全数字化X线摄影、超声及MRI对乳腺癌诊断价值的ROC曲线分析  

Full-Field Digital Mammography,Ultrasonography and MRI in Diagnosing Breast Cancer: ROC Curve Analysis

作　　者：武中林[1] 荣小翠[1] 赵俊京[1] 康一鹤 杨丽[1] 艾宁[1] 李智岗[1] 

机构地区：[1]河北医科大学第四医院放射科,石家庄050011

出　　处：《临床放射学杂志》2015年第3期355-359,共5页Journal of Clinical Radiology

摘　　要：目的通过受试者工作特征(ROC)曲线分析评估全数字化X线摄影、超声及MRI对于乳腺癌的诊断价值。方法选取在本院行X线、超声及MRI检查并经手术病理证实的乳腺癌患者57例(60个病灶)作为研究组,另选均行上述三种检查的良性病变23例(24个病灶)作为对照组。参考BI-RADS分类标准将术前X线、超声及MRI诊断分为五类:Ⅰ类:正常或肯定良性;Ⅱ类:可能良性;Ⅲ类:不能定性;Ⅳ类:可疑恶性;Ⅴ类:肯定恶性。由3名高年资相关专业医师采用盲法分别读片分类并与病理诊断对照,然后采用ROC曲线分析。结果研究组60个病灶中,X线摄影诊断为Ⅰ类4个,Ⅱ类2个,Ⅲ类1个,Ⅳ类16个,Ⅴ类37个;超声诊断分类依次为:1,1,7,21,30;MRI依次为0,1,1,13,45。ROC曲线分析:X线检查ROC曲线下面积(Az)=0.878(P=0.000),超声Az=0.865(P=0.000),MRI检查Az=0.925(P=0.000)。X线摄影的ROC曲线与另两条曲线相交,无法比较曲线下面积;MRI检查的Az高于超声检查(Z=2.06,P<0.05)。结论 (1)MRI检查用于乳腺病变诊断价值较高;X线摄影及超声检查诊断价值中等;MRI检查在乳腺病变诊断中无论敏感性、特异性均高于超声检查。(2)三种检查方法在乳腺病变诊断中都具有较高的价值,各有利弊,具有互补性,对于部分病变鉴别存在困难时,应仔细分析三种检查中的病变特点,结合临床病史以提高诊断正确率。Objective To evaluate full-field digital mammography,ultrasonogrphy and MRI in diagnosing breast cancer by using receiver operating curve（ ROC） analysis,and to discuss the causes of misdiagnosis and missed diagnosis made by three examination methods.Methods A total of 57 patients with breast cancer（ 60 malignant lesions in total） were enrolled in this study（ study group）.Mammography,ultrasonography and MRI were performed in all patients.Other 23 patients with benign breast lesion（ 24 lesions in total） were selected and used as the control group.Referring to the BI RADS classification standard,the preoperative diagnoses judged by mammography,ultrasonography and MRI were divided into 5categories： category Ⅰ： normal or definitely benign; category Ⅱ： probably benign; category Ⅲ： not defined; category Ⅳ：probably malignant; and category Ⅴ： definitely malignant.Using blind-method,the images were separately reviewed by three senior radiologists to determine the classification of the lesions and to compare the results with the pathological diagnoses.The data were evaluated using ROC analysis.Results In the malignant group（ 60 lesions）,the category Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ determined by mammography was seen in 4,2,one,16 and 37 lesions respectively; the category Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ determined by ultrasonography was observed in one,one,7,21 and 30 lesions respectively; and the category Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ determined by MRI was seen in zero,one,one,13 and 45 lesions.ROC analysis showed that the area measured by mammography,ultrasonography and MRI was 0.878（ P = 0.000）,0.865（ P = 0.000） and 0.925（ P = 0.000） respectively.As the ROC curve of mammography was intersected with the other two curves,the area under the curve could not be compared; the area under ROC of MRI was larger than that of ultrasonography,and the difference was statistically significant（ Z = 2.06,P 〈 0.05）.Conclusion（ 1） MRI has a higher value for the diagnosis of breast lesions,and the va

关 键 词：乳腺癌 受试者工作特征曲线 X线 超声 MRI 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44