乳腺专用伽玛显像不同图像分析方法对乳腺癌的诊断价值  

Diagnostic value of breast specific gamma imaging with combined visual and semi-quantitative method in patients with breast carcinoma

作　　者：谭辉[1] 张宏伟[2] 傅毅鹏 顾宇参[1] 胡鹏程[1] 张一秋[1] 修雁[1] 邬鹏跃[1] 石洪成[1] 

机构地区：[1]上海市影像医学研究所、复旦大学附属中山医院核医学科、复旦大学核医学研究所,200032 [2]上海市影像医学研究所、复旦大学附属中山医院普外科,200032

出　　处：《中华核医学与分子影像杂志》2015年第3期186-189,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的 探讨目测法及目测与半定量法结合分析乳腺专用伽玛显像（BSGI）图像对乳腺癌的诊断价值.方法 选取106例乳腺肿块拟行手术的患者,术前10 d内行BSGI,分别采用目测法（结果分为1～5级）和目测与半定量法结合分析图像.选出目测法分级≥3级的患者,选取其乳房头尾（CC）位与内外侧斜（MLO）位中病灶与邻近正常乳腺组织放射性计数比值（L/N）中的较大值作为BSGI图像分析的半定量指标.与术后病理进行对照,通过ROC曲线计算目测法诊断乳腺癌的灵敏度和特异性、目测与半定量法结合指标L/N的界值;两者结合采用序列试验方法计算其诊断乳腺癌的灵敏度和特异性.采用两样本t检验分析数据.结果 经手术及病理证实,106例乳腺肿块患者中良性疾病34例（49个良性病灶）,乳腺癌72例（73个恶性病灶及4个良性病灶）.目测法分级取3.5作为界值时,ROC AUC为0.901（95％ CI：0.838～ 0.965）最大,此时BSGI诊断乳腺癌的灵敏度和特异性分别为94.4％ （68/72）和73.5％ （25/34）.对目测法分级≥3级的85例进行半定量分析：取L/N 1.92作为界值,其ROC AUC为0.870（95％ CI：0.756～ 0.984）最大;恶性组L/N为3.29± 1.30,明显高于良性组（2.02±0.65;t=5.63,P＜0.05）.目测与半定量法结合诊断乳腺癌的灵敏度和特异性分别为91.7％ （66/72）和88.2％ （30/34）.结论 目测与半定量法结合分析BSGI图像,有助于提高乳腺癌诊断的特异性,具有增益价值.Objective To evaluate the value of breast specific gamma imaging （BSGI） in detecting primary breast cancer by combined visual and semi-quantitative method.Methods A total of 106 patients suspected of having breast cancer underwent BSGI.The diagnosis was confirmed by histological examination.Interpretation for BSGI was based on the visual （grades 1-5） and semi-quantitative assessment.For patients assessed as grade =3 or above,the ROI was drawn on craniocaudal and mediolateral oblique images respectively,and the count ratio of lesion to adjacent normal breast tissue （L/N） was calculated.The higber value of L/N was selected as index quantitative parameter.The optimal visual grade and L/N cut-off value were obtained through ROC analysis.The sensitivity and specificity of BSGI based on visual-only and combined visual and semi-quantitative assessment were evaluated respectively.Two-sample t test was used to analyze the data.Results Postoperative pathological results confirmed 34/106 cases （49 benign lesions） as benign and 72/106 as breast cancer （73 malignant lesions and 4 benign lesions）.The optimal visual grade was 3.5,with ROC AUC of 0.901 （95% CI：0.838-0.965）,sensitivity of 94.4% （68/72） and specificity of 73.5% （25/34）.The cut-off value of L/N was 1.92,with ROC AUC of 0.870 （95% CI：0.756-0.984）.The L/N value of patients with breast cancer was significantly higher than that of benign cases （3.29± 1.30 vs 2.02± 0.65;t =5.63,P〈0.05）.The sensitivity and specificity of combined visual and semi-quantitative method were 91.7% （66/72） and 88.2% （30/34） for diagnosing primary breast cancer.Conclusion Combined visual and semi-quantitative method on BSGI might improve the specificity for the diagnosis of breast carcinoma.

关 键 词：乳腺肿瘤 放射性核素显像 乳房X线摄影术 

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