A Comparison Of FFDM+DBT And MRI In The Diagnosis Of Benign And Malignant Breast Diseases

Objective:To explore the diagnostic value of benign and malignant breast diseases between full-field digital mammography(FFDM),digital breast tomosynthesis(DBT),FFDM combined with DBT and MRI,providing data support for the clinical large-scale application of FFDM+DBT.Methods:During the period from Nov.2019 to Feb.2021,116 patients with suspected lesions by palpation underwent further imaging exam in the first affiliated hospital of bengbu medical college.The FFDM,DBT and MRI were performed on all the patients.All breast lesions were analyzed according to BI-RADS.The pathological results were "gold standard",the kappa consistency test values and the sensitivity,specificity and accuracy of FFDM,DBT,FFDM+DBT and MRI were calculated.Receiver operating characteristic(ROC)curve were used to analyze the diagnostic efficacy of FFDM,DBT,FFDM+DBT and MRI in different gland types for benign and malignant diseases of the breast;the accuracy of FFDM,DBT,FFDM+DBT and MRI in the diagnosis of breast lesions of different pathological types were calculated.The differences in average glandular dose(AGD)between FFDM and DBT were analyzed.Results:Among the 116 lesions,86 were malignant and 30 were benign.There were no statistical differences in age,gland type and location of the 116 lesions(P>0.05).The kappa values of FFDM,DBT,FFDM+DBT and MRI with pathological results were0.55,0.66,0.71,0.74,respectively,and the agreement with pathological results was moderate,among which MRI with pathological results showed the best agreement.The sensitivity of FFDM,DBT,FFDM+DBT and MRI for the diagnosis of breast benign and malignant diseases was 82.56%,87.21%,88.37%,96.51%,respectively,and the specificity was 76.67%,83.33%,86.67%,73.33%,respectively,while the accuracy was81.03%,86.21%,87.93%,90.52%,respectively.The application of MRI for diagnosis could improve the sensitivity of FFDM by 13.95%,and the difference was statistically significant(P<0.05).The areas under the ROC curves(AUC)of FFDM,DBT,FFDM+DBT and MRI were 0.80,0.88,0.91 and 0.95,respectively,showing that the AUC values of MRI and FFDM+DBT were higher than those of FFDM with statistical significance(P<0.05),while there was no statistical difference in the other groups(P>0.05).The AUC values of FFDM,DBT,FFDM+DBT and MRI were 0.74,0.85,0.89 and 0.93,respectively,in 80 dense type breast,which were significantly higher than those of FFDM in both pairwise comparisons(P<0.05).The AUC values of FFDM,DBT,FFDM+DBT and MRI in 36 non dense breast tumors were 0.94,0.96,0.97,0.99,respectively,which were not statistically different between any groups(P>0.05).DBT and FFDM+DBT had the highest diagnostic accuracy of 84.62% in 13 adenosis cases.FFDM and FFDM+DBT had the highest diagnostic accuracy of 100% in 7 cases of fibroadenoma.DBT and FFDM+DBT had the highest diagnostic accuracy in 5 cases of intraductal papilloma,which was 100%.MRI had the highest diagnostic accuracy of100% in 5 cases of atypical hyperplasia.MRI had the highest diagnostic accuracy in 86 cases of invasive ductal carcinoma,5 cases of invasive lobular carcinoma and 2 cases of medullary carcinoma,which were 97.10%,100% and 100%,respectively.FFDM and FFDM+DBT had the highest diagnostic accuracy of 100% in 10 cases of ductal carcinoma in situ(DCIS).The accuracy of the four methods for 1 case of Paget’s disease was 100%.The single AGD of FFDM and DBT were(1.57±0.42)m Gy,(2.53±0.52)m Gy,respectively.The AGD of DBT was higher than that of FFDM,the difference was statistically significant(P<0.05).The AGD of FFDM,DBT and FFDM+DBT were(1.31±0.28)m Gy,(2.26±0.38)m Gy and(3.58±0.63)m Gy in 36 patients with non dense breast,and(1.69±0.42)m Gy,(2.65±0.53)m Gy,(4.37±0.89)m Gy in 80 patients with dense breast.The AGD of dense gland was higher than that of non dense gland,the difference was statistically significant(P<0.05).Conclusion:The consistency of FFDM,DBT,FFDM+DBT and MRI with pathological results was moderate,and the consistency of MRI was best.The diagnostic efficiency of FFDM+DBT is better than that of FFDM and DBT alone.It has similar diagnostic efficiency with MRI,and the diagnostic efficiency is not restricted by gland type.It is recommended that FFDM+DBT be used routinely in patients with dense breast.FFDM+DBT has high accuracy in the diagnosis of benign breast lesions,and MRI has high accuracy in the diagnosis of malignant breast lesions.The single AGD of DBT was higher than that of FFDM,and the single AGD of dense breast was higher than that of non dense breast.