| Objective:To evaluate diagnostic value of digital breast tomosynthesis(DBT),digital mammography(DM)and ultrasonography(US)in architecture distortion lesions(ADLs).Methods : Data of 79 patients(81 lesions)with architecture distortion confirmed by surgical pathology on DBT between December 2016 and May 2020 in our hospital were analyzed retrospectively.Following works were done according to the Breast Imaging Report and Data System(BI-RADS)and surgical pathology:(1)Compare differences in the diagnostic efficacy of the three modalities(DBT,DM,and US)in ADLs;(2)Using kappa analysis to evaluate the degree of consistency between the results of DBT,DM,US in distinguishing benign and malignant ADLs and the pathological results;(3)81 lesions were divided into benign and malignant ADLs groups.DBT and US features of the two groups were compared.According to the criterions of BI-RADS,the wheel-spoke structure,central density,overall size,central size and surrounding burr length of the lesions were compared on DBT;the shape,margins,surrounding structures,internal echo,posterior shadowing,and blood flow signal of lesions were compared on US.Results :(1)Diagnostic efficacy analysis,(1)Detection rates of DBT,DM and US in ADLs were 100%,60.5% and 97.5%,respectively.Detection rate of DBT in ADLs was significantly higher than that of DM and the difference was statistically significant(100%vs 60.5%)(p=0.001);Detection rate of DBT was slightly higher than that of US and the difference was not statistically significant(100% vs 97.5%)(p=0.497);Detection rate of US in ADLs was significantly higher than that of DM and the difference was statistically significant(97.5% vs 60.5%)(p=0.001).(2)DBT outperforms DM in terms of sensitivities and diagnostic accuracies in ADLs(84.8% vs 66.7%;74.1% vs65.3%)(p=0.091,0.287,respectively).US outperforms DM in terms of sensitivities and diagnostic accuracies in ADLs(75.8% vs 66.7%;73.4% vs 65.3%)(p=0.425,0.329,respectively).Sensitivities and diagnostic accuracies was found to be similar between DBT and US in ADLs(84.8% vs 75.8%;74.1% vs 73.4%)(p=0.353,0.925,respectively).No significant difference in the above aspects was shown between the three modalities of diagnosis;(3)Youden indexes of the three modalities(DBT,DM,US)were 51.5%,29.9%,41.1%,respectively.The diagnostic performance of DBT is superior to that of DM,and is similar to that of US.(2)Consistency between the diagnostic results by the three modalities(DBT,DM,US)and the pathological results was observed in differentiating benign and malignant ADs(Kappa: 0.490,0.290,0.465,respectively).It showed moderate consistency between the results of DBT or US group and pathologic;low consistency between the results of DM group and pathologic.(3)On DBT,(1)No significant difference was found between the two groups in their DBT appearances-spoke structure,center density,or microcalcification(p=0.912,0.075,0.986,respectively);(2)There were significant differences in center size of lesions [4.3(2.6,5.5)mm,4.5(3.5,5.5)mm],overall size of lesions [16.8(14.0,20.4)mm,27.0(20.5,35.3)mm] and peripheral burr length of lesions [9.6(7.0,12.9)mm,13.3(9.5,16.2)mm] between benign and malignant lesions(p=0.029,0.004,0.006,respectively);(3)Lesion that center size ≥5mm was more common in malignant ADLs group(p =0.001)and overall lesion size > 20 mm was more common in malignant ADLs group(p =0.002).(4)On US,(1)Posterior Echo attenuation was more common in malignant ADLs group(p=0.007);(2)Comparison of US imagings between the two groups: All lesions showed hypoechoic masses,there were no statistical differences in the shape,margins,internal echo,internal blood flow of lesions and surrounding structures,(p=0.188,0.298,0.11,0.495,0.75,respectively).Conclusion:(1)DBT can improve accuracy of detection and diagnosis of ADLs.(2)Some DBT imaging features can provide valuable information in the differentiation between benign and malignant ADLs of breast and an important basis for clinicians to make surgical treatment decisions. |
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