Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10042-10052
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10042
Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer
Yun Ren, Jiao Zhang, Jin-Dan Zhang, Jian-Zhong Xu
Yun Ren, Jin-Dan Zhang, Jian-Zhong Xu, Department of Breast Surgery, Changzhi People's Hospital Affiliated to Shanxi Medical University, Changzhi 046000, Shanxi Province, China
Jiao Zhang, Department of Diagnostic Radiology, Changzhi People's Hospital Affiliated to Shanxi Medical University, Changzhi 046000, Shanxi Province, China
Author contributions: Ren Y and Zhang J contributed equally to this study, and should be regarded as co-first authors; Ren Y, Zhang J and Xu JZ design the experiment; Ren Y and Zhang J drafted the work; all authors collected the data; Zhang JD and Xu JZ analysed and interpreted data; Ren Y and Zhang J wrote the article.
Institutional review board statement: This study was approved by the Changzhi People's Hospital Affiliated to Shanxi Medical University Medical Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have nothing to disclose.
Data sharing statement: Not available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Zhong Xu, Doctor, Chief Physician, Department of Breast Surgery, Changzhi People's Hospital Affiliated to Shanxi Medical University, No. 502 Changxing Zhong Road, Changzhi 046000, Shanxi Province, China. xjzzhuren@163.com
Received: May 26, 2022
Peer-review started: May 26, 2022
First decision: June 15, 2022
Revised: June 28, 2022
Accepted: August 22, 2022
Article in press: August 22, 2022
Published online: October 6, 2022
Processing time: 124 Days and 3.3 Hours
Abstract
BACKGROUND

The incidence and mortality rate of breast cancer in China rank 120th and 163rd, worldwide, respectively. The incidence of breast cancer is on the rise; the risk increases with age but is slightly reduced after menopause. Early screening, diagnosis, and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.

AIM

To evaluate the clinical value of magnetic resonance imaging (MRI) combined with digital breast tomosynthesis (DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.

METHODS

This study was divided into two parts. Firstly, 110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group, respectively. Both groups underwent DBT and MRI examination, and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer. Secondly, according to the operation method, 110 patients with breast cancer were divided into either a breast-conserving group (69 patients) or a modified radical mastectomy group (41 patients). The surgical effect, cosmetic effect, and quality of life of the two groups were compared.

RESULTS

Among the 110 cases of breast cancer, 66 were of invasive ductal carcinoma (60.00%), and 22 were of ductal carcinoma in situ (20.00%). Among the 110 cases of benign breast tumors, 55 were of breast fibromas (50.00%), and 27 were of breast adenosis (24.55%). The sensitivity, specificity, and area under the curve (AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%, 84.55%, and 0.791, respectively. The sensitivity, specificity, and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%, 85.45%, and 0.850, respectively. The sensitivity, specificity, and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%, 93.64%, and 0.955, respectively. The blood loss, operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group, and the difference was statistically significant (P < 0.05). After 3 mo of observation, the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group, and the difference was statistically significant (P < 0.05). Before surgery, the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ (P > 0.05). Three months after surgery, the quality-of-life scores in both groups were higher than those before surgery (P < 0.05), and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group (P < 0.05). In the observation of tumor recurrence rate two years after the operation, four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence. There was no significant difference in the recurrence rate between the two groups (χ2 = 0.668, P = 0.414 > 0.05).

CONCLUSION

MRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone. Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

Keywords: Breast cancer; Magnetic resonance; Digital mammography; Clinical value; Arc incision; Breast-conserving surgery; Digital breast tomosynthesis

Core Tip: This study analyzed the diagnostic method, compared the efficacy of magnetic resonance imaging combined with digital breast tomosynthesis in diagnosing breast cancer in the Shanxi Province, China, and analyzed the advantages of breast-conserving surgery over modified radical mastectomy. The purpose was to select the best diagnostic method and surgical plan for breast cancer to improve the diagnostic accuracy and patients’ quality of life.