病理性乳头溢液:乳腺导管造影与MRI的对比研究  

Pathological nipple discharge:A comparative study of galactography and MRI

作　　者：申霞 莫荣广 周志琴 蒋国元 SHEN Xia;MO Rongguang;ZHOU Zhiqin;JIANG Guoyuan(Breast Thyroid Center,the First People's Hospital of Zunyi,Guizhou Province(the Third Affiliated Hospital of Zunyi Medical University),Zunyi 563000,China)

机构地区：[1]贵州省遵义市第一人民医院(遵义医科大学第三附属医院)乳腺甲状腺中心,遵义563000

出　　处：《磁共振成像》2023年第6期75-81,共7页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的 比较乳腺导管造影(galactography, GL)与MRI对病理性乳头溢液(pathological nipple discharge, PND)患者的诊断价值以及对良、恶性病变的鉴别诊断价值。材料与方法 回顾性分析45例48个有乳头溢液的患乳,溢液性质为血性25个、黄色或淡黄色10个、浆液性7个、水样4个、褐色2个。所有病例均进行了GL和乳腺MRI,以病理结果为金标准,分别以包括乳腺癌、导管乳头状瘤、不典型增生为阳性发现时,以乳腺影像报告和数据系统(Breast Imaging Reporting and Data System, BI-RADS)4~5类定为阳性发现时,以BI-RADS 5类定为阳性发现时,比较两种检查技术对PND诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度。结果 45例48个患乳,病理结果显示恶性病变7个,均为单侧,包括浸润性导管癌2个,导管原位癌并微浸润5个;良性病变41个;GL对PND(乳腺癌、导管乳头状瘤、不典型增生)诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为97.05%、28.57%、76.74%、80.00%、77.08%,MRI分别为91.17%、50.00%、81.57%、70.00%、79.16%;以BI-RADS 4~5类定为阳性发现时,GL诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为100.00%、12.19%、16.27%、100.00%、25.00%,MRI分别为100.00%、24.39%、18.42%、100.00%、35.41%;以BI-RADAS 5类定为阳性发现时,GL诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为42.85%、97.56%、75.00%、90.90%、89.58%,MRI分别为85.71%、95.12%、75.00%、97.50%、93.75%;总体间率的比较采用χ2检验,二者之间差异均没有统计学意义(P>0.05);但针对乳腺癌MRI敏感度(85.71%)明显高于GL(42.85%),其准确度分别为93.75%和89.58%。结论 GL与MRI对PND诊断均有较高的准确度,MRI对乳腺癌的评估优于GL。Objective:To compare the diagnostic value of galactography(GL)and MRI in patients with pathological nipple discharge(PND)and differential for benign and malignant lesions.Materials and Methods:Forty-eight breasts with nipple discharge in 45 cases were analyzed retrospectively.The discharge was bloody in 25 cases,yellow or yellowish in 10 cases,serous in 7 cases,watery in 4 cases,brown in 2 cases.GL and MRI were performed in all cases,and pathological findings were used as the gold standard.When breast cancer,ductal papilloma and atypical hyperplasia,Breast Imaging Reporting and Data System(BI-RADS)4-5,BI-RADS 5 were selected as positive findings,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the two diagnostic techniques for PND were compared.Results:There were 48 breast lesions in 45 cases.The pathological results showed that there were 7 cases of malignant lesions,all of which were unilateral,including 2 cases of invasive ductal carcinoma,5 cases of ductal carcinoma in situ with microinvasion and 41 cases of benign lesions.GL for the accury diagnosis of PND(breast cancer,ductal papilloma,dysplasia),sensitivity,specificity,positive predictive value,negative predictive value was 97.05%,28.57%,76.74%,80.00%and 77.08%;MRI were 91.17%,50.00%,81.57%,70.00%and 79.16%.When BI-RADS category 4-5 was designated as a positive finding,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of GL diagnosis were 100.00%,12.19%,16.27%,100.00%,25.00%;MRI was 100.00%,24.39%,18.42%,100.00%,35.41%.When BI-RADS category 5 was designated as a positive finding,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of GL diagnosis were 42.85%,97.56%,75.00%,90.90%,89.58%;MRI was 85.71%,95.12%,75.00%,97.50%,93.75%.Theχ^(2) test was used for the comparison of rates between populations,and the difference between the two was not statistically significant(P>0.05).However,the sensitivity of MRI for breast cancer(85.71%

关 键 词：病理性乳头溢液 乳腺癌 鉴别诊断 乳腺导管造影 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R655.8[医药卫生—诊断学]