| Objective 1.To explore the characteristics of cone beam breast CT plain scan in normal women and healthy side of breast cancer breast tissue structure and define its reference value range.2.To explore the value of CBBCT plain scan and enhanced scan in differential diagnosis of benign and malignant breast lesions and surrounding breast tissue.Method 1.The data of 421 healthy subjects/672 sides and 317 healthy subjects/317 sides with breast cancer who underwent CBBCT from June 2019 to December 2020 were analyzed retrospectively.Measure the length of the healthy breast of normal women and breast cancer.According to the distance between the breast gland and fat structure from back to front and the front edge of the breast wall muscle,divide the breast structure into sections(every 1cm is a section).Measure the absolute CT values(directly measured CT values)of the fat,gland,nipple and breast wall muscle in different sections and quadrants of the breast,and calculate the overall and sectional reference value range,using independent sample t-test and one-way ANOVA to explore the characteristics and rules of CT value changes.2.The data of 189 patients who underwent CBBCT plain scan and enhanced scan from June 2019 to December 2020 were retrospectively analyzed,including 58 cases in benign group,79 cases in malignant group and 52 cases in control group.Independent sample t-test and one-way ANOVA were used to explore the differences of benign and malignant lesions between the CT values of lesions,Δ(L-A)normalized CT values andΔ*(L-G)normalized CT values;The CT values of ipsilateral fat,gland,breast wall muscle and nipple in benign group,malignant group and control group were analyzed.The diagnostic efficacy of CBBCT enhancement parameters for benign and malignant breast lesions and the best differential diagnostic threshold were evaluated by ROC curve.Result 1.The change rule of CT value and the reference range of overall CT value of breast tissue structure in normal women and healthy side of breast cancer were clarified.2.Age,gland type and segment distance can affect the change of absolute CT value of fat and gland.Segment distance has a certain correlation with absolute CT value of fat and gland,and a regression equation of CT reference value of normal breast gland and fat segment based on segment distance,age,gland type and other factors is established.3.The CT values of fat and glands in the healthy side of breast cancer treated with chemotherapy or chemotherapy+surgery were lower than those in the control group,and the difference was statistically significant.4.Before and after neoadjuvant chemotherapy,the CT values of fat,gland,breast wall muscle and nipple on the healthy side of breast cancer had no significant difference.5.During enhanced CBBCT scanning,the changes of lesion CT value,Δ(L-A)normalized CT value and Δ*(L-G)normalized CT value were basically consistent.The lesion CT value and normalized CT value of malignant group were higher than those of benign group,and there was no statistical difference between the CT value of enhanced phase 1st and enhanced phase 2nd.6.Among the parameters of CBBCT enhanced scanning,enhanced phase 1st-plain CT value,Δenhanced phase 1stΔplain CT value,Δ*enhanced phase 1st-Δ*plain CT value and Δenhancement rate of phase 1st enhancement were have higher diagnostic efficiency for differentiating benign and malignant breast lesions,and its AUC and the best differential diagnostic threshold are obtained.Conclusion 1.In this study,the change rule and reference value range of CT value of breast tissue structure in normal women and healthy side of breast cancer on CBBCT plain scan were clarified,and the regression equation of CT reference value of normal breast gland and fat based on segment distance,age,gland type and other factors was established.2.Absolute CT value of glands and CT value of lesions can be used in clinical diagnosis.3.Enhanced parameters such as enhanced phase 1st-plain CT value,Δenhanced phase 1st-Δ plain CT value,Δ*enhanced phase 1st-Δ*plain CT value,Δenhanced phase 1st enhancement rate have high diagnostic efficacy for differentiating benign and malignant breast lesions.4.The diagnostic efficacy of enhanced phase 1st(60s)is slightly higher than enhanced phase 2nd(110s).Part 1 A Preliminary Study on the Characteristics of Cone Beam Breast CT Values in Normal Female Breast StructuresObjective To investigate the characteristics of CT values of cone-beam breast CT in normal female breast and define the reference range of normal CT values.Method The data of 421 healthy subjects/672 sides who underwent plain CBBCT scanning from June 2019 to December 2020 were retrospectively analyzed.The length of breast was measured and the breast structure was divided into segments(each 1cm distance was one segment)according to the distance between the glands and adipose structures of the breast from back to front and the leading edge of the chest wall muscle.Absolute CT values(directly measured CT values)of fat,gland,nipple and chest wall muscle in different segments and different quadrants of non-focal areas of the breast were measured,and the normal reference ranges of overall and segment values were calculated.Independent sample T test was used to analyze the CT values of left and right breast as a whole and breast structures in different sections and quadrants to determine whether there was statistically significant difference between left and right breast groups.The glandular relative CT value was obtained by fat scaling the absolute CT value of glands(glandular relative CT value=absolute CT value of glands-absolute CT value of fat).The absolute CT value and relative CT value of glands were fitted by curve and equation analysis to explore the feasibility of direct application of absolute CT value of glands in clinical diagnosis.CT values of fat and gland in different ages,gland types,segment distances and quadrants were tested by independent sample T test and one-way ANOVA to explore the characteristics and rules of CT values change.Pearson correlation coefficient was used to evaluate the correlation between segment distance and absolute CT values of glands and fat.Multiple linear regression model was used to analyze the influencing factors of CT values of glands and fat,and the regression equation of CT reference values of normal breast glands and fat was established based on segment distance,age,gland type and other factors.Result(1)General CT values of normal breast tissue structure,Absolute CT value of gland-12.2～199.07HU,relative CT value of gland 122.2～302.68HU,absolute CT value of fat-190.4～-63.67HU,absolute CT value of chest wall muscle-136.68～43.36HU,Absolute CT value of nipple 176.39～334.02HU.(2)The absolute and relative CT values of glands in the same segment distance and the same quadrant between the left and right breast groups were more stable than the absolute CT values of fat.The fitting curve equation was as follows:gland absolute T value=0.94x gland relative CT value-118.6.Age and glandular types were correlated with CT values of gland and fat:the older the age,the smaller the absolute CT values of fat and the absolute and relative CT values of gland.The denser the glandular tissue,the greater the absolute CT value of fat and the absolute and relative CT value of glandular tissue.(3)There was a positive correlation between segment distance and total gland absolute CT value,but no correlation between segment distance and total fat absolute CT value.When the segment distance was≤4cm,the segment distance was positively correlated with absolute CT value of fat.When the segment distance was>4cm,the segment distance was negatively correlated with the absolute CT value of fat.The absolute CT values of fat and gland in nonuniform dense breast(type c)and dense breast(type d)were higher than those in scattered fibrogland and fatty breast(type a/b).(4)Based on the above research results,the regression equation of CT reference value of normal breast gland and fat segment based on segment distance,age,gland type and other factors was established as follows:①CT value of gland=2.909+12.228 X segment distance-3.223 × age(0=<45,1=≥45)+45.71 × gland type(a/b=0,c=1)+79.568 X gland type(a/b=0,d=1).②CT value of fat segment distance≤4cm=-157.772+4.535 × segment distance-1.517× age(0=<45,1=≥45)+16.844 × gland type(a/b=0,c=1)+31.443 × gland type(a/b=0,d=1).③CT value of fat segment distance>4cm=-119.325-1.611 ×segment distance-7.529 X age(0=<45,1=≥45)+6.816 × gland type(a/b=0,c=1)+9.576 X gland type(a/b=0,d=1).Conclusion(1)The distance between breast segment and chest wall muscle,patient age,gland type and other factors can affect the plain CBBCT values of normal breast glands and fat,so the reference range of normal overall CT values is large,and the clinical application efficacy is limited.(2)Segment distance was positively correlated with absolute CT value of gland;When the segment distance was≤4cm,the segment distance was positively correlated with the absolute CT value of fat,while when the segment distance was>4cm,the segment distance was negatively correlated with the absolute CT value of fat.(3)There was no statistical difference between absolute and relative CT values of glands in the same segment and quadrant,and the absolute CT values of glands could be used for clinical diagnosis.(4)The regression equation of CT reference values of normal breast glands and fat established based on segment distance,age,gland type and other factors can obtain the segment CT reference values which are more suitable for clinical diagnosis than the overall CT reference values,providing important help for improving the clinical diagnostic efficacy of CBBCT.Part 2 CBBCT CT Value Characteristics of Breast Tissue Structure on the Healthy Side of Breast Cancer Patients After TreatmentObjective To study the characteristics of CBBCT plain scan CT value of breast tissue structure on the healthy side of breast cancer patients after treatment,and to clarify the reference range of CT value.Method A total of 738 cases/989 healthy mammary glands of breast cancer patients who underwent plain CBBCT examination and met the inclusion criteria in our hospital from June 2019 to December 2020 were retrospectively analyzed,including 317 cases/317 healthy mammary glands of breast cancer patients in the healthy side group(hereinafter referred to as the healthy side group).421 cases/672 sides of healthy breast group(hereinafter referred to as control group).Independent sample T test was used to analyze the CT values of glands and adipose tissue in the control group and the healthy group as a whole and in different sections and quadrants.The reference range of CT value of breast tissue structure in healthy group was calculated.Univariate ANOVA analysis of variance was used to analyze the total and subdivided left breast,right breast control group and healthy side group.The data of the healthy group before and after neoadjuvant chemotherapy were analyzed by quantitative repeated measure ANOVA and one-way ANOVA test.Result(1)Reference range of overall CT value of breast tissue structure in the healthy side group:CT value of gland is-28.67～183.94HU,CT value of fat is-187.47～-12.33HU,CT value of chest wall muscle is-140.87～34.83HU,CT value of nipple is 161.78～334.42HU.(2)The plain CT values of CBBCT of breast tissue structure in the healthy side group and the control group were similar,showing good stability of CT values of glands in the same segment distance and in the same quadrant,but poor stability of CT values of fat.(3)The CT values of fat and gland in the healthy group treated with chemotherapy or chemotherapy plus surgery were lower than those in the control group,with statistically significant differences.There was no statistical difference between the CT values of fat and gland in the healthy group treated with surgery and the control group.The CT values of chest wall muscle and nipple in the healthy group and the control group were not statistically different.(4)Before and after neoadjuvant chemotherapy,CT values of fat,gland,chest wall muscle and nipple in the healthy group showed no statistical difference.(5)The range of CT reference values of fat and gland segments in the healthy side treated with chemotherapy or chemotherapy plus surgery were shown in Table 18 and 19.Conclusion(1)Breast cancer chemotherapy can reduce the CT values of glands and fat in the healthy breast.(2)The CT value change characteristics and reference values of the main tissue structure of the breast on the healthy side obtained in this study can provide a reference for clinical CBBCT follow-up diagnosis of breast cancer patients.Part 3 Characteristics and Differential Diagnosis Value of Cone Beam Breast CT Values in Benign and Malignant Breast LesionsObjective To investigate the CT value characteristics and differential diagnosis value of CBBCT on benign and malignant breast lesions and surrounding breast tissue structure.Method Data of 189 patients who underwent plain and enhanced CBBCT scanning from June 2019 to December 2020 were retrospectively analyzed,including 58 patients in the benign group,79 patients in the malignant group,and 52 patients in the control group.All patients had non-uniform dense glandular type(type c).Independent sample T test and univariate ANOVA test were used to analyze the differences of CT values of lesions,Δ(L-A)normalized CT values and Δ*(L-G)normalized CT values between benign and malignant groups.Univariate ANOVA test was used to analyze the differences in the CT values of ipsolateral fat,gland,chest wall muscle and nipple among benign group,malignant group and control group.The receiver operating characteristic curve(ROC curve)was drawn based on the enhancement parameters such as CT value and enhancement rate,and the area under the curve(AUC)was used to evaluate its diagnostic efficacy for benign and malignant breast lesions and determine the optimal differential diagnosis threshold.Result(1)During enhanced CBBCT scanning,the changes of lesion CT value,Δ(L-A)normalized CT value and Δ*(L-G)normalized CT value were basically consistent.The lesion CT value and normalized CT value of malignant group were higher than those of benign group,and there was no statistical difference between the CT value of enhanced phase 1st and enhanced phase 2nd.(2)There were no statistical differences in CT values of fat and chest wall muscle on the same side of the breast lesions.CT values of glands were normal group>benign group>malignant group.CT values of nipples were statistically different in plain scan and enhanced phase 2nd.There were no statistically significant differences in CT values of fat,gland and chest wall muscle at different scanning stages among benign,malignant and normal groups,while there were statistically significant differences in CT values of plain and enhanced papilla at phase 2nd between benign and malignant groups.(3)Among the parameters of CBBCT enhanced scanning,enhanced phase 1st-plain CT value,△ enhanced phase 1st-Δ plain CT value,Δ*enhanced phase 1st-Δ*plain CT value and Δ enhancement rate of phase 1st enhancement were have higher diagnostic efficiency for differentiating benign and malignant breast lesions.AUC values are 0.772,0.771,0.773 and 0.740,respectively.The optimal differential diagnosis thresholds for benign and malignant lesions were 49.5HU,44.0HU,64.8HU and 26.3%,respectively.(4)The diagnostic efficacy of enhanced phase 2nd enhancement parameters,such as enhanced phase 2nd-plain CT value,Δ enhanced phase 2nd-Δ plain CT value,Δ*enhanced phase 2nd-Δ*plain CT value,enhanced phase 2nd enhancement rate,Δ enhanced phase 2nd enhancement rate,Δ*enhanced phase 2nd enhancement rate,and Δ*enhanced phase 2nd enhancement rate,was lower than that of enhanced phase 1st.The AUC values were 0.757,0.722,0.749,0.665,0.663,0.615,respectively.The optimal differential diagnosis thresholds for benign and malignant lesions were 46.1HU,39.3HU,58.3HU,62%,27.5%,58.3%,respectively.Conclusion(1)There was no statistical difference in the diagnostic efficacy of lesion CT value,Δ(L-A)normalized CT value and Δ*(L-G)normalized CT value for benign and malignant breast lesions,and lesion CT value could be used for clinical diagnosis.(2)Enhanced parameters such as enhanced phase 1stplain CT value,Δ enhanced phase 1st-Δ plain CT value,Δ*enhanced phase 1stΔ*plain CT value,Δ enhanced phase 1st enhancement rate have high diagnostic efficacy for differentiating benign and malignant breast lesions.(3)The diagnostic efficacy of enhanced phase 1st(60s)is slightly higher than enhanced phase 2nd(110s). |
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