中国医学科学院学报

高级检索
中国医学科学院学报

中国医学科学院学报 ›› 2019, Vol. 41 ›› Issue (5): 667-672.doi: 10.3881/j.issn.1000-503X.10938

• 论著 • 上一篇    下一篇

动态增强磁共振成像、数字断层融合摄影和数字X线摄影在乳腺癌早期诊断中应用价值的比较

徐阿巧1,翁小波1,郑静1,李芝清2,王小玲3,张盛箭4()   

  1. 1 绍兴市中心医院 放射科
    2 病理科,浙江绍兴312030
    3 绍兴市人民医院放射科,浙江绍兴312000
    4 复旦大学附属肿瘤医院放射科,上海200032
  • 收稿日期:2018-10-18 出版日期:2019-10-30 发布日期:2019-11-08
  • 通讯作者: 张盛箭 E-mail:zhangshengjian@yeah.net
  • 基金资助:
    绍兴市公益性技术应用研究计划(2018C30140);浙江省医药卫生科研计划(2018KY8299)

Comparison of the Diagnostic Values of Dynamic Enhanced Magnetic Resonance Imaging,Digital Breast Tomosynthesis,and Digital Mammography for Early Breast Cancer

XU Aqiao1,WENG Xiaobo1,ZHENG Jing1,LI Zhiqing2,WANG Xiaoling3,ZHANG Shengjian4()   

  1. 1 Department of Radiology
    2 Department of Pathology,Shaoxing Center Hospital,Shaoxing,Zhejiang 312030,China
    3 Department of Radiology,Shaoxing People’s Hospital,Shaoxing,Zhejiang 312000,China;
    4 Department of Radiology,Tumor Hospital Affiliated to Fudan University,Shanghai 200032,China
  • Received:2018-10-18 Online:2019-10-30 Published:2019-11-08
  • Contact: Shengjian ZHANG E-mail:zhangshengjian@yeah.net
  • Supported by:
    Supported by Shaoxing Public Welfare Technology Application Research Program(2018C30140);Zhejiang Medical Research Program(2018KY8299)

摘要:

目的 比较乳腺动态增强磁共振成像(DCE-MRI)、数字断层融合摄影(DBT)和数字X线摄影(DM)在乳腺癌早期诊断中的应用价值。方法 回顾性分析2017年6月至2018年12月在绍兴市中心医院就诊、经手术病理证实的65例早期乳腺癌患者的临床资料,所有患者术前均行乳腺DCE-MRI、DBT和DM检查。以病理结果为金标准绘制ROC曲线,评价不同影像检查方法的诊断效能,采用Z检验对ROC曲线下面积进行比较,采用χ 2检验比较DCE-MRI、DBT、DM对早期乳腺癌的检出率、准确率、灵敏度和特异度的差异,采用Pearson相关分析分析不同影像检查方法评估早期乳腺癌病灶大小的准确率。 结果 DCE-MRI、DBT、DM基于BI-RADS分类诊断早期乳腺癌的ROC曲线的曲线下面积(AUC)分别为0.910、0.832、0.700,差异有统计学意义(z=2.132,P=0.001)。DCE-MRI、DBT、DM诊断早期乳腺癌的敏感度分别为92.3%、70.8%、52.5%;特异度分别为65.0%、85.0%、79.3%;诊断准确率分别为83.1%、70.8%、50.8%,其中,DCE-MRI(χ 2=15.330,P=0.0001)和DBT(χ 2=5.450,P=0.020)的诊断准确率均明显高于DM。DM、DBT、DCE-MRI测量值与病理测量结果均呈显著正相关(r=0.781,r=0.847,r=0.946,P值均<0.01)。 结论 DCE-MRI和DBT在早期乳腺癌的检出和诊断准确率方面具有明显的优势,较DM能显著提高早期乳腺癌的诊断效能,未普及乳腺磁共振检查的广大基层医疗单位可采用DBT提高乳腺癌早期检出。

关键词: 乳腺癌, 磁共振成像, 数字乳腺X线摄影, 数字乳腺断层融合

Abstract:

Objective To compare the values of dynamic enhanced magnetic resonance imaging(DCE-MRI),digital breast tomosynthesis(DBT),and digital mammography(DM)in the early detection and diagnosis of breast cancer.Methods We retrospectively analyzed the clinical and imaging data of 65 cases with early breast cancer confirmed by surgical pathology from June 2017 to December 2018.All patients underwent breast DCE-MRI,DM and DBT before surgery.The receiver operating characteristic(ROC)curves were drawn,with the pathological results as the gold standard,to evaluate the diagnostic performance of different examination methods.The areas under ROC curves(AUCs)were compared using Z test.The differences among DCE-MRI,DBT and DM in detecting early breast cancer were compared using chi-square test in terms of positive rates,accuracy,sensitivity,and specificity.Pearson correlation analysis was performed to assess the accuracy of these imaging methods in detecting the size of early breast cancer.Results The AUCs of DCE-MRI,DBT,and DM based on the BI-RADS classification for early diagnosis of breast cancer were 0.910,0.832,and 0.700,respectively(z=2.132,P=0.001);the sensitivity of DCE-MRI,DBT,and DM for early breast cancer was 92.3%,70.8%,and 52.5%,the specificity was 65.0%,85.0%,and 79.3%,and the accuracy was 83.1%,70.8%,and 50.8%,indicating that DCE-MRI(χ 2=15.330,P=0.0001) and DBT(χ 2=5.450,P=0.020) had significantly higher diagnostic accuracy than DM.The measurement results of DM,DBT,and DCE-MRI were positively correlated with the pathological measurements(r=0.781,r=0.847,r=0.946;all P<0.01). Conclusions DCE-MRI and DBT have higher positive rates and accuracies than DM in detecting early breast cancer.Medical institutions where DCE-MRI is still not available can use DBT to improve the early detection of breast cancer.

Key words: breast cancer, magnetic resonance imaging, digital mammography, digital breast tomosynthesis

中图分类号: