摘要
目的:探讨数字乳腺断层融合X线摄影(DBT)、超声和MRI对乳腺非肿块强化(NME)病变的诊断价值.方法:回顾性分析2018年3月—2023年6月在本院经乳腺 MRI检查发现乳腺NME病变且经手术病理证实的156例患者的病例资料.156例中,良性病变60例(38.46％),恶性病变96例(61.54％).所有患者术前行DBT、超声和MRI检查(包括T1WI、脂肪抑制T2WI、DWI及动态增强序列).参照美国放射学会(ACR)乳腺影像报告数据系统(BI-RADS)分类标准来评估乳腺NME病变的影像学表现.采用受试者工作特征(ROC)曲线比较DBT、超声、MRI及多模态联合诊断对良、恶性乳腺NME病变的鉴别诊断效能,采用Z检验比较单项或联合检查诊断不同病理类型乳腺NME病变的诊断符合率.结果:良、恶性乳腺NME组之间患者年龄(t=4.841,P=0.000)和绝经状态(x2=7.708,P=0.005)的差异具有统计学意义.各检查方法在诊断乳腺NME病变良、恶性方面的符合率:MRI(83.97％)＞三者联合检查(82.69％)＞DBT(74.36％)＞超声(73.72％),差异具有统计学意义(x2=8.132,P=0.043).DBT、超声、MRI及三者联合检查鉴别乳腺NME病变良恶性的ROC曲线下面积(AUC)分别为0.760、0.774、0.814和0.791;采用Delong检验对各种方法的AUC进行两两比较,差异均无统计学意义(P＞0.05).Z检验结果显示,DBT、超声、MRI及联合检查对乳腺恶性肿瘤、浸润性癌、非浸润性癌、良性肿瘤及腺病的诊断符合率的差异均具有统计学意义(P＜0.05),而对导管内乳头状瘤、纤维腺瘤、非典型增生及其它良性病变的诊断符合率的差异均无统计学意义(P＞0.05).结论:与DBT和超声检查相比,MRI能较显著提高对乳腺NME病变良恶性的诊断准确性.
Abstract
Objective:To investigate and compare the diagnostic value of digital breast tomosyn-thesis fusion radiography(DBT),ultrasound and MRI for non-mass-enhancing(NME)lesions of the breast.Methods:The clinical and imaging data of 156 patients with breast NME lesions detected by breast MRI and confirmed by surgical pathology from March 2018 to June 2023 in our hospital were retrospectively analyzed.Of the 156 cases,60 cases(38.46％)were benign and 96 cases(61.54％)were malignant.All patients underwent preoperative DBT,ultrasound and MRI examinations,and the MRI sequences included T1 WI,fat-suppressed T2WI,DWI and dynamic contrast enhanced sequences.The imaging features of breast NME lesions was evaluated and classification taken the Breast Imaging Re-porting Data System(BI-RADS)formulated by American College of Radiology(ACR)as the criteria.The ROC curve analysis was made to evaluate diagnostic efficacy of DBT,ultrasound,MRI and multi-modality method for benign and malignant breast NME lesions,and the difference of the diagnostic ac-curacy between the examinations was tested using the Z-test,and the diagnostic compliance rate of the single or combined examinations for diagnosis of breast NME lesions of different pathologic types was analyzed.The diagnostic compliance rate of single or combined examinations for the diagnosis of diffe-rent pathological types of breast NME lesions was analyzed.Results:The differences of patient age(t=4.841,P＜0.001)and menopausal status(x2=7.708,P=0.005)between the benign and malignant breast NME groups were statistically significant.The accuracy of each examination method in diagno-sing benign and malignant breast NME lesions:MRI(83.97％)＞combined three examinations(82.69％)＞DBT(74.36％)＞ultrasound(73.72％),with a statistically significant difference(X2=8.132,P=0.043).The area under the ROC curve(AUC)for DBT,ultrasound,MRI and the combined examination of the three to identify the benign and malignant breast NME lesions were 0.760,0.774,0.814 and 0.791,respectively;the differences were not statistically significant by the two-by-two com-parisons of Delong's test(all P＞0.05).Comparison of the diagnostic efficacy of DBT,ultrasound,MRI and combined examination of breast NME lesions of different pathological types showed that the differences in the diagnostic compliance rates of DBT,ultrasound,MRI and combined examination for breast malignant tumors,invasive carcinomas,non-invasive carcinomas,benign tumors and adenopa-thies were statistically significant(P＜0.05),while the differences in the diagnostic compliance rates of intraductal papillomas,fibroadenomas,atypical hyperplasia and other benign lesions.The difference in diagnostic compliance rates for intraductal papillomas,fibroadenomas,atypical hyperplasia and other benign lesions was not statistically significant(P＞0.05).Conclusion:Compared with DBT and ultra-sonography,MRI more significantly improves the diagnostic accuracy of the benign and malignant na-ture of breast NME lesions.
维普
万方数据