增强乳腺X线摄影和超声对致密型乳腺良恶性病变的诊断效能对比分析  

Comparative analysis of contrast-enhanced mammography and ultrasound in the diagnosis of benign and malignant lesions of dense breast

作　　者：李成威 彭莉雯 郭雪贞[1] 曾益辉 李鸿恩 沈敏[1] LI Chengwei;PENG Liwen;GUO Xuezhen;ZENG Yihui;LI Hongen;SHEN Min(Department of Radiology,Guangdong Women's and Children's Hospital,Guangdong Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院放射科,广东广州511442

出　　处：《现代肿瘤医学》2024年第17期3319-3326,共8页Journal of Modern Oncology

摘　　要：目的:探讨增强乳腺X线摄影(CEM)与彩色多普勒超声对致密型乳腺良恶性病变的诊断价值。方法:回顾性分析2019年10月至2021年08月我院临床怀疑乳腺病变的105例致密型乳腺患者资料。所有患者均行乳腺CEM、超声检查。以手术病理结果为“金标准”,采用Z检验绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under curve,AUC),采用χ^(2)检验,比较两种单独检查和联合诊断致密型乳腺良恶性病变的诊断效能。结果:105例致密型乳腺患者中,经病理诊断确诊恶性肿瘤48例,良性57例。CEM、超声、联合检查诊断乳腺癌的敏感度分别为87.50%、87.50%、97.92%,特异度分别为77.19%、78.95%、85.96%,准确度分别为81.90%、82.86%、91.43%。CEM、超声及联合检查在诊断致密型乳腺良恶性疾病的敏感度、特异度、准确率、阳性预测值、阴性预测值方面比较,差异无统计学意义(P> 0.05)。两两比较,联合检查敏感度高于CEM、超声单项检查,联合检查准确度及阴性预测值均高于CEM单项检查,差异均具有统计学意义(P均<0.05)。CEM、超声、联合诊断对致密型乳腺中乳腺癌的AUC分别为0.823、0.832、0.919。两两比较,CEM与超声比较,差异无统计学意义(P> 0.05),CEM、超声分别与联合检查比较,差异具有统计学意义(P均<0.05)。不同乳腺腺体组织分类比较:CEM、超声诊断乳腺疾病敏感度、特异度在不均匀致密型中均明显高于极度致密型,差异具有显著统计学意义(P均<0.05)。结论:CEM在致密型乳腺良恶性疾病诊断中与超声均具有较高的诊断效能,CEM联合超声检查可提高敏感度、特异度及准确率,有助于致密型乳腺疾病的临床诊断。Objective:To explore the diagnostic value of contrast-enhanced energy spectrum mammography(CEM) and color Doppler ultrasound in benign and malignant lesions of dense breast.Methods:The data of 105 patients with dense breast with suspected breast lesions in our hospital from October 2019 to August 2021 were retrospectively analyzed.All patients underwent breast CEM and ultrasound examination.With the pathological results of surgery as the "gold standard",the receiver operating characteristic(ROC) curve was drawn by Z-test,and the area under the curve(AUC) was calculated.The χ^(2) test was used to compare the diagnostic efficacy of two separate examinations and combined examination in the diagnosis of benign and malignant dense breast lesions.Results:Among 105 patients with dense breast,48 cases were malignant and 57 cases were benign.The sensitivity of CEM,ultrasound and combined examination in the diagnosis of breast cancer were 87.50%,87.50% and 97.92%,the specificity was 77.19%,78.95% and 85.96%,and the accuracy was 81.90%,82.86% and 91.43%,respectively.There was no significant difference in sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CEM,ultrasound and combined examination in the diagnosis of benign and malignant dense breast diseases(P>0.05).The sensitivity of combined examination was higher than that of CEM and single ultrasound examination,and the accuracy and negative predictive value of combined examination were higher than that of CEM single examination,with statistical significance(P<0.05).The AUC of CEM,ultrasound and combined diagnosis for dense breast cancer were 0.823,0.832 and 0.919,respectively.CEM and ultrasound showed no statistically significant difference(P>0.05),while CEM and ultrasound showed statistically significant difference(P<0.05) compared with combined examination.Comparison of different breast gland tissue classification showed the sensitivity and specificity of CEM ultrasound in diagnosis of breast diseases were significantly higher i

关 键 词：对比增强能谱乳腺X线摄影 超声 致密型乳腺 乳腺肿瘤 诊断效能 

分 类 号：R737.9[医药卫生—肿瘤]