首页|多模态MRI与DBT联合对早期乳腺癌精准诊治的临床研究

多模态MRI与DBT联合对早期乳腺癌精准诊治的临床研究

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目的:分析多模态磁共振成像(MRI)与数字乳腺体层摄影(DBT)联合对早期乳腺癌精准诊治的价值.方法:回顾性分析 2023 年 1 月—2024 年 6 月赣南医科大学第一附属医院接受诊断的 117 例疑似早期乳腺癌患者的临床资料.均采用多模态MRI和DBT诊断,以病理诊断结果为"金标准".比较多模态MRI、DBT单独和联合诊断早期乳腺癌的诊断效果(敏感度、特异度、准确度、漏诊率、误诊率、阳性预测值、阴性预测值);对比恶性和良性患者的多模态MRI影像学特征差异、多模态MRI参数[微血管密度(MVD)、峰值强化率、达峰时间].结果:117 例疑似早期乳腺癌患者,病理结果证实 65 例阳性,52 例阴性;采用多模态MRI诊断出 62 例阳性,55 例阴性;采用DBT诊断出 60 例阳性,57 例阴性;采用多模态MRI联合DBT诊断出 73 例阳性,44 例阴性.多模态MRI联合DBT诊断特异度为 80.77%(42/52)、误诊率为 19.23%(10/52),与多模态MRI单独诊断[80.77%(42/52)、19.23%(10/52)]和DBT单独诊断[78.85%(41/52)、21.15%(11/52)]对比,差异均无统计学意义(P>0.05);多模态MRI联合DBT诊断敏感度为 96.92%(63/65)、准确度为 89.74%(105/117),较多模态MRI单独诊断[80.00%(52/65)、80.34%(94/117)]和DBT单独诊断[75.38%(49/65)、76.92%(90/117)]均高,漏诊率为3.08%(2/65),较多模态MRI、DBT单独诊断[20.00%(13/65)、24.62%(16/65)]均低,差异均有统计学意义(P<0.05).多模态MRI联合DBT诊断阳性预测值为 86.30%(63/73),与多模态MRI、DBT单独诊断[83.87%(52/62)、81.67%(49/60)]对比,差异均无统计学意义(P>0.05);多模态MRI联合DBT诊断阴性预测值为 95.45%(42/44),较多模态MRI、DBT单独诊断[76.36%(42/55)、71.93%(41/57)]均高,差异均有统计学意义(P<0.05).与良性患者比,恶性患者病灶以大小≥2 cm、形态不规则、边缘模糊、高密度为主,差异均有统计学意义(P<0.05).与良性患者比,恶性患者MVD、峰值强化率较高,达峰时间较短,差异均有统计学意义(P<0.05).结论:多模态MRI联合DBT诊断早期乳腺癌,可获取更丰富的影像信息,提高诊断效果,为临床早期诊断提供参考.
Clinical Study on the Accurate Diagnosis and Treatment of Early Breast Cancer by Combined Multimodal MRI and DBT
Objective:To analyze the value of multimodal magnetic resonance imaging(MRI)combined with digital breast tomosynthesis(DBT)in the accurate diagnosis and treatment of early breast cancer.Method:The clinical data of 117 suspected early breast cancer patients diagnosed in the First Affiliated Hospital of Gannan Medical University from January 2023 to June 2024 were retrospectively analyzed.Both used multimodal MRI and DBT diagnosis,with pathological diagnosis results as the"gold standard".The diagnostic effects(sensitivity,specificity,accuracy,missed diagnosis rate,misdiagnosis rate,positive predictive value,negative predictive value)of multimodal MRI and DBT alone and jointly in the diagnosis of early breast cancer were compared;the differences in multimodal MRI imaging features and multimodal MRI parameters[microvascular density(MVD),peak enhancement rate,and time to peak]between malignant and benign patients were compared.Result:In 117 cases of suspected early breast cancer,pathological results confirmed that 65 cases were positive and 52 cases were negative;62 cases were positive and 55 cases were negative by multimodal MRI diagnose;60 cases were positive and 57 cases were negative by DBT diagnose;73 cases were positive and 44 cases were negative by multimodal MRI combined with DBT diagnose.The diagnostic specificity of multimodal MRI combined with DBT was 80.77%(42/52),and the misdiagnosis rate was 19.23%(10/52),compared with the diagnosis of multimodal MRI alone[80.77%(42/52),19.23%(10/52)],and DBT alone[78.85%(41/52),21.15%(11/52)],the differences were not statistically significant(P>0.05);the sensitivity of multimodal MRI combined with DBT for diagnosis was 96.92%(63/65),and the accuracy was 89.74%(105/117),which were higher than 80.00%(52/65),80.34%(94/117)of modality MRI alone diagnosed,and DBT alone diagnosed[75.38%(49/65),76.92%(90/117)],missed diagnosis rate of 3.08%(2/65),which was lower than those[20.00%(13/65),24.62%(16/65)]of more modality MRI and DBT alone diagnosed,the differences were statistically significant(P<0.05).The positive predictive value of multimodal MRI combined with DBT diagnosis was 86.30%(63/73),which compared with 83.87%(52/62)and 81.67%(49/60)of multimodal MRI and DBT diagnosis alone,the differences were not statistically significant(P>0.05);the negative predictive value of multimodal MRI combined with DBT diagnosis was 95.45%(42/44),which was higher than 76.36%(42/55)and 71.93%(41/57)of multimodal MRI and DBT alone diagnosis,the differences were statistically significant(P<0.05).Compared with benign patients,malignant patients mainly have lesions with a size of≥2 cm,irregular shape,blurred edges,and high density,and the differences were statistically significant(P<0.05).Compared with benign patients,malignant patients MVD and peak enhancement rate were higher,peak time was shorter,the differences were statistically significant(P<0.05).Conclusion:The combination of multimodal MRI and DBT in the diagnosis of early breast cancer can provide richer imaging information and improve diagnostic performance,offering a reference for early clinical diagnosis.

Early breast cancerMultimodal magnetic resonance imagingDigital breast tomosynthesis

伍小珠、陈班、黄莉、李振华、冷桂香、李梅芳

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赣南医科大学第一附属医院医学影像科 江西 赣州 341000

赣南医科大学第一附属医院心内科 江西 赣州 341000

乐东黎族自治县人民医院放射科 海南 乐东 572500

赣南医科大学第一附属医院乳腺外科 江西 赣州 341000

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早期乳腺癌 多模态磁共振成像 数字乳腺体层摄影

赣州市科技局课题项目

GZ2022ZSF233

2024

中国医学创新
中国保健协会

中国医学创新

影响因子:1.706
ISSN:1674-4985
年,卷(期):2024.21(25)