数字化乳腺断层摄影对浸润性乳腺导管癌病灶大小测量准确性及影响因素分析  

Analysis of accuracy and influencing factors of digital mammary tomography in measuring the size of invasive ductal breast cancer

作　　者：李鸿恩 李悦龙 黄育斌[1] 曾益辉 张亮[1] 梅世伟[1] LI Hongen;LI Yuelong;HUANG Yubin;ZENG Yihui;ZHANG Liang;MEI Shiwei(Department of Radiology,Guangdong Province Hospital for Women and Children Healthcare,Guangdong 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：《现代肿瘤医学》2024年第19期3731-3737,共7页Journal of Modern Oncology

摘　　要：目的:探讨数字化乳腺断层摄影(digital breast tomosynthesis,DBT)评估浸润性乳腺导管癌(invasive mammary ductal carcinoma,IDC)病变大小的准确性,并分析其影响因素。方法:回顾性分析2019年03月至2022年08月在我院经手术病理确诊为IDC的145例患者的临床资料,所有患者术前均行DBT检查。以手术切除新鲜标本病理测量值为金标准,采用Spearman相关分析和Bland-Altman图比较DBT预估IDC病灶大小的相关性及一致性检验。采用多因素Logistic回归分析DBT测量IDC病灶大小不准确的预测因素。结果:DBT及病理测量病灶大小的中位数(四分位间距)分别为2.1(1.5,2.8)cm、2.5(2.0,3.0)cm。DBT检查测量病灶大小一致率为75.86%(110/145),低估病灶21.38%(31/145),高估病灶2.76%(4/145)。Spearman相关分析显示,DBT与病理测量IDC病灶大小呈中度正相关,r=0.575,P<0.001。Bland-Altman分析显示,DBT检查较病理金标准,略低估病灶大小,平均差值为-0.408 cm,95%CI为-0.559~-0.258。多因素Logistic回归分析显示,病理测量大小>2 cm及肿块形态不规则形是DBT测量IDC病灶大小不准确的独立危险因素(OR=8.110,95%CI为2.077~31.672,P=0.003;OR=0.301,95%CI为0.113~0.798,P=0.016)。结论:DBT检查测量IDC病灶大小与病理测量值呈中度相关,对IDC病灶大小测量一致率较高,可以作为IDC术前预估病灶大小的依据,但仍存在低估病灶大小的情况。病理测量大小>2 cm及肿块形态不规则形IDC更易出现测量病灶大小不准确。Objective:To investigate the accuracy of digital breast tomosynthesis(DBT)in evaluating the lesion size of invasive mammary ductal carcinoma(IDC),and analyze the influencing factors.Methods:The clinical data of 145 patients diagnosed with IDC by surgical pathology in our hospital from March 2019 to August 2022 were retrospectively analyzed.All patients underwent DBT examination before surgery.Spearman correlation analysis and Bland-Altman chart were used to compare the correlation and consistency of DBT in predicting IDC lesion size.Multivariate Logistic regression was used to analyze the predictive factors of inaccurate DBT measurement of IDC lesion size.Results:The median(interquartile distance)of focal size measured by DBT and pathology were 2.1(1.5,2.8)cm and 2.5(2.0,3.0)cm,respectively.The consistent rate of lesion size measured by DBT was 75.86%(110/145),underestimation 21.38%(31/145)and overestimation 2.76%(4/145).Spearman correlation analysis showed that DBT was moderately positively correlated with pathologically measured IDC lesion size(r=0.575,P<0.001).Bland-Altman analysis showed that the DBT examination slightly underestimated the lesion size compared with the pathological gold standard,with a mean difference of-0.408 cm and 95%CI of-0.559~-0.258.Multivariate Logistic regression analysis showed that pathological measurement size>2 cm and irregular mass shape were independent risk factors for inaccurate DBT measurement of IDC lesion size(OR=8.110,95%CI 2.077~31.672,P=0.003).(OR=0.301,95%CI was 0.113~0.798,P=0.016).Conclusion:The size of IDC lesions measured by DBT showed a moderate correlation with the pathological measurements,and the consistency rate of IDC lesion size measurements was high,which could be used as a basis for predicting the size of IDC lesions before surgery,but there were still cases of underestimating the size of lesions.It is more likely that the lesion size of IDC with pathological measurement size>2 cm and irregular tumor shape will be inaccurate.

关 键 词：数字化乳腺断层成像 病灶大小 浸润性乳腺导管癌 影响因素 

分 类 号：R737.9[医药卫生—肿瘤]