超声及数字乳腺断层摄影对乳腺囊实性肿块的诊断价值  

Diagnostic value of ultrasound and digital breast tomosynthesis in breast complex cystic and solid mass

作　　者：徐美红 文婵娟[1] 曾辉[1] 潘德润 曾兆东 陈卫国[1] XU Meihong;WEN Chanjuan;ZENG Hui;PAN Derun;ZENG Zhaodong;CHEN Weiguo(Department of Radiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院放射科,广东广州510515

出　　处：《分子影像学杂志》2023年第3期398-406,共9页Journal of Molecular Imaging

基　　金：国家自然科学基金(82171929);广东省自然科学基金(2019A1515011168);吴阶平医学基金会临床科研专项资助基金(320.6750.2021-06-36)。

摘　　要：目的分析乳腺囊实性肿块声像图及数字乳腺断层摄影(DBT)图像特征,探讨超声(US)及DBT及二者联合对乳腺囊实性肿块良恶性判别的诊断价值。方法回顾性分析乳腺囊实性肿块251例患者共257个肿块。根据超声声像图特征将肿块分为4型,计算各型阳性预测值。分析声像图特征、DBT图像特征与恶性的相关性;以病理结果为金标准,比较US、DBT及US+DBT的诊断效能。结果乳腺囊实性肿块恶性率为30.4%。Ⅰ~Ⅳ型囊实性肿块阳性预测值分别为0、22.2%、19.3%和38.0%,差异有统计学意义(P<0.001)。年龄及US特征中的肿块大小、分型、形态、生长方式、边缘、钙化、肿块内血流、异常腋窝淋巴结以及DBT特征中的肿块大小、形态、边缘、密度、钙化、小梁结构、腺体分型差异有统计学意义(P<0.05)。US、DBT、US+DBT的AUC值分别为0.806、0.880、0.903。US与DBT、US+DBT的AUC值对比,差异均有统计学意义(P<0.05),US+DBT与DBT的AUC值对比,差异无统计学意义(P>0.05)。结论DBT对乳腺囊实性肿块良恶性判别的诊断效能优于US,两者联合可明显提高诊断的准确性,增加诊断的敏感度和特异性。Objective To analyze the ultrasonographic and DBT features of breast complex cystic and solid mass,and to explore the diagnostic value of ultrasound(US),digital breast tomosynthesis(DBT)and their combination in differentiating benign and malignant breast complex cystic and solid mass.Methods A total of 257 masses in 251 patients with breast complex cystic and solid mass were analyzed retrospectively.According to the sonographic features,the masses were divided into 4 types,and the positive predictive values of each type were calculated.The correlation between the features of sonogram,DBT and malignancy was analyzed.The diagnostic efficacy of US,DBT and US+DBT was compared according to the pathological results as the gold standard.Results The malignant rate of breast complex cystic and solid mass was 30.4%.The positive predictive values of I-IV type complex cystic and solid mass were 0,22.2%,19.3%and 38.0%,respectively(P<0.001).There were significant differences in age,tumor size,classification,morphology,growth mode,margin,calcification,blood flow in the tumor,abnormal ALN in ultrasonic characteristics,and tumor size,morphology,margin,density,calcification,trabecular structure and gland classification in DBT characteristics(P<0.05).The AUC values for US,DBT and US+DBT were 0.806,0.880 and 0.903,respectively.There was significant difference in AUC between US and DBT,US+DBT(P<0.05),but there was no significant difference in AUC between US+DBT and DBT(P<0.05).Conclusion The diagnostic efficacy of DBT in differentiating benign and malignant breast complex cystic and solid mass is better than that of US.The combination of DBT and US can significantly improve the diagnostic accuracy,sensitivity and specificity.

关 键 词：乳腺 囊实性肿块 超声 数字乳腺断层摄影 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]