基于FFDM并联3.0T MRI-DCE对乳腺癌筛检价值的研究  

Study on the value of full-field digital mammography combined with dynamic contrast-enhanced 3.0T MRI in the screening of breast cancer

作　　者：马彦云[1,2] 康艳旗 张珍珍[2] 贾田菊 宁艳云 张辉 MA Yanyun;KANG Yanqi;ZHANG Zhenzhen;JIA Tianju;NING Yanyun;ZHANG Hui(Department of Radiology,First Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China;Department of Medical Imaging,Shanxi Medical University;Institute of Mining,Taiyuan University of Technology)

机构地区：[1]山西医科大学第一医院放射科,太原030001 [2]山西医科大学医学影像系 [3]太原理工大学矿业学院

出　　处：《山西医科大学学报》2018年第7期862-865,共4页Journal of Shanxi Medical University

基　　金：山西省研究生教育创新项目(2017BY076);山西医科大学科技创新基金资助项目(01201514);山西医科大学第一医院医技护理基金资助项目(YH1303)

摘　　要：目的分析评价全数字化乳腺X线摄影与磁共振动态增强扫描各自及并联应用后在乳腺癌筛检中的应用价值。方法回顾性分析2014-04~2017-10在我院经穿刺或手术病理证实的、术前均行FFDM及3.0T MRI-DCE检查的50例(57个病灶)乳腺癌及24例(25个病灶)乳腺良性病变女性患者资料,比较两种方法单独和联合使用时诊断乳腺癌的诊断效能。结果 (1)FFDM、DCE-MRI、FFDM+DCE三种方法诊断乳腺癌的特异度无统计学差异。(2)DCE-MRI诊断乳腺癌的敏感度(85.96%)、阳性预测值(90.74%)、阴性预测值(71.43%)、Yonden’s index(0.66)均较FFDM高,漏诊率(14.04%)低于FFDM(21.05%);但并联二者后诊断乳腺癌的敏感度(96.49%)、阳性预测值(91.67%)、阴性预测值(90.91%)、Yonden’s index(0.76)均高于单独应用FFDM及DCE-MRI,漏诊率(0.51%)明显低于二者单独应用,且差异均有统计学意义(P<0.05)。(3)FFDM+DCE的ROC曲线下面积0.882(P=0.000,95%CI 0.785-0.980)高于DCE 0.830(P=0.000,95%CI0.724-0.935)及FFDM 0.795(P=0.000,95%CI为0.685-0.905)。结论在FFDM初筛的基础上有针对性地联合DCE-MRI检查,可明显提高乳腺疾病诊断效能。Objective To evaluate the application value of full-field digital mammography(FFDM)and dynamic enhanced MRI(DCE-MRI)in the screening of breast cancer.Methods Fifty female patients(57 lesions)with breast cancer and 24 female patients(25 lesions)with benign breast disease confirmed by needle biopsy or pathology from April 2014 to October 2017 were reviewed.All these patients underwent both mammography and dynamic contrast-enhanced MR imaging(DCE-MRI)before operation,and the diagnostic efficacy of FFDM,DCE-MRI or their combination in the diagnosis of breast cancer was compared.Results ①There was no significant difference in the specificity of FFDM,DCE and FFDM combined with DCE in the diagnosis of breast cancer.②The sensitivity of DCE-MRI in the diagnosis of breast cancer was 85.96%,the positive predictive value was 90.74%,the negative predictive value was 71.43%,the Yonden’s index was 0.66,and all of them were higher than that of FFDM.But the rate of missed diagnosis by DCE-MRI was lower than that by FFDM(14.04%vs 21.05%).The diagnostic sensitivity of FFDM combined with DCE for breast cancer(96.49%),positive predictive value(91.67%),negative predictive value(90.91%),and Yonden’s index(0.76)were all higher than those of FFDM or DCE-MRI alone,and the rate of missed diagnosis(0.51%)was significantly lower than that of the two alone(P<0.05).③The area under the ROC curve of FFDM+DCE was 0.882(P=0.000,95%CI 0.785-0.980),higher than that of DCE(0.830,P=0.000,95%CI 0.724-0.935)and FFDM(0.795,P=0.000,95%CI 0.685-0.905).Conclusion FFDM combined with DCE-MRI can significantly improve the diagnostic efficiency for breast diseases.

关 键 词：乳腺癌 筛检 全数字化乳腺X线摄影 磁共振 

分 类 号：R737.9[医药卫生—肿瘤]