Kaiser评分与表观扩散系数对哺乳期乳腺良恶性病变的鉴别诊断效能研究  

Study on the differential diagnostic efficacy of Kaiser score and apparent diffusion coefficient values for benign and malignant breast lesions during lactation

作　　者：杨喆璇 赵鑫[1,2] 谭世芳 程美英[1,2] 沈艳勇[1] 张晓雪 冯占起 王长浩 YANG Zhexuan;ZHAO Xin;TAN Shifang;CHENG Meiying;SHEN Yanyong;ZHANG Xiaoxue;FENG Zhanqi;WANG Changhao(Medical Imaging Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Tianjian Laboratory of Advanced Biomedical Sciences,Institute of Advanced Biomedical Sciences,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院医学影像科,郑州450052 [2]天健先进生物医学实验室/郑州大学生物医药高等研究院,郑州450052

出　　处：《磁共振成像》2024年第6期87-93,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：天健先进生物医学实验室立项资助项目。

摘　　要：目的评估Kaiser评分与表观扩散系数(apparent diffusion coefficient,ADC)对哺乳期乳腺病变良恶性的鉴别诊断效能。材料与方法回顾性分析2016年10月至2023年10月于郑州大学第三附属医院行术前乳腺MRI检查的65例哺乳期乳腺病变患者的临床、病理及影像资料,根据病理结果将这些病例分为恶性组31例,良性组34例。每位患者选取一个主病灶进行Kaiser评分和ADC值测量,将Kaiser评分大于4的病灶根据其ADC值进行二次评分,得到新的预测指标Kaiser+。以病理结果为金标准,使用受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值、Kaiser评分和Kaiser+评分的诊断效能,计算其曲线下面积(area under the curve,AUC)、敏感度、特异度和准确度,并通过DeLong检验对三者的AUC进行比较。结果ADC值的AUC为0.818[95%置信区间(confidence interval,CI):0.709~0.927];Kaiser评分的AUC为0.881(95%CI:0.791~0.971);Kaiser+评分的AUC为0.910(95%CI:0.931~0.990);Kaiser+评分与ADC值的AUC(0.910 vs.0.818)差异具有统计学意义(P=0.011),Kaiser评分与ADC值的AUC(0.881 vs.0.818)差异无统计学意义(P=0.141),Kaiser+评分与Kaiser评分的AUC(0.910 vs.0.881)差异无统计学意义(P=0.151)。结论Kaiser+评分相较于ADC值具有更高的诊断效能,可以较为准确地鉴别哺乳期乳腺良恶性病变,为临床制订个性化的治疗方案提供参考。Objective:To evaluate the diagnostic performance of Kaiser score and apparent diffusion coefficient(ADC)in the differential diagnosis of benign and malignant breast lesions during lactation.Materials and Methods:This retrospective study enrolled 65 patients who underwent breast MRI in the Third Affiliated Hospital of Zhengzhou University from October 2016 to October 2023.The clinical,pathological and imaging data of 65 patients were collected.According to the pathological results,the cases were divided into malignant group(31 cases)and benign group(34 cases).One primary lesion was selected from each patient for Kaiser score and ADC value measurement.Lesions with Kaiser scores greater than 4 were reevaluated based on their ADC values,and new predictive indicator Kaiser+were obtained.Using pathological results as the gold standard,and receiver operating characteristic(ROC)curve was used to compare the diagnostic accuracy of ADC value.Calculated the area under the curve(AUC),sensitivity,specificity,and accuracy,and compared the AUC of the three using DeLong test.Results:The AUC of ADC value was 0.818[95%confidence interval(CI):0.709-0.927].The AUC of Kaiser score was 0.881(95%CI:0.791-0.971).The AUC of Kaiser+score was 0.910(95%CI:0.931-0.990).The AUC between Kaiser+score and ADC value was statistically significant(0.910 vs.0.818,P=0.011).There was no significant difference in AUC between Kaiser score and ADC value(0.881 vs.0.818,P=0.141),and there was no significant difference in AUC between Kaiser+score and Kaiser score(0.910 vs.0.881,P=0.151).Conclusions:Kaiser+score has higher diagnostic efficiency than ADC value,which can accurately identify benign and malignant breast lesions during lactation and provide reference for clinical development of personalized treatment plans.

关 键 词：哺乳期乳腺癌 鉴别诊断 Kaiser评分 表观扩散系数 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]