Evaluation of clinical efficacy of full field digital mammography (FFDM) used alone and in combition with digital breast tomosynthesis in diagnosis of breast cancer

doi:10.16150/j.1671-2870.2024.04.006

Abstract

Abstract:

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.

Key words: Digital breast tomosynthesis, Full field mammography, Diagnostic efficiency, Mass, Architectural distortions

CLC Number:

FU Qiuyi, ZHAN Ying, TAN Ling, ZHU Hong, ZHU Naiyi, SUN Kun, CHAI Li, CHAI Weimin. Evaluation of clinical efficacy of full field digital mammography (FFDM) used alone and in combition with digital breast tomosynthesis in diagnosis of breast cancer[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(04): 385-391.

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Item	Groups	Numbers
Age distribution (case level)	10-20	1
	20-30	22
	30-40	92
	40-50	98
	50-60	65
	60-70	65
	70-80	41
	80-90	5
	Total	389
Pathological distribution (breast level)	Benign	257
	Fibroadenoma	94
	Intraductal papilloma	26
	Benign/Borderline phyllodes tumor	12
	Granulomatous mastitis	5
	Complex sclerosing lesion	5
	Adenomyoepithelioma	3
	Others^#	112
	Malignant	207
	Invasive ductal carcinoma	103
	Invasive breast carcinoma^*	55
	Ductal carcinoma in situ	24
	Invasive lobular carcinoma	5
	Solid papillary carcinoma in situ	6
	Invasive solid papillary carcinoma	4
	Mucinous carcinoma	5
	Metaplastic carcinoma	2
	Invasive apocrine carcinoma	1
	Invasive micropapillary carcinoma	1
	Encapsulated papillary carcinoma	1
	Total	464

Assessment	Likelihood of Cancer
BI-RADS Categories	Category 1	0
	Category 2	0
	Category 3	0-2%
	Category 4A	2%-10%
	Category 4B	10%-50%
	Category 4C	50%-95%
	Category 5	≥95%

Item	FFDM	FFDM+DBT	Χ²	P values
Masses	46.55%（216/464）	62.5%（290/464）	4.5231	0.033 0
Calcifications	33.84%（157/464）	23.92%（111/464）	75.325	<0.000 1
Architectural distortion	5.17%（24/464）	11.42%（53/464）	344.3	<0.000 1
Asymmetries	20.91%（97/464）	8.41%（39/464）	206.1	<0.000 1

Item	FFDM	FFDM+DBT	Χ²	P values	Confidence interval
Masses	0.875 9	0.918 6	-2.878 1	0.004	[-0.071 8,-0.013 6]
Calcifications	0.918 7	0.949 3	-1.504 5	0.132	[-0.070 3,0.009 2]
Architectural distortion	0.861 5	0.910 2	-0.919 74	0.358	[-0.152 7,0.055 1]
Asymmetries	0.827 9	0.779 2	1.049 9	0.294	[-0.042 2,0.139 6]