乳腺X线摄影联合MRI鉴别不同阶段乳腺癌的临床价值  

Clinical value of x-ray mammography combined with MRI in distinguishing breast cancer at different stages

作　　者：赵玉乔 陈永亚 赵亮 ZHAO Yuqiao;CHEN Yongya;ZHAO Liang(Department of Imaging Center,Shijiazhuang People's Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄市人民医院影像中心,河北石家庄050000

出　　处：《医学影像学杂志》2025年第3期64-68,共5页Journal of Medical Imaging

基　　金：河北省医学科学研究重点课题计划项目(编号:20180867);河北省石家庄市科学技术研究项目(编号:211460523)。

摘　　要：目的 探讨乳腺X线摄影联合MRI鉴别诊断非肿块型纯导管原位癌(DCIS)、导管原位癌伴微浸润(DCIS-MI)和浸润性导管癌(IDC)的价值。方法 选取经手术病理检查确诊的110例乳腺癌患者临床资料。所有患者于病理检查前接受乳腺X线摄影和MRI检查,以病理检查结果作为依据,分析乳腺X线摄影联合MRI在DCIS、DCIS-MI和IDC鉴别诊断中的价值,并分析乳腺X线摄影、MRI单独及联合诊断DCIS、DCIS-MI和IDC结果与病理检查结果的一致性。结果 经病理检查确诊,110例乳腺癌患者中DCIS 38例,DCIS-MI 42例,IDC 30例。乳腺X线摄影联合MRI诊断DCIS、DCIS-MI和IDC的准确率为95.45%(105/110),高于乳腺X线摄影与MRI单独诊断的85.45%(94/110)、87.27%(96/110),差异有统计学意义(P<0.05);乳腺X线摄影与MRI单独诊断DCIS、DCIS-MI和IDC的准确率比较,差异无统计学意义(P>0.05)。经Kappa一致性检验,乳腺X线摄影诊断DCIS、DCIS-MI和IDC结果与病理诊断结果的一致性一般(Kappa=0.781,P<0.001);MRI诊断DCIS、DCIS-MI和IDC结果与病理诊断结果的一致性较高(Kappa=0.807,P<0.001);乳腺X线摄影联合MRI诊断DCIS、DCIS-MI和IDC结果与病理诊断结果的一致性极高(Kappa=0.931,P<0.001)。DCIS组、DCIS-MI组和IDC组表观扩散系数ADC_(max)值比较,差异无统计学意义(P>0.05);DCIS组ADC_(min)最高,DCIS-MI组次之,IDC组最低,差异有统计学意义(P<0.05);DCIS组早期强化率(EER)值最低,DCIS-MI组次之,IDC组最高,差异有统计学意义(P<0.05)。结论 乳腺X线摄影联合MRI在DCIS、DCIS-MI和IDC的鉴别诊断中具有较高的价值。Objective To explore the value of x-ray mammography combined with MRI in the differential diagnosis of ductal carcinoma in situ(DCIS),ductal carcinoma in situ with microinvasion(DCIS-MI),and invasive ductal carcinoma(IDC).Methods 110 patients with breast cancer diagnosed by surgery and pathology were selected.All patients underwent x-ray mam-mography and MRI before pathological examination.Based on the pathological examination results,the value of x-ray mammogra-phy combined with MRI in the differential diagnosis of DCIS,DCIS-MI,and IDC was analyzed,and the consistency between x-ray mammography and MRI alone and in combination in diagnosing DCIS,DCIS-MI,and IDC.And pathological examination re-sults were analyzed.Results Pathological examination confirmed that there were 38 cases of DCIS,42 cases of DCIS-MI and 30 cases of IDC in 110 cases of breast cancer.The accuracy of x-ray mammography combined with MRI in diagnosing DCIS,DCIS-MI,and IDC was 95.45%(105/110),which was higher than 85.45%(94/110)and 87.27%(96/110)of x-ray mammogra-phy and MRI alone,with a statistically significant difference(P<0.05).There was no statistically significant difference in the ac-curacy of x-ray mammography and MRI in diagnosing DCIS,DCIS-MI,and IDC separately(P>0.05).According to the Kappa consistency test,the consistency between the results of x-ray mammography diagnosis of DCIS,DCIS-MI,and IDC and patho-logical diagnosis was general(Kappa=0.781,P<0.001).The consistency between the results of MRI(MRI)diagnosis of DCIS,DCIS-MI,and IDC and pathological diagnosis was general(Kappa=0.807,P<0.001).The consistency between the results of x-ray mammography combined with MRI in diagnosing DCIS,DCIS-MI,and IDC and pathological diagnosis was high(Kappa=0.931,P<0.001).There was no statistically significant difference in the apparent diffusion coefficient ADCmax values among the DCIS group,DCIS-MI group,and IDC group(P>0.05).The DCIS group had the highest ADCmin,followed by the DCIS-MI group,and the IDC group had the lowest,with a statistically

关 键 词：乳腺导管原位癌 非肿块型纯导管原位癌 浸润性导管癌 乳腺X线摄影 磁共振成像 

分 类 号：R737.7[医药卫生—肿瘤] R445[医药卫生—临床医学]