回顾性对比分析乳腺X线摄影可疑钙化病变为纤维腺瘤和浸润性乳腺癌的影像学特征  

Retrospective differential diagnosis of suspicious calcification on mammography of breast fibroadenoma and invasive breast cancer

作　　者：丁宁[1] 孔令燕[1] 刘海民[3] 蔡丰[1] 孙强[2] 金征宇[1] DING Ning;KONG Lingyan;LIU Haimin;CAI Feng;SUN Qiang;JIN Zhengyu(Department of Radiology,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Breast Surgery,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Medical Record,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院放射科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院乳腺外科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院病案科,北京100730

出　　处：《肿瘤影像学》2020年第2期73-78,共6页Oncoradiology

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(2017YFC1309100);中国医学科学院中央级公益性科研院所基本科研业务费专项(2018PT32003、2017PT32004)。

摘　　要：目的:研究乳腺X线摄影表现为可疑钙化的纤维腺瘤及乳腺癌不同的影像学特点,探讨其对纤维腺瘤、乳腺癌的鉴别价值。方法:回顾并分析2014年6月-2016年9月术前乳腺X线摄影中出现可疑钙化的患者,纳入其中活检(手术)病理学检查证实为纤维腺瘤、乳腺癌的两组队列,单变量分析考察影像学特征与良恶性的关系,筛选出有意义的影像学征象,进行logistic回归分析建立预测模型,并做受试者工作特征(receiver operating characteristic,ROC)曲线评估影像学特征良恶性鉴别效能。结果:乳腺癌组钙化合并肿块的比例较纤维腺瘤组更高,肿块边界不清的特点更加明显。另外乳腺癌组多形性钙化明显多于纤维腺瘤组。经logistic回归分析,肿块边界清晰-不清程度是乳腺癌的显著预测因子(OR=2.84,95%CI:1.35~5.97,P=0.006)。根据logistic回归模型的预测概率建立ROC曲线,曲线下面积(area under curve,AUC)为0.742±0.073(P=0.005,95%CI:0.599~0.885)。结论:对于乳腺X线摄影可疑钙化,是否合并肿块、合并的肿块边界特征、是否出现细小多形性钙化对鉴别纤维腺瘤和乳腺癌诊断价值较高。Objective:To investigate the different imaging features of mammography with suspicious calcification of fibroadenoma and breast cancer,and to explore its value in the identification of fibroadenoma and breast cancer.Methods:Patients with suspicious calcification during preoperative mammography from Jun.2014 to Sep.2016 with biopsy or surgical pathology confirmed fibroadenomas and breast cancer were retrospectively included.Using univariate analysis to investigate the relationship between image characteristics and pathology results,screen out meaningful imaging features to perform logistic regression analysis and to build prediction model,and draw receiver operating characteristic(ROC)curve to evaluate the effectiveness of image characteristics.Results:The proportion of calcification and masses in breast cancer group was higher than that in fibroid adenoma group,and the features of unclear mass boundaries were more obvious.In addition,polymorphic calcification was significantly more in breast cancer group than in fibroid adenoma group.Logistic regression analysis showed that the clear-unclear mass boundary was a significant predictor for breast cancer(OR=2.84,95%CI:1.35-5.97,P=0.006).The ROC curve was established based on the predicted probability of the logistic regression model.The area under curve(AUC)was 0.742±0.073(P=0.005,95%CI:0.599-0.885).Conclusion:For suspected calcification of mammography,the appearance of mass,the boundary features of the combined mass,and whether there are small polymorphic calcifications are of high value for the differential diagnostis of fibroadenoma calcification and breast cancer.

关 键 词：乳腺X线摄影 钙化 纤维腺瘤 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤] R445.4[医药卫生—临床医学]