对比增强乳腺X线摄影术前测量乳腺癌肿块大小能力研究  

Study on the ability of preoperative measurement of the size of breast cancer mass by contrast-enhanced digital mammography

作　　者：钱春红 高毅 王奇峰 沈茜刚 李瑞敏 汤伟 QIAN Chunhong;GAO Yi;WANG Qifeng;SHEN Xigang;LI Ruimin;TANG Wei(Department of Diagnostic Radiology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Ultrasound,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Pathology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Radiology,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215028,Jiangsu Province,China)

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学附属肿瘤医院超声科,复旦大学上海医学院肿瘤学系,上海200032 [3]复旦大学附属肿瘤医院病理科,复旦大学上海医学院肿瘤学系,上海200032 [4]上海交通大学医学院附属苏州九龙医院放射科,江苏苏州215028

出　　处：《肿瘤影像学》2021年第3期155-161,共7页Oncoradiology

基　　金：中国科技部国家重点研发计划“数字诊疗装备研发”重点专项(2017YFC0109403)。

摘　　要：目的:对比传统影像学检查方法与对比增强乳腺X线摄影(contrast-enhanced digital mammography,CEDM)术前测量乳腺癌肿块大小的能力。方法:回顾并研究经病理学检查证实为乳腺癌的105例患者的临床资料,所有患者均行全数字化乳腺X线摄影(full-field digital mammography,FFDM)、超声、磁共振成像(magnetic resonance imaging,MRI)及CEDM检查。由3名经验丰富的放射科医师和1名超声科医师分别测量目标肿块最大径,利用方差分析比较上述检查方法与术后大体标本测量值之间的差异;利用Pearson相关系数分析上述方法所获结果与病理学测量值之间的一致性,同时采用配对t检验评价CEDM术前评估肿块大小的效能。结果:105例患者共发现118枚肿块,对照纳入、排除标准排除15枚肿块,最后纳入103枚可测量的肿块进行研究。CEDM、MRI所测肿瘤最大径与病理学大体标本测量结果相比,差异无统计学意义(P>0.05),而超声、FFDM与病理学大体标本测量值相比,差异有统计学意义(超声:t=3.68,P=0.000 9;FFDM:t=2.76,P=0.010 5)。CEDM、MRI测量值与病理学大体标本测量结果的相关性明显高于超声和FFDM,各诊断方式的测量结果分别为r=0.89(CEDM),r=0.86(MRI),r=0.68(FFDM),r=0.71(超声)。结论:CEDM对乳腺癌肿块大小评估效能明显优于超声和FFDM,与MRI相似;CEDM技术在乳腺癌术前分期中应用前景可期。Objective: To compare the effcacy of contrast-enhanced digital mammography(CEDM) with conventional imaging methods in assessing the size of breast cancer mass before surgery. Methods: A total of 105 breast cancer patients confirmed by pathology were collected in this study. All patients underwent full-field digital mammography(FFDM), ultrasound, magnetic resonance imaging(MRI) and CEDM. Three experienced radiologists and one sonographer respectively measured the longest diameter of the target mass, and compared the difference between the above inspection methods and the postoperative gross specimen measurement value by analysis of variance;Pearson correlation coeffcient was used to analyze the agreement between the results obtained by the above methods and the pathological measurement values, and the paired t test was used to evaluate the effcacy of CEDM in evaluating the size of the tumor before surgery. Results: A total of 118 masses were found in 105 patients, while 15 masses were excluded for the patients received operation after adjuvant chemotherapy. Finally, 103 masses with measurable tumor size were included for further research. There was no significantly difference between the maximum tumor size measured by CEDM, MRI and gross specimen group(both P>0.05), while there was remarkable difference between the gross specimen group and FFDM(t=2.76,P=0.010 5), or the ultrasound(t=3.68, P=0.000 9) group. The coeffcient of correlation with pathological data of CEDM(r=0.89)and MRI(r=0.86) were significantly higher than those of ultrasound(r=0.71) and FFDM(r=0.68). Conclusion: CEDM and MRI are superior to FFDM and ultrasound in the preoperative assessment of breast tumor size. As a new mammography technology, CEDM has good clinical application prospect in preoperative staging of breast cancer.

关 键 词：乳腺癌 全数字化乳腺X线摄影 磁共振成像 对比增强乳腺X线摄影 超声 

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