无定形钙化良恶性判断的影响因素  

Factors affecting the diagnostic performance of suspicious amorphous calcification

作　　者：王慧 王思奇[1] 娄鉴娟 邹启桂 王守巨 WANG Hui;WANG Siqi;LOU Jianjuan;ZOU Qigui;WANG Shouju(Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China;Department of Radiology,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210000,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210000 [2]南京中医药大学附属南京中医院放射科,江苏南京210000

出　　处：《分子影像学杂志》2023年第3期381-388,共8页Journal of Molecular Imaging

基　　金：国家自然科学基金优秀青年科学基金项目(82022034);江苏省自然科学基金杰出青年基金项目(BK20200032)。

摘　　要：目的探讨影响可疑无定形钙化诊断正确性的因素,并通过定量分析评估各影响因素的诊断性能。方法回顾性研究2019年6月1日~2021年6月1日进行乳腺X线检查的118例患者(120个病灶),患者均为女性,年龄46.7±9.7岁,中位年龄46岁。由2位工作10年以上从事乳腺影像诊断的医师对所有病例进行双盲诊断,入组病例依照2013年第5版乳腺影像报告和数据系统(BI-RADS)作为诊断标准进行描述分类,以病理结果为金标准,通过诊断试验评价指标及ROC曲线分析确定各种影响因素对可疑无定形钙化良恶性结果判断的诊断性能。结果乳腺动态增强磁共振(DCE-MRI)对可疑无定形钙化敏感性、特异性、阳性预测值和阴性预测值分别为100%、71.4%、71.4%、100%,曲线下面积为0.857(95%CI:0.782~0.914)。DCE-MRI检出了所有的恶性病变,点状强化病例在DCE-MRI显示的3种强化类型中诊断特异性最高,为94.4%,曲线下面积最大,为0.972(95%CI:0.785~1.000,P<0.05)。在全体入组病例中,可疑无定形钙化恶性率为41.7%;而在无伴随征象的纯钙化组中,可疑无定形钙化的恶性率则降为24%。在钙化分布类型中,集群及区域分布的可疑无定形钙化恶性率在BI-RADS 4B等级,曲线下面积分别为0.895(95%CI:0.798~0.955)、0.815(95%CI:0.650~0.924),区域分布病例的恶性率最低为25%,在其中的纯钙化组中,恶性率则降至8%。结论乳腺DCE-MRI具有高敏感度,检测出所有的恶性病灶,其中点状强化病灶诊断特异性最高。在影响可疑无定形钙化诊断的诸多因素中,纯钙化组比有伴随征象组诊断特异性明显提高,对可疑无定形钙化良恶性的判断有很大的价值。钙化分布中,区域分布的纯钙化组恶性率最低,可以选择定期临床随访,从而避免一些不必要的活检或手术。Objective To explore the factors that affect the accuracy of diagnosis of suspicious amorphous calcification and explore while the diagnostic performance of each factor is quantitatively evaluated.Methods A retrospective study was conducted on a selected group of 118 patients(120 lesions),who underwent mammography from June 1,2019 to June 1,2021.All patients were female,with an average age of 46.7±9.7 years old and a median age of 46 years old.A double-blind diagnosis of all cases was performed by two doctors who engaged in breast imaging diagnosis for more than 10 years.The patients were described and classified according to the 5th edition of breast imaging reporting and diagnostic system(BI-RADS)in 2013 as diagnostic criteria,while the pathological findings were chosen as the gold standard.The evaluation indexes of diagnostic tests and ROC curves were used to analyze and determine the diagnostic performance of each affecting factor on the benign and malignant results of suspicious amorphous calcification.Results The sensitivity,the specificity,the positive predictive value and the negative predictive value of breast dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for suspicious amorphous calcification were 100%,71.4%,71.4%and 100%respectively.The area under curve was 0.857(95%CI:0.782-0.914).All the malignant lesions were correctly diagnosed.The diagnostic specificity of the focus and foci enhancement cases was 94.4%and the area under curve was 0.972(95%CI:0.785-1.000,P<0.05),that were both largest among the three types of enhancement demonstrated by DCE-MRI.The malignancy rate of suspicious amorphous calcification was 41.7%in all patients,but decreased to 24%in the pure calcification group without associated features.When considering the four kinds of calcification distribution types,only the malignancy rate of suspicious amorphous calcification with grouped and regional distribution was in BI-RADS 4B,and the area under curve of them were 0.895(95%CI:0.798-0.955)and 0.815(95%CI:0.650-0.924),resp

关 键 词：乳腺 动态增强磁共振 无定形钙化 受试者工作特征曲线 特异性 

分 类 号：R737.9[医药卫生—肿瘤]