对比增强能谱乳腺X线摄影联合临床指标鉴别乳腺病灶良恶性的价值  

Value of Contrast-Enhanced Spectral Mammography Combined with Clinical Indicators in the Differentiation of Benign and Malignant Breast Lesions

作　　者：周宜静 周明舸 李宇峰 刘保 ZHOU Yijing;ZHOU Mingge;LI Yufeng;LIU Bao(Department of Nuclear Medicine,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Changzhou 213003,China;不详)

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院医学影像科,江苏常州213003 [2]苏州大学附属第三医院、常州市第一人民医院核医学科,江苏常州213003

出　　处：《中国医学影像学杂志》2024年第12期1237-1242,共6页Chinese Journal of Medical Imaging

摘　　要：目的 探讨基于对比增强能谱乳腺X线摄影(CESM)低能图乳腺影像报告和数据系统(BI-RADS)评分联合强化程度评分及临床指标在乳腺病灶良恶性鉴别中的价值。资料与方法 回顾性收集2018年1月—2023年6月因乳腺疾病在苏州大学附属第三医院接受CESM检查且低能图BI-RADS评分3类及以上的女性患者193例,根据手术或穿刺病理结果,分为恶性组及良性组,比较两组患者的一般资料、影像特征及强化程度。使用Logistic回归构建低能图BI-RADS评分联合强化程度评分及临床指标的预测模型(模型3),评估模型3的预测效能,并与模型1(低能图BI-RADS评分)、模型2(低能图BI-RADS评分+强化程度评分)进行比较。结果 193例患者中良性73例,恶性120例。恶性组和良性组的年龄(t=3.75,P<0.001)、绝经史(χ^(2)=14.00,P<0.001)、低能图BI-RADS评分(P<0.001)及强化程度评分差异有统计学意义(P<0.001)。模型1、模型2和模型3的曲线下面积分别为0.852、0.859、0.871,从曲线下面积、净重新分类指数、综合判别改善指数及决策曲线综合分析,模型3优于模型1和模型2。模型3的最佳截断值为0.595,对应的敏感度为82.2%,特异度为83.3%。结论 在低能图BI-RADS 3类及以上的可疑乳腺癌患者中,基于低能图BI-RADS评分联合强化程度及临床指标有助于提高CESM诊断乳腺癌的效能。Purpose To investigate the value of the breast imaging reporting and data system(BI-RADS)score of low-energy image combined with enhancement score and clinical indicators in the differentiation of benign and malignant breast lesions based on contrast-enhanced spectral mammography(CESM).Materials and Methods A total of 193 female patients,who underwent CESM examination in the Third Affiliated Hospital of Soochow University from January 2018 to June 2023,with BI-RADS score of Class 3 or higher based on low-energy image were retrospectively collected.According to the surgical or puncture pathological results,all patients were divided into malignant and benign groups.The general information,imaging features and enhancement degree between the two groups were compared,respectively.Logistic regression was used to construct a predictive model(Model 3)for the combination of BI-RADS score based on low-energy image,enhancement score and clinical indicators.The predictive performance of Model 3 was evaluated and compared with Model 1(BI-RADS score based on low-energy image)and Model 2(BI-RADS score based on low-energy image+enhancement score).Results Of 193 patients,73 were benign and 120 were malignant.There were significant differences in age(t=3.75,P<0.001),menopausal history(χ^(2)=14.00,P<0.001),BI-RADS score based on low-energy image(χ^(2)=77.36,P<0.001)and enhancement score(χ^(2)=36.34,P<0.001)between the malignant and benign groups.The area under the curve(AUC)of Model 1,Model 2 and Model 3 were 0.852,0.859 and 0.871,respectively.The AUC,net reclassification improvement,integrated discrimination improvement and decision curve of Model 3 were better than those of Model 1 and Model 2.The optimal cutoff value for Model 3 was 0.595,with a corresponding sensitivity of 82.2%and specificity of 83.3%.Conclusion In the suspected breast cancer patients of category 3 and above of BI-RADS based on low-energy image,the combination of enhancement score and clinical indicators based on BI-RADS score of low-energy image is helpful

关 键 词：乳房X线摄影术 乳腺肿瘤 诊断 鉴别 

分 类 号：R737.9[医药卫生—肿瘤] R445.4[医药卫生—临床医学]