乳腺癌的比较影像学研究  

Comparative imaging in the diagnosis of breast cancer

作　　者：张晓[1] 汤光宇[1] 叶雯[1] 马方[1] 刘勇[1] 华婷[1] 

机构地区：[1]同济大学附属第十人民医院放射科,上海200072

出　　处：《实用放射学杂志》2014年第3期434-438,共5页Journal of Practical Radiology

基　　金：上海市科委“创新行动计划”生物医药处重点项目（10411953700）.

摘　　要：目的 比较乳腺X线摄影、超声、磁共振不同影像组合与单纯磁共振诊断乳腺癌的价值。方法 对90例怀疑乳腺癌患者进行前瞻性研究，分别行乳腺磁共振（平扫＋动态增强＋扩散加权成像）、乳腺X线摄影、乳腺三维超声检查，以手术病理诊断结果为标准，分析乳腺X线摄影（XRM）、超声（US）、磁共振（MRI）及XRM＋US、MRI＋XRM、MRI＋US、MRI＋XRM＋US对乳腺癌诊断的准确度，敏感性，特异性，阴性预测值，阳性预测值，并比较乳腺X线摄影、超声、XRM＋US及MRI＋XRM、MRI＋US、MRI＋XRM＋US与单纯MRI诊断乳腺癌的价值。结果 MRI＋US＋XRM敏感性（98.2%，χ2=25.9，P=0.000），MRI＋US敏感性（94.5%，χ2=53.3，P=0.002）,MRI＋XRM敏感性（94.5%，χ2=41.9，P=0.000）均高于单独的MRI（90.9%）,差异均有显著统计学意义，MRI诊断乳腺癌的敏感性（90.9%）显著高于XRM（72.7%，χ2=9.52，P=0.002）与US（80.0%，χ2=24.80，P=0.000），差异均有显著统计学意义，MRI诊断乳腺癌的特异性、阳性预测值（分别为82.9%、89.3%）显著高于XRM、US及其联合诊断（34.3%~65.7%,69.4%~81.2%），而MRI＋US＋XRM联合诊断乳腺癌的阴性预测值（92.9%）显著高于单纯的MRI（85.3%）、MRI＋US（88.5%）及MRI＋XRM（85.7%）检查。ROC曲线显示MRI诊断乳腺癌的准确性为0.88，显著高于XRM（0.75,P〈0.001）和US（0.71,P〈0.001）及XRM＋US（0.73，P=0.001），差异均有显著统计学意义；MRI＋XRM诊断准确性为0.85（P=0.064）、MRI＋US为0.86（P=0.421）及MRI＋US＋XRM为0.85（P=0.132）,与单独的MRI比较，均无显著差异。结论 MRI诊断乳腺癌的敏感性和特异性显著高于XRM和US，而它们之间的联合检查可以显著提高诊断乳腺癌的敏感性，但并不能明显提高诊断乳腺癌的准确度。Objective To compare the value of combination of MRI and mammography and/or ultrasound examination with that of MRI alone in diagnosing breast cancer. Methods Ninety women suspected as breast cancer underwent ultrasound, mammography and MRI （including routine imaging, dynamic contrast-enhanced imaging and diffusion weighted imaging） examination. Using pathological results as a golden standard, diagnostic performance [ sensitivity, specificity, accuracy, positive and negative predictive values） of each examination method and combinations with different methods were calculated respectively. The value of diagnusing breast cancer was compared among different methods and their combinations. Results The diagnostic sensitivity of MRI was significantly higher than that of XRM （72.7% ,X2=9.52,P=0. 0021 and US （80.0% ,X2 =24.80,P=0. 000） ,respectively. The sensitivity of MRI＋US-I-XRM （98.2%,X2 =25.9,P=0. 000）,MRI-I-US （94.5%,X2 =53.3 , P=0. 002 ） and MRI＋XRM （ 94.5%,X2 =41.9, P=0. 000）were significantly higher than that of MRI （90. 9% ）. The diagnostic specificity and positive predictive value of MRI （82. 9% ,89.3 % ） were significantly better than those of any combinations （34.3%-65.7%, 69.4%-81.2%）. The diagnostic negative predictive value using MRI＋ US＋XRM {92. 9% ） was higher than that of other methods （MRI 85. 3%, MRI-t-US 88. 5%, MRI＋XRM 85.7% ,respectively）. Based on the receiver operating characteristic curves, the area under the curve of MRI （0.88） was significantly higher than that of XRM （0.75 , P〈0.001） , US（0.71 ,P%0.001） andXRM＋US （0.73 ,P=0.001 ）. However, there was no significant difference between MRI and combinations such as MRI ＋ XRM （0. 85, P=0. 064）, MRI＋US （0. 86,P=0. 421） and MRI＋ US＋ XRM （0.85,P=0. 132）. Conclusion The sensitivity and specificity of MRI are higher than those of XRM and US in diagno sing breast cancer. MRI combined other methods can obviously improve the diagnostic sensitivity, but can not sig

关 键 词：乳腺癌 磁共振成像 超声 乳房X线摄影 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]