jiang Tumor Hospital were included in this study.Two breast radiologists examined and evaluated DBT and MRI of any clinical information or histopathological diagnosis.McNemar’s test and correction for continuity were applied to compare these methods’ sensitivity,specificity and coincidence rate.Pearson’s chi-squared test,and Fisher’s exact test were conducted to compare the positive predictive value and negative predictive value of different methods.The diagnostic confidence was evaluated by receiver operator characteristic(ROC)curve analysis and matched the areas under curve(AUC)to stratified comparison according to different ages,lesion sizes and pathological types.Results:Among 486 women,histological examination revealed 304 women with malignant lesions(62.6%)and 182 women with benign lesions(37.4%).The sensitivity of DBT,MRI,and DBT combined with MRI were 88.2%,96.4% and 98.4%,respectively.The specificity of DBT,MRI and DBT combined with MRI,were 90.7%,87.4% and 84.6%,respectively.It was found that the diagnostic sensitivity and negative predictive value of MRI for dense breast were significantly higher than those of DBT(P < 0.05).The diagnostic sensitivity,coincidence rate and negative predictive value of DBT combined with MRI were significantly higher than those of DBT,but their specificity was lower than that of DBT(P< 0.05).The AUC of DBT,MRI and their combined diagnosis were 0.894,0.919 and0.915,respectively.There was no significant difference in the Z-test between pairwise comparisons(P > 0.05).In different age groups,the diagnostic sensitivity and coincidence rate of MRI in all ages were higher than those of DBT,but the mainly difference isbetween 41~50 years old.MRI found 13.8% more malignant lesions than DBT,and combined diagnosis sensitivity was 100%.MRI and DBT combined with MRI were significantly different from DBT(P < 0.001).In the diagnosis of breast cancer with a lesion within 2 cm,the sensitivity of MRI and DBT combined with MRI were 10% and11% higher than that of DBT,respective.In the diagnosis of carcinoma in situ,MRI and DBT have comparable diagnostic performance.Conclusion: 3.0-T MRI can provide more imaging information,which had higher diagnostic performance than that of DBT in women with dense breasts categorized by breast composition c and d,especially when the lesion is within 2 cm or the age is between 41 and 50 years.We suggest that additional MRI should be considered when DBT is negative in this population...