Diagnostic Efficacy Of DBT+FFDM For Breast Cancer And Its Application In Single And Double Positions

Part I Diagnostic efficacy of DBT + FFDM for breast cancerObjective The incidence of breast cancer is increasing every year and is closely related to the increase in the level of screening tests.So to explore the detection rate and diagnostic efficacy of digital breast tomosynthesis(DBT)in combination with full-field digital mammography(FFDM)for breast cancer.Methods Retrospective analysis of imaging data of 141 breast cancer patients in Zhejiang Cancer Hospital from March 2020 to April 2021,patients underwent both DBT and FFDM of the breast.The DBT images of the patients were read and combined with FFDM by 2 diagnostic breast imaging physicians respectively,and the pathological findings were used as the gold standard for comparison.We analyzed the detection rate and diagnostic efficacy of DBT examination combined with FFDM on the patients’ benign and malignant breast lesions.Results There were 141 patients,aged 23-76 years(52.13±10.059),with a median age of 52 years.According to the ACR 2013 version of BI-RADS system classification criteria: 3 cases in category a,40 cases in category b,84 cases in category c,and 14 cases in category d.According to the BI-RADS rating criteria,two diagnosticians used DBT combined with FFDM and FFDM alone for diagnosis,respectively.The results of the two diagnostic modalities were as follows: the false positive rate,false negative rate,accuracy,specificity and sensitivity for the diagnosis of FFDM reading by the junior diagnostician were 9%,22%,88%,91% and 78%,respectively;the false positive rate,false negative rate,accuracy,specificity and sensitivity for the diagnosis of DBT + FFDM were 7%,8%,92%,93%,and 92%,respectively;the senior diagnostician’s diagnosis of DBT + FFDM was 7%,8%,92%,93% and 92%,respectively.The false-positive,false-negative,accuracy,specificity and sensitivity rates were 8%,22%,88%,92% and 78%,respectively;the false-positive,false-negative,accuracy,specificity and sensitivity rates were 4%,5%,95%,96% and 95%,respectively,for DBT + FFDM by senior diagnosticians.The ROC curves of the two diagnostic modalities for the junior diagnosticians were FFDM:0.875,CI(0.818,0.931),FFDM+DBT:0.946,CI(0.904,0.988);the ROC curves of the two diagnostic modalities for the senior diagnosticians were FFDM:0.890,CI(0.838,0.948)FFDM+DBT: 0.958,CI(0.919,0.996).Conclusion False-positive and false-negative rates of results using DBT+FFDM were lower than those of FFDM in both single and dual positions,and the diagnostic accuracy,specificity and sensitivity were higher than those of FFDM,and the diagnostic efficacy of FFDM+DBT dual positions was higher than that of single positions for senior/low-grade diagnosticians,and the accuracy,sensitivity and specificity MLO were higher than those of CC positions between FFDM+DBT-CC and FFDM+DBT-MLO single positions.Part Ⅱ Diagnostic efficacy of DBT single/dual position + FFDM for breast cancerObjective As the incidence of breast cancer has increased,the means of screening for breast cancer has also been increasingly developed.As previously mentioned the results of DBT have greatly improved the detection rate of breast cancer,but the radiation dose to the patient during the examination is significantly higher than that of FFDM.To explore the detection rate and diagnostic efficacy of digital breast tomosynthesis(DBT)combined with full-field digital mammography(FFDM)in a single position(Craniocaudal,CC or Mediolateral Oblique,MLO)for breast cancer.Methods Retrospective analysis of imaging data of 141 breast cancer patients in Zhejiang Cancer Hospital from March 2020 to April 2021,patients underwent both breast DBT and FFDM.The DBT images of patients were read in single and double position and combined with FFDM by 2 diagnostic breast imaging physicians,respectively,with pathological findings as the gold standard for control.We analyzed the detection rate and diagnostic efficacy of single-and dual-position DBT examinations combined with FFDM for benign and malignant breast lesions.Results There were 141 patients,aged 23-76 years(52.13±10.059),with a median age of 52 years.According to the ACR 2013 version of BI-RADS system classification criteria: 3 cases in category a,40 cases in category b,84 cases in category c,and 14 cases in category d.According to the BI-RADS rating criteria,two diagnosticians used four diagnostic modalities(DBT-CC combined with FFDM,DBT-MLO combined with FFDM,bipositional DBT(CC+MLO)combined with FFDM and FFDM alone)for diagnosis.Using the pathological findings as the gold standard,the diagnostic results of the four diagnostic modalities were obtained as follows: the false positive rate,false negative rate,accuracy,specificity and sensitivity of the diagnosis of FFDM by the low level diagnostic physicians were 9%,22%,88%,91% and 78%,respectively;the false positive rate,false negative rate,accuracy,specificity and sensitivity of the diagnosis of DBT + FFDM were 7%,8%,92%,93% and 92%,respectively;for the diagnosis of FFDM + DBT-CC,the false positive rate,false negative rate,accuracy,specificity and sensitivity were 9%,16%,89%,91% and 84%,respectively;for the diagnosis of FFDM + DBT-MLO,the false positive rate,false negative rate,accuracy,specificity and sensitivity were 9%,11%,91%,91% and 89%,respectively;for the diagnosis of FFDM + DBT-MLO,the false positive rate,false negative rate,accuracy,specificity and sensitivity were 9%,11%,91% and 89%,respectively.The false-positive rate,false-negative rate,accuracy,specificity and sensitivity of the diagnosis of FFDM by senior diagnosticians were 8%,22%,88%,92% and 78%,respectively;the false-positive rate,false-negative rate,accuracy,specificity and sensitivity of the diagnosis of DBT + FFDM were 4%,5%,95%,96% and 95%;for FFDM + DBT-CC,the diagnostic results,false positive rate,false negative rate,accuracy,specificity and sensitivity were 9%,11%,90%,91% and 89%,respectively;for FFDM + DBT-MLO,the diagnostic results,false positive rate,false negative rate,accuracy,specificity and sensitivity were 4%,8%,95%,96% and 92%,respectively.Conclusion False-positive and false-negative rates of results using DBT+FFDM were lower than those of FFDM in both single and dual positions,and the diagnostic accuracy,specificity and sensitivity were higher than those of FFDM,and the diagnostic efficacy of FFDM+DBT dual positions was higher than that of single positions for senior/low-grade diagnosticians,and the accuracy,sensitivity and specificity of MLO were higher than those of CC positions between FFDM+DBT-CC and FFDM+DBT-MLO single positions.