数字乳腺断层合成摄影和对比增强乳腺X线摄影检查对乳腺BI-RADS 4类病变的诊断价值  

Comparison of diagnostic values between digital breast tomosynthesis and contrast-enhanced mammography for BI-RADS 4 breast lesions

作　　者：王梅[1] 张紫燕 朱建国[1] 刘斐[1] 李海歌[1] WANG Mei;ZHANG Ziyan;ZHU Jianguo;LIU Fei;LI Haige(Department of Medical Imaging,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院医学影像科,江苏南京210011

出　　处：《医学影像学杂志》2024年第10期62-66,共5页Journal of Medical Imaging

摘　　要：目的探讨对比增强乳腺X线摄影(CEM)与全数字化乳腺X线摄影(FFDM)、数字乳腺断层合成摄影(DBT)检查在乳腺BI-RADS 4类病变中大小评估及良恶性鉴别诊断价值。方法选取经病理证实的124例患者(136个BI-RADS 4类病灶),术前均行CEM、FFDM和DBT检查,分别采用Spearman相关分析和Bland-Altman图评价CEM、FFDM和DBT与病理标本测量的病灶最大径的相关性和一致性;采用受试者工作特征曲线(ROC)评价CEM、FFDM和DBT鉴别乳腺BI-RADS 4类良恶性病变的诊断效能。结果CEM、FFDM和DBT与病理测量病灶大小的相关系数分别为r=0.902,r=0.856和r=0.892(均P<0.001)。CEM、FFDM、DBT测量的病灶最大径与手术病理测量值的平均差值分别为0.24 cm、0.21 cm和0.11 cm。CEM、FFDM、DBT对乳腺良恶性病变诊断的敏感度分别为85.51%、65.22%、79.71%,特异度分别为88.06%、77.61%、77.61%,准确度分别为86.76%、71.32%、78.68%。两两比较结果显示,CEM的ROC曲线下面积(area under the curve,AUC)均高于FFDM、DBT,差异有统计学意义(均P<0.01),而DBT与FFDM的AUC差异无统计学意义(P>0.05)。结论DBT对BI-RADS 4类乳腺病变的大小评估较FFDM、CEM更准确,CEM对乳腺BI-RADS 4类良恶性病变的鉴别诊断效能优于FFDM、DBT。Objective To analyze the values of contrast-enhanced mammography(CEM),full-field digital mammography(FFDM),and digital breast tomosynthesis(DBT)in the size assessment and differential diagnosis of BI-RADS 4 lesions.Methods A total of 124 patients with 136 BI-RADS 4 breast lesions confirmed by pathology were enrolled in this study.All pa-tients underwent FFDM,DBT and CEM examinations before surgery.The correlation and agreement between FFDM,DBT,CEM and histopathologic tumor size were evaluated by Spearman correlation analysis and Bland-Altman analysis.The receiveroperating characteristic curve(ROC)was plotted to analyze the diagnostic efficacy of FFDM,DBT and CEM in differentiating benign and malignant breast lesions of BI-RADS 4 category.Results The values measured by FFDM,DBT and CEM were posi-tively correlated with the pathological measurement(r=0.856,r=0.892 and 0.902,all P<0.001).For size differences,the mean for histopathology versus FFDM,DBT and CEM was 0.21 cm,0.11 cm and 0.24 cm.The sensitivity of FFDM,DBT and CEM for assessment of benign and malignant breast lesions were 65.22%,79.71%and 85.51%,the specificity were 77.61%,77.61%and 88.06%,and the accuracy were 71.32%,78.68%and 86.76%,correspondingly.The area under the curve(AUC)of CEM was significantly higher than FFDM and DBT(both P<0.01),while,there was no significantly difference between the AUC of DBT and FFDM(P>0.05).Conclusions DBT is superior to FFDM and CEM for the evaluation of breast lesions size of BIRADS 4 category.The differential diagnostic efficiency of CEM is superior to FFDM and DBT.

关 键 词：乳腺 全数字化乳腺X线摄影检查 数字乳腺断层合成摄影检查 对比增强乳腺摄影检查 

分 类 号：R655.8[医药卫生—外科学] R445.4[医药卫生—临床医学]