乳腺MRI在病理性乳头溢液诊断中的价值  

Value of magnetic resonance imaging in diagnosis of pathological nipple discharge

作　　者：杨阳[1] 王殊[1] 佟富中[1] 刘宏军[1] 杨后圃[1] 王思源[1] 刘淼[1] Yang Yang;Wang Shu;Tong Fuzhong;Liu Hongjun;Yang Houpu;Wang Siyuan;Liu Miao(Breast Disease Center,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院乳腺外科,100044

出　　处：《中华普通外科杂志》2021年第8期575-578,共4页Chinese Journal of General Surgery

基　　金：国家重点研发计划资助(2016YFC0901302)。

摘　　要：目的评价乳腺MRI在病理性乳头溢液诊断中的价值。方法回顾性分析2010年10月—2020年10月因乳头溢液就诊于北京大学人民医院并且行乳腺MRI检查和手术治疗的184例患者,结合临床特征、超声和钼靶检查及病理结果,分析MRI对病理性溢液疾病诊断的灵敏度、特异度、阳性预测值及阴性预测值。结果本组184例患者中术后病理证实乳腺癌43例(23.4%),导管内乳头状瘤96例(52.2%),其他良性病45例(24.5%)。MRI对导管内病变诊断的灵敏度为76.8%,特异度为52.2%,阳性预测值为82.8%,阴性预测值为42.9%;对病理性乳头溢液恶性疾病评估诊断的灵敏度为97.7%,特异度为41.1%,阳性预测值为33.6%,阴性预测值为98.3%。在43例乳腺癌中,有10例(23.3%)是超声和钼靶检查均为阴性的隐匿乳腺癌,通过MRI获得确诊。MRI对隐匿性恶性肿瘤的灵敏度为81.8%,特异度为53.7%,阳性预测值24.4%,阴性预测值97.3%。结论乳腺MRI在病理性溢液诊断中具有灵敏度高和阴性预测值高的优势,特别是对于乳腺超声和钼靶阴性的隐匿型乳腺癌患者,MRI是一种有价值的诊断工具。Objective To explore the diagnostic value of magnetic resonance imaging(MRI)for patients with pathologic nipple discharge.Methods A retrospective analysis was made on patients with nipple discharge who underwent breast MRI and surgical excision between Oct 2010 to Oct 2020.Sensitivity,specificity,positive predictive value,and negative predictive value of MRI were calculated.Results A total of 184 patients fulfilled our selection criteria,including breast cancer in 43 cases(23.4%),intraductal papilloma in 96 cases(52.2%)and other benign diseases in 45 cases(24.5%).The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of MRI for intraductal lesions of pathologic nipple discharge were respectively 76.8%,52.2%,82.8%and 42.9%.The sensitivity,specificity,PPV and NPV of MRI for pathologic malignant nipple discharge were respectively 97.7%,41.1%,33.6%and 98.3%.Among the 43 cases of breast cancer,10 cases(23.3%)were occult malignancy with negative ultrasound and mammography and malignant lesions were detected by MRI.The sensitivity,specificity,PPV and NPV of MRI for occult malignancy were 81.8%,53.7%,24.4%,and 97.3%.Conclusion MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge,especially when conventional imaging is negative.

关 键 词：乳腺肿瘤 磁共振波谱学 病理性乳头溢液 诊断 

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