对比增强能谱乳腺X线摄影增强相对信号值对乳腺癌的诊断价值  

Contrast-Enhanced Spectral Mammography Enhanced Relative Signal Value in the Diagnosis of Breast Cancer

作　　者：李鸿恩 王霞[1] 张丽[1] 曾益辉 江魁明[1] 张嫣[1] LI Hongen;WANG Xia;ZHANG Li;ZENG Yihui;JIANG Kuiming;ZHANG Yan(Department of Radiology,Guangdong Province Hospital for Women and Children Healthcare,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院放射科,广东广州511400

出　　处：《中国医学影像学杂志》2023年第10期1043-1048,共6页Chinese Journal of Medical Imaging

基　　金：广州市科技计划项目基金(202002030217)。

摘　　要：目的探讨对比增强能谱乳腺X线摄影(CESM)增强相对信号值在乳腺癌诊断中的价值。资料与方法回顾性分析2019年4月—2020年10月于广东省妇幼保健院行CESM检查临床疑诊乳腺肿瘤103例患者资料,分析CESM的诊断效能,并采用受试者工作特征曲线进行分析。测量患者CESM剪影图像病灶中心(A1)、病灶边缘(A2)和病灶同侧正常腺体区(A3)的平均信号值,计算病灶中心及边缘增强相对信号值,以手术或组织活检病理结果为“金标准”,分析不同疾病CESM增强相对信号值特点。结果103例患者中,病理确诊44例乳腺癌及59例良性病灶。CESM诊断乳腺癌的敏感度为93.18%,特异度为84.75%,准确度为88.35%,阳性预测值为82.00%,阴性预测值为94.34%。CESM诊断乳腺疾病曲线下面积为0.890。增强相对信号值与病理诊断的关系:32例浸润性癌、6例导管原位癌、29例纤维腺瘤或纤维腺瘤伴腺病、11例腺病或腺病伴囊肿、11例乳头状瘤样增生的A1区域增强相对信号值分别为0.0443(0.0242,0.0813)、0.0382(0.0147,0.0498)、0.0125(0.0020,0.0253)、0.0025(0.0015,0.0145)、0.0030(0.0000,0.0284),A2区域增强相对信号值分别为0.0262(0.0170,0.0444)、0.0279(0.0121,0.0404)、0.0085(0.0013,0.0125)、0.0010(0.0005,0.0020)、0.0020(0.0005,0.0115)。乳腺癌A1区域增强相对信号值0.0477(0.0274,0.0717)高于良性病灶组0.0070(0.0015,0.0284),差异有统计学意义(Z=-5.394,P<0.001);乳腺癌A2区域增强相对信号值0.0262(0.0159,0.0444)高于良性病灶组0.0030(0.0005,0.0130),差异有统计学意义(Z=-5.401,P<0.001)。结论采用CESM检查增强相对信号值对乳腺病变进行定量分析,乳腺癌病灶中心及边缘增强相对信号值明显高于良性病灶,不同增强相对信号值对术前准确评估乳腺癌具有重要意义。Purpose To investigate the value of contrast-enhanced spectral mammography(CESM)enhanced relative signal value in the diagnosis of breast cancer.Materials and Methods The data of 103 patients with clinically suspicious breast tumors who admitted to Guangdong Province Hospital for Women and Children Health care from April 2019 to October 2020 were retrospectively analyzed,CESM was performed,and the diagnostic efficacy and receiver operating characteristic curve analysis of CESM were also analyzed.The average signal value of the lesion center(A1),lesion edge(A2),and normal gland area(A3)on the same side of the lesion in the CESM silhouette image of the patients were measured,and the relative signal value of the center and edge enhancement of the lesion were calculated.Taking the pathological results of surgery or tissue biopsy as the gold standard,the relative signal value characteristics of CESM enhancement in different diseases were analyzed.Results Among the 103 patients,44 cases of breast cancer and 59 cases of benign lesions were confirmed by pathology.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CESM in the diagnosis of breast cancer were 93.18%,84.75%,88.35%,82.00%and 94.34%.The area under the curve of breast disease diagnosed by CESM was 0.890.Enhanced correlation between relative signal value and pathological diagnosis:in 32 cases of invasive carcinoma,6 cases of ductal carcinoma in situ,29 cases of fibladenoma or fibladenoma with adenosis,11 cases of adenosis or adenosis with cyst,and 11 cases of papillomatoid hyperplasia,the enhanced relative signal values of A1 region were 0.0443(0.0242,0.0813)and 0.0382(0.0147,0.0498),0.0125(0.0020,0.0253),0.0025(0.0015,0.0145),0.0030(0,0.0284),respectively.The enhanced relative signal values in A2 region were 0.0262(0.0170,0.0444),0.0279(0.0121,0.0404),0.0085(0.0013,0.0125)and 0.0010(0.0005,0.0020),0.0020(0.0005,0.0115).The enhanced relative signal value of breast cancer A1 region 0.0477(0.0274,0.0717)was higher than

关 键 词：乳腺肿瘤 乳房X线摄影术 诊断 鉴别 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]