数字乳腺断层摄影与MRI在乳腺良恶性疾病诊断中的比较

王祥芝; 汤晓敏; 杨菊萍; 高之振; 谢宗玉; 沈俊杰

doi:10.16766/j.cnki.issn.1674-4152.002017

数字乳腺断层摄影与MRI在乳腺良恶性疾病诊断中的比较

doi: 10.16766/j.cnki.issn.1674-4152.002017

1.
蚌埠医学院第一附属医院放射科，安徽蚌埠 233004
2.
蚌埠医学院研究生院，安徽蚌埠 233030

基金项目:

安徽省高校自然科学研究重点项目 KJ2019A0402

蚌埠医学院转化医学重点专项 BYTM2019043

详细信息

通讯作者:
沈俊杰，E-mail: 395932108@qq.com

中图分类号: R445 R737.9
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- 被引次数: 0
出版历程
- 收稿日期: 2012-12-15
- 网络出版日期: 2022-02-16

A comparison of diagnosis of benign and malignant breast diseases between digital breast tomosynthesis and MRI

1.
Department of Radiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨数字化乳腺摄影(digital mammography，DM)、数字乳腺断层摄影(digital breast tomosynthesis，DBT)和MRI在乳腺良恶性疾病诊断中的比较。方法回顾性分析2019年1月—2020年10月就诊蚌埠医学院第一附属医院，临床触诊怀疑存在乳腺病灶且同时行DM、DBT、MRI三种检查的116例乳腺疾病患者的资料。对所有图像中病灶参照乳腺影像报告和数据系统(BI-RADS)标准分类，以病理结果为“金标准”，评价DM+DBT和MRI对乳腺良恶性疾病的诊断效能、显示恶性病灶大小和相关恶性征象的能力、DM与DBT的辐射剂量差异。结果 116例病灶中恶性86例，良性30例。DM+DBT、MRI诊断乳腺良恶性疾病的敏感度为88.4%、96.5%，特异度为86.7%、73.3%，准确度为87.9%、90.5%;两者的ROC曲线下面积(AUC)分别为0.911和0.948，差异无统计学意义(Z=1.084，P=0.278);DM+DBT与MRI均稍高估恶性肿瘤大小，但两者与病理大小均存在较好的一致性(均P＞0.05);DM+DBT在显示微钙化方面优于MRI(χ²=22.114，P＜0.05)，在显示胸大肌浸润和腋窝淋巴结方面低于MRI(χ²=4.900、21.333，均P＜0.05)。DM的平均辐射剂量为(1.574±0.422)mGy，DBT的平均辐射剂量为(2.534±0.521)mGy，DBT的辐射剂量高于DM的辐射剂量，差异具有统计学意义(t=-29.213，P＜0.001)。结论 DM+DBT可以较准确的诊断乳腺良恶性疾病，与MRI相似。而且简单易行，无须注射对比剂，建议有致密型乳腺内病变的患者常规行DM+DBT检查。
- 数字乳腺断层摄影 /
- 磁共振 /
- 乳腺疾病 /
- 肿瘤大小 /
- 钙化
Abstract: Objective To explore the diagnostic of benign and malignant breast diseases between digital mammography (DM), digital breast tomosynthesis (DBT) and MRI. Methods During the period from January 2019 to October 2020, 116 patients with suspected lesions by palpation underwent further imaging exam in the First Affiliated Hospital of Bengbu Medical College. The DM, DBT and MRI were performed on all the patients. All breast lesions were analyzed according to BI-RADS. The pathological results were "gold standard" to evaluate the diagnostic efficacy of the DM+DBT and MRI in benign and malignant breast diseases. The ability of the DM+DBT and MRI to evaluate the actual lesion size and malignant signs. The difference of average glandular dose between DM and DBT. Results Among the 116 lesions, 86 were malignant and 30 were benign. The sensitivity of DM+DBT was 88.4%, specificity 86.7%, and accuracy 87.9%. The sensitivity of MRI was 96.5%, specificity 73.3%, and accuracy 90.5%. The ROC area under the curve of DM+DBT and MRI for diagnosis of breast diseases were 0.911 and 0.948. There was no significant difference in AUC value between DM+DBT and MRI (Z=1.084, P=0.278). The DM+DBT and MRI were slightly overestimated the size of malignant tumor, but both of them were positively correlated with the pathological measurements (all P>0.05). The calcification was significantly higher for DM+DBT detection than for MRI (χ²=22.114, P < 0.05). The infiltration of pectoralis major and axillary lymph nodes were significantly higher for MRI than that for DM+DBT detection (χ²=4.900, 21.333, all P < 0.05). The average glandular dose (AGD) of DM and DBT was (1.574±0.422) mGy and (2.534±0.521) mGy, respectively. The AGD of DBT was significantly higher than DM (t=-29.213, P < 0.001). Conclusion DM+DBT can effectively diagnose benign and malignant breast lesions, providing a comparable efficiency to MRI. It is easy for patients and does not need contrast injections. DM+DBT is recommend for patients with dense gland type breast.
- Digital breast tomosynthesis /
- Magnetic resonance imaging /
- Breast diseases /
- Tumor size /
- Calcification

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图 1 两者诊断乳腺良恶性疾病的诊断效能比较

下载: 全尺寸图片幻灯片

图 2 DBT与MRI测量的病灶大小与病理大小的Bland-Altman图

下载: 全尺寸图片幻灯片

图 3 1例浸润性导管癌Ⅰ级影像

注：患者女，54岁，不均匀致密型腺体。A为DM示右乳中央区偏后局灶结构紊乱; B为DM示局部放大图，内可见多发细小针尖样钙化(箭头所示); C为DBT示右乳中央区偏后不规则肿块伴星芒征，浸润性生长，内见钙化(箭头所示); D为MRI增强示右乳内上象限不规则肿块伴星芒征，双乳另见多发小结节。

下载: 全尺寸图片幻灯片

表 1 2种检查方法显示乳腺癌恶性征象比较(例)

检查方法	例数	不规则肿块	星芒征	钙化	肿大淋巴结	胸大肌浸润
DM+DBT	86	68	45	28	11	6
MRI	86	71	47	4	36	14
χ²值		0.364	0.083	22.114	21.333	4.900
P值		0.549	0.774	＜0.001	＜0.001	0.021

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