MRI、乳腺X线摄影和超声对乳腺导管原位癌检出的效能  

A retrospective comparison of MRI,ultrasound and X-ray mammography in detecting breast ductal carcinoma in situ

作　　者：李玉欣 王嬴煊 程流泉[1] 郑一琼[2] 刘梅[3] 王知力[4] 李席如[2] 王建东[2] 李梦露[1] Li Yuxin;Wang Yingxuan;Cheng Liuquan;Zheng Yiqiong;Liu Mei;Wang Zhili;Li Xiru;Wang Jiandong;Li Menglu(Department of Radiology,PLA General Hospital,Beijing 100853,China;Department of General Surgery,PLA General Hospital,Beijing 100853,China;Department of Pathology,PLA General Hospital,Beijing 100853,China;Department of Ultrasound,PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院放射科,北京100853 [2]解放军总医院普通外科,北京100853 [3]解放军总医院病理科,北京100853 [4]解放军总医院超声科,北京100853 [5]长沙市第一医院放射科,410000 [6]北京水利医院放射科,100038

出　　处：《中华放射学杂志》2020年第6期557-562,共6页Chinese Journal of Radiology

摘　　要：目的探讨乳腺X线摄影(XMG)、超声(US)和MRI在导管原位癌(DCIS)检出与定性诊断的效能和差异。方法回顾性分析2011年1月至2017年12月解放军总医院经手术病理证实为DCIS,术前行US和(或)XMG和(或)MRI检查的241例女性乳腺DCIS连续患者。189例接受US检查,61例接受XMG检查,159例接受MRI检查,其中32例同时进行了US、XMG和MRI 3种检查。所有病灶均进行乳腺影像报告和数据系统(BI-RADS)分类,计算灵敏度和假阴性率,并评价诊断效能,采用χ²检验进行比较。分析影响3种检查方法灵敏度的相关因素。结果XMG、US和MRI的诊断灵敏度分别为65.9%(29/44)、71.6%(101/141)和91.2%(145/159),差异有统计学意义(χ²=24.034,P<0.001)。XMG受腺体组织类型及病变特点影响易低估或漏诊,而对非肿块型病变的不敏感是US低估或漏诊的主要原因;MRI低估患者14例中,5例由XMG和(或)US诊断为BI-RADS 4类及以上,低估主要原因是DCIS伴发腺瘤等良性病变。结论MRI诊断DCIS灵敏度高于XMG和US,假阴性漏诊少,XMG和US的假阴性率不可忽视。Objective To compare the efficacies of MRI,X-ray mammography(XMG)and Ultrasound(US)in detecting and diagnosing breast ductal carcinoma in situ(DCIS).Methods Two hundred and forty one consecutive patients with pathology-confirmed DCIS were retrospectively recruited from January 2011 to December 2017 in PLA General Hospital.The imaging examination modalities included MRI and/or XMG and/or US.The breast imaging reporting and data system(BI-RADS)categorizations by MRI,XMG and US were compared and their sensitivities of detecting DCIS were calculated.The causes of underestimation on MRI were interpreted with the information of XMG and US.Chi-square test was used to compare the differences.Results The diagnostic sensitivity of XMG,US and MRI was 65.9%(29/44),71.6%(101/141)and 91.2%(145/159),respectively,with statistical significant differences(χ²=24.034,P<0.001).Breast density and lesion type would influence the sensitivity of XMG.And the sensitivity of US was decreased because of non-mass lesion.Of the 14 cases under-evaluated as BI-RADS category 1 to 3 on MRI,5 were corrected by XMG and/or US to BI-RADS category 4.The cause of underestimation on MRI was the coexistence of DCIS with adenoma or other benign lesion.Conclusion The retrospective comparison of MRI,XMG and US in this study showed that MRI had significant higher sensitivity in detecting breast DCIS,while the false negative rates of XMG and US were un-negligible.

关 键 词：乳腺肿瘤 磁共振成像 乳房X线摄影术 超声检查 

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