超声和钼靶及MRI对三阴性乳腺癌的诊断价值  

Values of ultrasound, mammography and MRI to the diagnosis of triple negative breast cancer

作　　者：王璇 李珺[1] 赵海东[1] WANG Xuan;LI Jun;ZHAO Haidong(Department of Breast Surgery,the Second Hospital of Dalian Medical University,Dalian 116027,China)

机构地区：[1]大连医科大学附属第二医院乳腺外科,辽宁大连116027

出　　处：《中华实用诊断与治疗杂志》2020年第8期773-777,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：大连市科技创新基金项目(2018J13SN096)。

摘　　要：目的探讨超声、钼靶、动态增强MRI及三者联合检查诊断三阴性乳腺癌的价值。方法乳腺癌患者274例,根据术后免疫组织化学结果分为三阴性组32例和非三阴性组242例,其中非三阴性组再分为Luminal A亚组61例,Luminal B亚组124例,HER-2过表达组57例。均行超声、钼靶及动态增强MRI检查,采用多因素logistic回归分析超声、钼靶及动态增强MRI影像特征诊断三阴性乳腺癌的影响因素,并建立联合诊断回归方程;以组织病理学检查为金标准,比较动态增强MRI不均匀强化、超声形态规整和钼靶边界清晰诊断三阴性乳腺癌的灵敏度、特异度和准确率;绘制ROC曲线,评估联合诊断回归方程诊断三阴性乳腺癌的效能。结果三阴性组超声形态规整、边界清晰、后方声影增强、血流分级(Ⅱ~Ⅲ级)比率,钼靶形态规整、边界清晰比率,动态增强MRI形态规整、边界清晰、环形强化、T2加权像中央区强化和边缘强化比率均高于非三阴性组及其3个亚组(P<0.05),钼靶微钙化比率和动态增强MRI不均匀强化比率低于非三阴性组及其3个亚组(P<0.05)。非三阴性乳腺癌各亚组超声形态规整比率,钼靶形态规整、边界清晰、不对称致密影、腺体结构紊乱和微钙化比率,动态增强MRI不均匀强化和环形强化比率比较差异有统计学意义(P<0.05)。超声形态规整(OR=153.395,95%CI:2.080~11 314.618,P=0.022)、钼靶边界清晰(OR=434.504,95%CI:2.555~73 891.629,P=0.020)及动态增强MRI不均匀强化(OR<0.001,95%CI:<0.001~0.787,P=0.045)是诊断三阴性乳腺癌的独立影响因素。动态增强MRI不均匀强化诊断三阴性乳腺癌的灵敏度(85.1%)高于超声形态规整(65.6%)和钼靶边界清晰(84.3%)(P<0.05),特异度(93.8%)和准确率(86.1%)与超声形态规整(86.4%、83.9%)和钼靶边界清晰(78.5%、79.2%)比较差异无统计学意义(P>0.05);超声形态规整诊断三阴性乳腺癌的灵敏度、特异度和准确率与钼靶边界�Objective To investigate the values of ultrasound, mammography and dynamic contrast-enhanced MRI(DCE-MRI) to the diagnosis of triple negative breast cancer. Methods A total of 274 patients were divided into triple negative group(n=32) and non-triple negative group(n=242) according to the immunohistochemical results, and non-triple negative group was redivided into luminal A subgroup(n=61), luminal B subgroup(n=124) and HER-2 overexpression subgroup(n=57). All patients received ultrasound, mammography and DCE-MRI. Multivariate logistic regression analysis was used to assess the influencing factors of ultrasound, mammography and DCE-MRI for the diagnosis of triple negative breast cancer, and the combined diagnosis regression equation was established. The histopathological result was used as the gold standard to compare the sensitivities, specificities and accuracies of DCE-MRI inhomogeneous enhancement, ultrasound regular shape and mammography clear boundary on the diagnosis of triple negative breast cancer. ROC was drawn to evaluate the efficacy of the combined diagnosis equation. Results The percentages of regular shape and clear boundary of ultrasound, mammography and DCR-MRI, the rear acoustic shadows enhancement and blood flow grade Ⅱ-Ⅲ of ultrasound, as well as the ring-like enhancement and central and edge enhancement in T2 of DCE-MRI were higher in triple negative group than those in non-triple negative group and three subgroups(P<0.05),while the percentages of microcalcification of mammography and inhomogeneous enhancement of DCE-MRI were lower in triple negative group than those in non-triple negative group and three subgroups(P<0.05).There were significant differences in the percentages of ultrasound regular shape,mammography regular shape,clear boundary,asymmetric dense shadow,mammary gland structure turbulence and microcalcifications,as well as DCE-MRI inhomogeneous enhancement and ring-like enhancement in non-triple negative group(P<0.05).Ultrasound regular shape(OR=153.395,95%CI:2.080-11 314.618,

关 键 词：乳腺癌 三阴性 超声 钼靶 动态增强MRI 

分 类 号：R737.9[医药卫生—肿瘤] R445[医药卫生—临床医学]