乳腺MRI与乳腺X线检查诊断导管原位癌的敏感度研究  

MRI outstands mammogram in sensitivity of breast ductal carcinoma in situ ： an analysis of 122 cases

作　　者：郁骐襄[1] 陈小松[1] 吴佳毅[1] 韩宝三[1] 何建蓉[1] 朱丽[1] 陈伟国[1] 李亚芬[1] 谭令[1] 柴维敏[1] 汪登斌[1] 费晓春[1] 袁菲[1] 金晓龙[1] 沈坤炜[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院乳腺疾病诊治中心,200025

出　　处：《中华外科杂志》2013年第1期26-29,共4页Chinese Journal of Surgery

基　　金：上海市科学技术委员会基础性研究计划资助项目（09411961400）;上海市教育科学技术委员会重点学科（肿瘤学）资助项目（J50208）;国家自然科学基金资助项目（81172520）

摘　　要：目的在乳腺导管原位癌（DCIS）、DCIS伴微浸润（DCIS．MI）的患者中分别比较乳腺X线检查（MG）及乳腺MRI诊断的敏感度。方法2009年8月至2011年11月，接受手术治疗的122例连续病例被纳入此项研究，其中包括72例DCIS及50例DCIS—MI。患者均为女性，平均年龄分别为52．6岁和54．4岁。收集患者术前乳腺影像学诊断报告（MG及MRI），以术后石蜡病理诊断为金标准，分析这两种诊断方式的敏感度。结果乳腺MRI检测DCIS及DCIS—MI的敏感度分别为84．7％和94．0％（x。=2．500，P=0．114）。多因素分析提示乳腺MRI的诊断敏感度与肿瘤分化程度相关（OR=3．471，P=0．031）。MG检测DCIS及DCIS．MI的敏感度分别42．4％和80．0％（x^2=16．555，P=0．000）。MG诊断敏感度与钙化相关（OR=11．287，P=0．001）。在DCIS及DCIS—MI患者中，乳腺MRI均较MG有更高的敏感度（x^2=27．028和4．540P=0．000和0．040）。结论乳腺MRI较MG能更敏感地诊断DCIS及DCIS—MI病灶。MG诊断敏感度与是否存在钙化相关，而患者临床特征及肿瘤生物学特征并不影响MRI的诊断敏感度，且MRI对分化差的DCIS及DCIS—MI肿瘤具有更高的敏感度。Objectives To compare the sensitivity of mammogram and breast dedicated MRI in detecting ductal carcinoma in situ with microinvaion （DCIS-MI） and ductal carcinoma in situ （DCIS） lesions, and to further investigate the independent predictive factors of mammogram and MRI sensitivity. Methods From August 2009 to November 2011, 122 consecutive confirmed breast cancer patients who had received operations were recruited for this clinical research. These patients were divided into two groups including DCIS （72 cases ） and DCIS-MI （50 cases ） based on pathologic reports. All the patients were female, with mean ages of 52. 6 years and 54. 4 years. Preoperative bilateral breast mammogram, breast dedicated MRI depictions and reports as well as histopathologieal reports were collected. Results Sensitivity of MRI outstood mammogram in each subgroups： 84. 7% vs. 42.4% in DCIS （Xz =27. 028, P = 0. 000） , 94. 0% vs. 80.0% in DCIS-MI group （~2 =4. 540, P =0. 040）. And further analysis showed that MRI was more sensitive to high nuclear grade DCIS and DCIS-MI lesions than low nuclear grade ones （ OR = 3.471, P = 0. 031 ）. Results of logistic regression analysis proved microcalcification was an independent predictive factor of mammogram sensitivity （ OR = 11. 287, P = 0. 001 ）. Conclusions Sensitivity of breast dedicated MRI is superior to mammogram in detecting DCIS and DCIS-MI groups. Lesions with microcalcifiation is an independent predictive marker which meant that mammozram would achieve high detection rate in cancers presented calcification on mammogram image when compared with non-calcification. Diagnostic performance of breast MRI is less affected by clinical and pathological characteristics of the early stage breast cancer patients but further increased detection rate is observed in DCIS and DCIS-MI with high nuclear grade lesions which indicated that MRI could detect more early stage cancers with relative more aggression biological behaviour and provide these patients with early surgical i

关 键 词：癌 导管 乳腺 乳腺肿瘤 磁共振成像 乳房X线摄影术 

分 类 号：R737.9[医药卫生—肿瘤]