对比增强X线摄影对乳腺可疑病变的诊断价值  

Diagnostic performance of contrast-enhanced spectral mammography in suspected breast lesions based on histological results

作　　者：文婵娟[1] 徐维敏[1] 曾辉[1] 何子龙[1] 吴杰芳[1] 徐泽园 汪思娜 秦耿耿[1] 陈卫国[1] Wen Chanjuan;Xu Weimin;Zeng Hui;He Zilong;Wu Jiefang;Xu Zeyuan;Wang Sina;Qin Genggeng;Chen Weiguo(Department of Radiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院放射科,广州510515

出　　处：《中华放射学杂志》2019年第9期737-741,共5页Chinese Journal of Radiology

基　　金：南方医科大学临床研究启动计划(LC2016ZD018);南方医院院长基金(2016C042);南方医科大学创新培育项目(PY2018N034);广东省自然科学基金(2018A0303130215).

摘　　要：目的探讨对比增强X线摄影(CESM)对可疑乳腺病变的诊断价值.方法前瞻性纳入南方医科大学南方医院2017年12月至2018年7月临床或筛查发现乳腺可疑病变,最终经病理活检或手术病理确诊的97例患者.均行全视野数字乳腺X线摄影(FFDM)+数字乳腺断层摄影(DBT)检查,并在此基础上行标准头尾位及内外斜位CESM检查.对影像图像进行分析,观察病变可见性、病变特征、强化类型、强化程度及乳腺影像报告和数据系统(BI-RADS)分类等.以病理结果为金标准,采用ROC对比结合CESM和不结合CESM两种方法的诊断效能.结果 97例患者共检出120个病灶,恶性病灶89个,包括81个浸润性癌和8个导管原位癌;良性病变31个.120个病灶中,CESM表现为无强化2个,轻度强化22个,中度强化15个,高度强化81个.肿块型强化96个,其中环形强化12个;非肿块型强化22个.结合CESM和不结合CESM两种方法基于BI-RADS恶性可能性积分的ROC下面积分别为0.923、0.900,差异有统计学意义(P<0.01).以BI-RADS 4b类及以上为阳性时,两种方法的敏感度分别为91.0%、80.9%,特异度分别为87.1%、93.5%.相对于FFDM和DBT,CESM能发现更多的乳腺癌病灶.结论 CESM诊断效能优于FFDM+DBT,对于可疑病变,行CESM检查可以提高乳腺癌诊断的准确性.Objective To assess the diagnostic performance of contrast-enhanced spectral mammography (CESM) in suspected breast lesions. Methods A total of 97 patients with suspected breast cancer identified by clinical examination or screening underwent two-views CESM examination on the basis of digital breast tomosynthesis (DBT) combined with full-field digital mammography (FFDM), and they were finally confirmed by biopsy or pathology. Three senior radiologists analyzed images, including lesion visibility, lesion characteristics, enhancement type, degree of enhancement, BIRDS classification, etc. Finally, based on the pathology, we compared the CESM+DBT+FFDM and DBT+FFDM two models according to sensitivity, specificity and ROC for diagnostic performance. Results There were a total of 120 lesions. Eighty-nine lesions were malignant, 31 benign;CESM was not enhanced in 2 cases, mild enhancement was performed in 22 cases, moderately intensive in 15 cases, highly intensive in 81 cases, and 2 cases were not enhanced;mass-enhanced in 96 cases, including ring-enhanced in 12 cases, 22 cases of non-mass type. The sensitivities of the combination of CESM and not combination of CESM were 91.0% and 80.9%, respectively, and the specificities were 93.5% and 87.1%, respectively. The area under the ROC curve of combination of CESM was higher than the without combination of CESM (0.923 and 0.900, P<0.05), The difference was statistically significant. Conclusion For suspicious lesions, CESM examination can improve the diagnosis accuracy of breast cancer.

关 键 词：乳腺肿瘤 对比增强X线摄影 数字乳腺断层摄影 对比研究 

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