• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3521-3526
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• 2016

Digital breast tomosynthesis (DBT) as a breast cancer screening modality, through generation of three-dimensional images during standard mammographic compression, can reduce interference from breast tissue overlap, increasing conspicuity of invasive cancers while concomitantly reducing false-positive results. We here conducted a systematic review on previous studies to synthesize the evidence of DBT efficacy, eventually 18 articles being included in the analysis. The most commonly emerging topics were advantages of DBT screening tool in terms of recall rates, cancer detection rates and cost-effectiveness, preventing unnecessary burdens on women and the healthcare system. Further research is needed to evaluate the potential impact of DBT on longer-term outcomes, such as interval cancer rates and mortality, to better understand the broader clinical and economic implications of its adoption.

• Asian Pacific Journal of Cancer Prevention
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• 제16권9호
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• pp.4109-4114
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• 2015

Background: Full-field digital mammography (FFDM) with dense breasts has a high rate of missed diagnosis, and digital breast tomosynthesis (DBT) could reduce organization overlapping and provide more reliable images for BI-RADS classification. This study aims to explore application of COMBO (FFDM+DBT) for effect and significance of BI-RADS classification of breast cancer. Materials and Methods: In this study, we selected 832 patients who had been treated from May 2013 to November 2013. Classify FFDM and COMBO examination according to BI-RADS separately and compare the differences for glands in the image of the same patient in judgment, mass characteristics display and indirect signs. Employ Paired Wilcoxon rank sum test was used in 79 breast cancer patients to find differences between two examine methods. Results: The results indicated that COMBO pattern is able to observe more details in distribution of glands when estimating content. Paired Wilcoxon rank sum test showed that overall classification level of COMBO is higher significantly compared to FFDM to BI-RADS diagnosis and classification of breast (P<0.05). The area under FFDM ROC curve is 0.805, while that is 0.941 in COMBO pattern. COMBO shows relation of mass with the surrounding tissues, the calcification in the mass, and multiple foci clearly in breast cancer tissues. The optimal sensitivity of cut-off value in COMBO pattern is 82.9%, which is higher than that in FFDM (60%). They share the same specificity which is both 93.2%. Conclusions: Digital Breast Tomosynthesis (DBT) could be used for the BI-RADS classification in breast cancer in clinical.

• 한국콘텐츠학회논문지
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• 제15권11호
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• pp.322-328
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• 2015

본 연구는 기존의 Mammogram와 Tomosynthesis를 비교하여 진단적 가치를 평가하고 피검자의 유선선량을 비교하여 Tomosynthesis의 활용에 대해서 고찰해 보고자 하였다. 2015년 1월 한 달 동안 본원을 내원한 환자 62명을 대상으로 선행 검사를 시행한 후 어떤 병변이 있을 때 추가적으로 Tomosynthesis를 시행하였는지 분석하였다. 유방촬영용 ACR phantom을 이용하였으며 자동 노출이 되도록 설정된 상태에서 촬영한 kVp와 mAs를 기준으로 하여 kVp는 고정하고 mAs를 단계적으로 변화를 주어 유선선량을 분석하였다. 그 결과 Tomosynthesis가 유방 병변 구별에 우수하였으며 2D Mammogram과 비교할 때 확연한 대조도 차이를 보였다. 또한 두 검사의 평균유선선량에서는 Mammogram(1.15 mGy)보다 Tomosynthesis(1.48 mGy)가 0.33 mGy정도 높았으나 추가검사의 불필요함으로 인해 장기적으로는 피폭선량이 감소하는 효과를 보였다. 그러므로 Tomosynthesis는 유방의 진단적 가치를 높임과 동시에 피폭선량을 줄일 수 있는 검사이며 향후 유방질환의 검사에 적합하게 적용되고 응용할 수 있을 것이다.

• 대한영상의학회지
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• 제81권4호
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• pp.886-898
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• 2020

목적 본 연구는 부인암을 가진 여성에서 유방암의 선별검사로서의 디지털 유방단층 촬영술을 평가하였다. 대상과 방법 부인암을 가진 환자들 중 검진 목적으로 디지털 유방단층 촬영술을 촬영한 환자들을 대상으로 후향적 연구를 시행하였으며 유방암 발견율, 소환율, 민감도, 특이도, 양성예측도를 계산하였다. 양성예측도 1은 모든 양성 선별검사 중 1년 이내에 조직 검사에서 유방암을 진단받은 환자의 백분율로 정의되었다. 양성예측도 2는 진단 검사에서 조직검사의 필요 판정을 받은 후(그리고 선별 검사에서 Breast Imaging Reporting and Data System 카테고리 4, 5를 받은 후) 1년 이내에 조직검사에서 유방암을 진단받은 환자의 백분율로 정의되었다. 양성예측도 3은 실제로 조직검사를 시행 받은 환자 중 1년 이내에 조직검사에서 유방암을 진단받은 환자의 백분율로 정의되었다. 검진으로 발견된 암의 각 경우에 대해 환자의 나이, 부인암의 종류, 유방 밀도, 영상의 특징, 최종 Breast Imaging Reporting and Data System 평가, 조직학적 유형, T 및 N 병기, 분자아형 및 Ki-67 지수를 분석했다. 결과 전체 508명 중 7개의 유방암이 발견되었으며 유방암 발견율은 1000건 당 암 13.8이었다. 민감도는 100%, 특이도는 83.2%였으며 위음성률은 1000건 당 0이었다. 양성예측도 1, 양성예측도 2, 양성예측도 3은 각각 7.7, 31.8, 31.8이었으며 소환율은 17.9%였다. 결론 본 연구에서 디지털 유방단층 촬영술은 높은 유방암 발견율, 높은 민감도, 높은 양성예측도를 보이며 T, N 병기가 낮은 초기 암에 대해 높은 발견율을 보였다. 따라서 부인암 환자와 같은 고위험군에서 유방암의 선별검사로서 디지털 유방단층 촬영술이 유용할 수 있다.

• 대한영상의학회지
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• 제84권2호
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• pp.320-331
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• 2023

유방촬영술을 이용한 유방암 검진은 표준 영상 방법이다. 초음파에서 보이지 않고 유방촬영술이나 디지털 유방 토모신테시스에서만 보이는 의심스러운 석회화, 구조 왜곡의 조직학적 진단을 위해 입체정위생검과 유방촬영술 유도하 수술 전 위치결정술을 시행한다. 본 종설에서는 입체정위생검의 적응증 및 비적응증, 방법, 입체정위생검 후 클립 삽입과 디지털 유방 토모신테시스 유도하 입체정위생검에 대해 알아보고자 한다. 또한, 유방촬영술 유도하 수술 전 위치결정술을 침위치결정술과 비침위치결정술로 나누어 소개하고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.3037-3040
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• 2013

Introduction: Mammography is the most basic modality in breast cancer imaging. However, the overlap of breast tissue depicted on conventional two-dimensional mammography (2DMMG) may create significant obstacles to detecting abnormalities, especially in dense or heterogeneously dense breasts. In three-dimensional digital breast tomosynthesis (3DBT), tomographic images of the breast are reconstructed from multiple projections acquired at different angles. It has reported that this technology allows the generation of 3D data, therefore overcoming the limitations of conventional 2DMMG for Western women. We assessed the detectability of lesions by conventional 2DMMG and 3DBT in diagnosis of breast cancer for Japanese women. Methods: The subjects were 195 breasts of 99 patients (median age of 48 years, range 34~82 years) that had been pathologically diagnosed with breast cancer from December 20, 2010 through March 31, 2011. Both conventional 2DMMG and 3DBT imaging were performed for all patients. Detectability of lesions was assessed based on differences in category class. Results: Of the affected breasts, 77 (75.5%) had lesions assigned to the same categories by 2DMMG and 3DBT. For 24 (23.5%) lesions, the category increased in 3DBT indicating improvement in diagnostic performance compared to 2DMMG. 3DBT improved diagnostic sensitivity for patients with mass, focal asymmetric density (FAD), and architectural distortion. However, 3DBT was not statistically superior in diagnosis of the presence or absence of calcification. Conclusions: In this study, 3DBT was superior in diagnosing lesions in form of mass, FAD, and/or architectural distortion. 3DBT is a novel technique that may provide a breakthrough in solving the difficulties of diagnosis caused by parenchyma overlap for Japanese women.

• Korean Journal of Radiology
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• 제23권11호
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• pp.1031-1043
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• 2022

Objective: To compare digital breast tomosynthesis (DBT) and MRI as an adjunct to full-field digital mammography (FFDM) for the preoperative evaluation of women with breast cancer based on mammographic density. Materials and Methods: This retrospective study enrolled 280 patients with breast cancer who had undergone FFDM, DBT, and MRI for preoperative local tumor staging. Three radiologists independently sought the index cancer and additional ipsilateral and contralateral breast cancers using either FFDM alone, DBT plus FFDM, or MRI plus FFDM. Diagnostic performances across the three radiologists were compared among the reading modes in all patients and subgroups with dense (n = 186) and non-dense breasts (n = 94) according to mammographic density. Results: Of 280 patients, 46 (16.4%) had 48 additional (39 ipsilateral and nine contralateral) cancers in addition to the index cancer. For index cancers, both DBT plus FFDM and MRI plus FFDM showed sensitivities of 100% in the non-dense group. In the dense group, DBT plus FFDM showed lower sensitivity than that of MRI plus FFDM (94.6% vs. 99.6%, p < 0.001). For additional ipsilateral cancers, DBT plus FFDM showed specificity and positive predictive value (PPV) of 100% in the non-dense group, but sensitivity and negative predictive value (NPV) were not statistically different from those of MRI plus FFDM (p > 0.05). In the dense group, DBT plus FFDM showed higher specificity (98.2% vs. 94.1%, p = 0.005) and PPV (83.1% vs. 65.4%; p = 0.036) than those of MRI plus FFDM, but lower sensitivity (59.9% vs. 75.3%; p = 0.049). For contralateral cancers, DBT plus FFDM showed higher specificity than that of MRI plus FFDM (99.0% vs. 96.7%, p = 0.014), however, the other values did not differ (all p > 0.05) in the dense group. Conclusion: DBT plus FFDM showed an overall higher specificity than that of MRI plus FFDM regardless of breast density, perhaps without substantial loss in sensitivity and NPV in the diagnosis of additional cancers. Thus, DBT may have the potential to be used as a preoperative breast cancer staging tool.

• Korean Journal of Radiology
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• 제22권8호
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• pp.1240-1252
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• 2021

Objective: To compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis. Materials and Methods: Ovid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies. Results: Twenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86-0.93) and 0.90 (95% CI 0.84-0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68-0.83) and 0.83 (95% CI 0.73-0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93-0.97) for DBT and 0.86 (95% CI 0.82-0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses. Conclusion: Use of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.

• Korean Journal of Radiology
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• 제24권4호
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• pp.274-283
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• 2023

Objective: To compare the outcomes of digital breast tomosynthesis (DBT) screening combined with ultrasound (US) with those of digital mammography (DM) combined with US in women with dense breasts. Materials and Methods: A retrospective database search identified consecutive asymptomatic women with dense breasts who underwent breast cancer screening with DBT or DM and whole-breast US simultaneously between June 2016 and July 2019. Women who underwent DBT + US (DBT cohort) and DM + US (DM cohort) were matched using 1:2 ratio according to mammographic density, age, menopausal status, hormone replacement therapy, and a family history of breast cancer. The cancer detection rate (CDR) per 1000 screening examinations, abnormal interpretation rate (AIR), sensitivity, and specificity were compared. Results: A total of 863 women in the DBT cohort were matched with 1726 women in the DM cohort (median age, 53 years; interquartile range, 40-78 years) and 26 breast cancers (9 in the DBT cohort and 17 in the DM cohort) were identified. The DBT and DM cohorts showed comparable CDR (10.4 [9 of 863; 95% confidence interval {CI}: 4.8-19.7] vs. 9.8 [17 of 1726; 95% CI: 5.7-15.7] per 1000 examinations, respectively; P = 0.889). DBT cohort showed a higher AIR than the DM cohort (31.6% [273 of 863; 95% CI: 28.5%-34.9%] vs. 22.4% [387 of 1726; 95% CI: 20.5%-24.5%]; P < 0.001). The sensitivity for both cohorts was 100%. In women with negative findings on DBT or DM, supplemental US yielded similar CDRs in both DBT and DM cohorts (4.0 vs. 3.3 per 1000 examinations, respectively; P = 0.803) and higher AIR in the DBT cohort (24.8% [188 of 758; 95% CI: 21.8%-28.0%] vs. 16.9% [257 of 1516; 95% CI: 15.1%-18.9%; P < 0.001). Conclusion: DBT screening combined with US showed comparable CDR but lower specificity than DM screening combined with US in women with dense breasts.

• 한국의학물리학회지:의학물리
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• 제25권4호
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• pp.271-280
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• 2014

최근에 디지털 유방촬영술(digital mammography, DM)의 해부학적 구조의 겹침 현상과 컴퓨터단층촬영영상(computed tomography, CT)의 높은 환자 선량을 해결하기 위해 디지털 유방단층영상합성장치(digital breast tomosynthesis, DBT)에 대한 연구 개발이 활발하게 수행되고 있다. 하지만 DBT 시스템은 제한된 각도로 영상을 획득하면서 급격한 데이터 결핍으로 인해 다른 층의 간섭으로 인한 인공물(artifacts)이 발생한다. 이를 완화시키기 위해 적절한 필터가 필요하다. 본 논문에서는 DBT 시스템에서 FBP 알고리즘을 이용하여 영상재구성 시 발생되는 인공물을 줄이기 위해 적절한 필터조합을 찾는 것이 궁극적인 목적이다. 시뮬레이션과 실제 실험을 통해 동일한 영상 획득조건에서 FBP 알고리즘을 이용해 재구성된 영상을 분석하여 다양한 필터 조합들의 특성을 조사했다. 필터 특성에 대한 평가를 하기 위해 영상 및 프로파일의 분석과 COV (coefficient of variation)를 이용하여 인공물과 잡음에 대한 평가를 하였다. 본 연구 결과를 통해 분광필터(spectral filter)의 파라미터 인자 값들을 조절하여 cut-off frequency를 설정함으로써 고주파 영역에 있는 영상의 잡음을 줄일 수 있었다. DBT 시스템에서 유방팬텀을 재구성한 영상들을 비교했을 때 분광필터의 파라미터 인자를 0.25로 적용한 영상의 결과는 분광필터를 적용하지 않았을 때보다 영상의 잡음을 10%로 감소시킬 수 있었다. 절편두께필터(slice thickness filter)의 파라미터 인자의 값들을 조절하여 정보들의 불균형을 줄임으로써 다른 층의 간섭으로 인한 인공물을 감소시킬 수 있었다. 결론적으로, 본 연구를 통해 FBP 알고리즘으로 재구성했을 때 필터들의 기본 특성을 확인 할 수 있었으며, 적절한 필터 조합이 실제 화질 개선에 기여한 것으로 확인할 수 있었다. 이 연구 결과는 다양한 필터 조합에 따른 잡음과 데이터 결핍에 의한 인공물에 대한 정보를 제공하여 DBT 시스템의 개발 및 임상화적용 연구에 기반이 될 것으로 기대된다.