目的：分析全野数字乳腺X线摄影（full field digital mammography, FFDM）单独及联合数字乳腺断层合成X线摄影（digital breast tomosynthesis, DBT）对不同类型乳腺病灶的诊断能力差异。方法：前瞻性纳入2021年11月至2022年6月在上海交通大学医学院附属瑞金医院进行术前乳腺X线检查的患者共计389例，每例患者行Combo模式拍摄的同时获得FFDM图像和DBT图像，所有图像经具有乳腺影像诊断工作10年以上经验的放射科医师阅片。以病理学结果作为金标准，分析乳腺的影像学评价与病理学金标准的一致性，评价FFDM与FFDM+DBT数体诊断效能[灵敏度、特异度、准确率、阳性预测值（positive predictive value, PPV）、阴性预测值（negative predictive value, NPV）、受试者操作特征（receiver operating characteristic, ROC）曲线的线下面积（area under curve, AUC）诊断能力]的差异，并比较FFDM与FFDM+DBT在不同类型乳腺病灶中的诊断效能差异。结果：FFDM+DBT的整体诊断能力较FFDM显著提高（P<0.0001），FFDM+DBT的特异度、灵敏度、准确率、PPV、NPV显著提高（86.96%、89.11%、88.15%、86.54%、89.45%比80.19%、87.16%、84.05%、83.42%、84.53%），差异有统计学意义（P<0.05）；FFDM+DBT诊断乳腺癌ROC的AUC较FFDM显著提高（0.906比0.869， P<0.01）。FFDM+DBT对肿块的检出率较FFDM显著提高（62.5%，46.55%，P<0.05），FFDM+DBT对结构扭曲的检出率较FFDM显著提高（11.42%比5.17%，P<0.05）；对于肿块病灶良恶性，FFDM+DBT诊断的AUC较FFDM显著提高（0.918 6比0.8759，P=0.004）。结论：相比于FFDM单独检查，FFDM+DBT检查对乳腺肿块和相关结构扭曲的显示更有优势，对乳腺良恶性病灶的诊断效能更高。

Objective To compare the detective and diagnostic ability of full field digital mammography (FFDM) alone and digital breast tomosynthesis (DBT) combined with FFDM (FFDM+DBT) in different types of lesions. Method A total of 389 patients who underwent preoperative mammography in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 were prospectively included in this study. FFDM images and DBT images were obtained from each patient in the Combo mode. All images were interpreted by senior radiologists, who have been involved in breast imaging diagnosis for more than 10 years. Using the pathological results as the gold standard, the consistency between the imaging evaluation and the gold standard was analyzed to evaluate the differences in diagnostic efficacy between FFDM and DBT (FFDM+DBT), and the differences in diagnostic efficacy in different types of lesions. Indice of diagnostic efficacy includes sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), area under curve (AUC) receiver operating characteristic curve (ROC) for diagnosing breast cancer and overall diagnostic ability between FFDM and FFDM+DBT were compared. Results The overall diagnostic capability of FFDM+DBT was significantly improved compared with FFDM alone (P<0.000 1); the specificity, sensitivity, accuracy, PPV, and NPV of FFDM+DBT were significantly higher than FFDM alone (86.96%, 89.11%, 88.15%, 86.54%, 89.45% vs 80.19%, 87.16%, 84.05%, 83.42%, 84.53%) (P<0.05). The AUC of FFDM+DBT diagnostic ROC for breast cancer was significantly higher than FFDM alone (0.906 vs 0.869, P<0.01); the detection rate of masses by FFDM+DBT was significantly higher than that of FFDM alone (62.5% vs 46.55%, P<0.05); the detection rate of structural distortions by FFDM+DBT was significantly higher than that by FFDM alone (11.42% vs 5.17%, P<0.05). The AUC of FFDM+DBT diagnosis for malignant mass lesions was significantly higher than that of FFDM alone (0.9186 vs 0.8759, P=0.004). Conclusions Compared to FFDM FFDM+DBT examination demonstrates a superior advantage in displaying breast masses and related structural distortions, with higher diagnostic efficiency for differentiating benign and malignant breast lesions.