| Part One: Study on the Value and Cost-Effectiveness Analysis of Cone-Beam Breast Ct,Mammography,Ultrasound and Magnetic Resonance in the Diagnosis of Breast LesionsObjective: To analyze the clinical application value and cost-effectiveness of cone-beam breast CT(CBBCT),mammography(MAM),breast ultrasound(BUS)and magnetic resonance(MRI)examinations in the diagnosis of breast lesions.Methods: In this study,139 patients with breast diseases(including 143lesions)who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University from July 2019 to December 2019 were retrospectively collected.All patients underwent CBBCT,MAM,BUS and MRI examinations,and then underwent surgery or puncture to confirm the pathological results.The imaging data of CBBCT,MAM,BUS,MRI and 11 different combined examination schemes(MRI+MAM,MAM+BUS,CBBCT+MRI,MRI+BUS,CBBCT+MAM,CBBCT+BUS,MRI+MAM+BUS,CBBCT+MRI+BUS,CBBCT+MAM+BUS,CBBCT+MRI+MAM,CBBCT+MAM+BUS+MRI)were valuated according to the classification criteria of Breast Imaging Report and Data system(BI-RADS).Using pathological results as the gold standard,the diagnostic efficacy of each examination protocol was compared.Receiver operating characteristic curve(ROC)was used to analyze the area under the curve(AUC)of each imaging protocol,and the cost-effectiveness ratio of each examination protocol was evaluated.Results: Among 143 breast lesions,126 were malignant and 17 were benign.The diagnostic efficiency of CBBCT and MRI in a single examination was significantly higher than that of BUS and MAM.The diagnostic sensitivity of CBBCT and MRI were 95.24% and 96.03%,the specificity were 58.82% and47.06%,and the accuracy were 90.91% and 90.21%,respectively.Positive predictive value(PPV)was 94.49% and 93.08%,and negative predictive value(NPV)was 62.50% and 61.54%,respectively.In the combined examination,the CBBCT+MRI scheme had the best diagnostic efficiency,and its sensitivity,specificity,accuracy,PPV and NPV were 100%,41.18%,93.00%,92.65% and100%,respectively.The ROC curve showed that the diagnostic value of CBBCT,MRI and CBBCT+MRI among the 15 examination schemes was better,and the area under the curve(AUC)was all greater than 0.7,and the AUC value was 0.770,0.715 and 0.706,respectively.The AUC value of CBBCT was the highest.The cost-effectiveness analysis of 15 examination schemes showed that the costeffectiveness ratio of single examination for CBBCT,MRI,MAM and BUS was13.26,8.44,2.53 and 0.91,respectively,and BUS had the lowest costeffectiveness ratio.Based on the cost-effectiveness ratio of BUS,the incremental cost-effectiveness ratio of CBBCT,MRI and MAM was 134.80,89.28 and-35.80,respectively.The cost-effectiveness ratio of the joint inspection schemes is generally higher than that of the single inspection schemes.Conclusions:(1)The diagnostic efficiency of CBBCT for breast lesions was significantly better than that of MAM and BUS,and was comparable to that of MRI.CBBCT combined with MRI can improve the accuracy of diagnosis of benign and malignant breast lesions.(2)From the perspective of health economics,the cost-effectiveness ratio of combined examination is generally higher than that of single examination,while the cost-effectiveness ratio of BUS is the lowest,so it can be used as the first choice for the diagnosis of breast lesions.(3)Although the cost-effectiveness ratio of BUS is lower than that of CBBCT and MRI,its diagnostic efficiency is inferior to that of CBBCT and MRI.Therefore,in the case of patients with sufficient economic conditions,the selection of CBBCT or MRI and other examination programs can provide a more reliable imaging basis for the diagnosis of benign and malignant breast lesions.Part Two: Comparison of Diagnostic Performance And Health Economics Evaluation of Cone Beam Breast Ct And Magnetic Resonance Imaging in Dense Breast LesionsObjective: The diagnostic performance of cone-beam breast CT(CBBCT)and magnetic resonance imaging(MRI)in dense breast lesions was compared,and the clinical application value of CBBCT in dense breast lesions was discussed.Meanwhile,the applicability of CBBCT and MRI in the diagnosis of dense breast lesions was evaluated from the perspective of health economics.Methods : Retrospective analysis was performed on 128 patients with breast lesions admitted to the Affiliated Cancer Hospital of Guangxi Medical University from July 2019 to September 2020.All patients with dense breast were diagnosed by CBBCT and MRI,respectively.The signs of dense breast lesions were compared between CBBCT and MRI,and the pathological results were taken as the gold standard to evaluate the diagnostic value of CBBCT and MRI in dense breast lesions.The direct and indirect expenses of 128 patients with dense breast lesions during the appointment waiting for the results of examination were investigated retrospectively,and the health and economic significance of CBBCT and MRI in dense breast lesions was analyzed.Results: 99 cases of malignant lesions and 29 cases of benign lesions were confirmed by pathology in 128 patients with dense breast lesions.In the signs of dense breast lesions,the detection rate of calcification in CBBCT was significantly higher than that in MRI,and the difference was statistically significant(P=0.024).The maximum diameter of the same lesion measured by CBBCT was smaller than that of MRI,but the detection rate of MRI in lesion mass,peripheral vascular signs and nipple invagination was higher than that of CBBCT,but the difference was not statistically significant.(P > 0.05).The sensitivity(95.96%),specificity(69.00%)and accuracy(89.84%)of MRI in the diagnosis of dense breast lesions were all higher than that of CBBCT(89.90%),specificity(51.72%)and accuracy(81.25%),and there was no statistical significance in the sensitivity and specificity between the two(P > 0.05).The difference of accuracy was statistically significant(P < 0.05).The area under the ROC curve(AUC)of CBBCT and MRI was 0.831 and 0.919,respectively,the difference was statistically significant(Z value was 2.162,P=0.031).Questionnaire survey was conducted on the examination costs of CBBCT and MRI,and the results showed that the examination costs were RMB 1798.30 and RMB 5583.63 respectively,and the cost-effectiveness ratio of the two was 22.13 and 62.15,respectively.The cost-effectiveness ratio of CBBCT was significantly lower than that of MRI,and the cost-effectiveness ratio of CBBCT was taken as the benchmark.The incremental cost-effectiveness ratio of MRI was 440.15.Conclusions:(1)CBBCT has a high diagnostic value in differentiating the nature of dense breast lesions.The accuracy of CBBCT in the diagnosis of dense breast lesions is lower than that of MRI,but it can also reach 81.25%.(2)The ability of CBBCT to display the signs of dense breast lesions was comparable to that of MRI,but the detection rate of calcification was significantly higher than that of MRI.(3)The cost-effectiveness ratio of CBBCT is significantly lower than that of MRI.Therefore,from the perspective of health economics,choosing CBBCT as the diagnostic method for patients with dense breast lesions can effectively reduce the economic burden on the premise of ensuring a certain diagnostic quality. |
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