Comparation of diagnosis value of ultrasound, conventional mammography and dynamic in breast lesions with calcification categorized 3-5
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摘要:
目的比较常规超声、常规乳腺X线摄影(MG)及动态增强磁共振(DCE-MRI)对乳腺BI-RADS 3~5类钙化性病变的诊断效能。 方法回顾性分析2010年1月~2019年2月同时完成超声、MG和MRI的82例患者共85个含钙化原发初治病灶，与病理结果为诊断金标准，计算其敏感度、特异性、准确性、阳性预测值及阴性预测值，比较三者之间的诊断效能；并根据超声和MG BI-RADS评估将病灶分为一致组和不一致组，计算3种乳腺影像学检查方法的曲线下面积，分析总体组和不一致组的诊断效能。 结果MG、超声和DCE-MRI在诊断乳腺BI-RADS 3~5类钙化性病变的敏感性、特异性、准确性、阳性预测值与阴性预测值分别为80.0% vs 82.2% vs 93.3%、75.0% vs 77.5% vs 87.5%、77.6% vs 80.0% vs 90.6%、78.3% vs 80.4% vs 89.4%、77.0% vs 79.5% vs 92.1%，诊断价值差异有统计学意义(P=0.022、0.019)。MG和超声的曲线下面积在总体组和不一致组分别为0.821、0.565和0.872、0.649，而DCE-MRI对应值分别为0.956和0.948，明显优于MG和超声(P < 0.05)。 结论DCE-MRI在鉴别诊断乳腺BI-RDAS 3~5类钙化性病变方面优于MG和超声，尤其是当二者出现不同诊断意见时。 Abstract:ObjectiveTo compare the efficacy of conventional ultrasound (US), conventional mammography (MG) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of breast lesions with calcification categorized 3-5. MethodsBetween January 2010 and February 2019, a total of 85 untreated breast lesions with calcification from 82 patients who underwent US, MG and MRI at the same time were retrospectively analyzed. All the lesions were confirmed by histopathological assessment. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were evaluated, and the diagnostic value of the three modalities were compared. Lesions were divided into consistent or inconsistent group on the basis of BI-RADS MG and US assessment. The diagnostic efficacy of three methods in the overall and inconsistent group were assessed by receiver operating characteristic (ROC) curve analysis. ResultsThe sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MG, US and MRI in the diagnosis of breast lesions with calcification were 80.0% vs 82.2% vs 93.3%、75.0% vs 77.5% vs 87.5%、77.6% vs 80.0% vs 90.6%、78.3% vs 80.4% vs 89.4%、77.0% vs 79.5% vs 92.1%, respectively, with significant difference (P=0.022、0.019). The AUCs of MG and US were 0.821, 0.872 for overall group and 0.565, 0.649 for inconsistent group. The corresponding values of MRI were 0.956 and 0.948, which were significantly prior to those of MG and US (P < 0.05). ConclusionThe DCE-MRI has a better diagnostic efficiency than MG or US alone in the differentiation of the breast lesions with calcification especially when disagreement occurred. -
图 1 乳腺导管内原位癌在MG、超声和MRI的影像学表现
56岁女性患者，左乳外上象限弥漫细小钙化病变，病理诊断为乳腺导管内原位癌.A: MG诊断为BI-RADS 4A类; B: 超声诊断为BI-RADS 4A类; C: MRI诊断为BI-RADS 4B类(“↑”所指为病灶).
Figure 1. Imaging of breast intraductal carcinoma in suit by MG、US and MRI
图 3 当超声和MG不一致时，三种乳腺影像学检查方法的ROC
Figure 3. ROC of the three modalities in the inconsistent group.
表 1 三种检查方法对乳腺BI-RADS 3~5类钙化性病变的诊断情况
Table 1. Diagnosis of breast lesions with calcification categorized 3-5 by three methods
检查方法 病理结果 良性 恶性 超声 良性 31 8 恶性 9 37 DCD-MRI 良性 35 3 恶性 5 42 MG 良性 30 9 恶性 10 36 
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表 2 三种乳腺影像学检查方法的诊断效能
Table 2. Diagnostic performance of the three modalities in differentiation of benign and malignant breast lesions with calcification
检查方法 敏感度(%) 特异性(%) 准确率(%) 阳性预测值(%) 阴性预测值(%) 诊断符合率 总体组AUC 不一致组AUC 一致组 不一致组 MG 80.0 75.0 77.6 78.3 77.0 0.821 0.565 58/67 8/18 超声 82.2 77.5 80.0 80.4 79.5 0.872 0.649 10/18 DCE-MRI 93.3 87.5 90.6 89.4 92.1 0.956 0.948 61/67 16/18 P* - – 0.019 – – 0.0021 0.0108 – – P# - – 0.022 – – 0.0054 0.0079 – – P*: MRI vs MG; P#: MRI vs超声; MG: 常规乳腺X线摄影; DCE-MRI: 动态增强磁共振; AUC: 曲线下面积.
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表 3 三种检查方法的BI-RADS分类与病理结果对照
Table 3. Comparison of scores of the three modalities with pathology results
乳腺分级 US-BI-RADS US-BI-RADS US-BI-RADS n 病理结果 符合率(%) n 病理结果 符合率(%) n 病理结果 符合率(%) (-) (+) (-) (+) (-) (+) 3 18 17 1 94.4 19 19 0 100.0 28 22 6 78.6 4A 21 14 7 66.7 19 16 3 84.2 11 8 3 72.7 4B 18 7 11 61.1 8 3 5 62.5 14 6 8 57.1 4C 11 2 9 81.8 6 1 5 83.3 5 1 4 80.0 5 17 0 17 100.0 33 1 32 97.0 27 3 24 88.9
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表 4 null致组与不一致组的分布
Table 4. Distribution of consistent and inconsistent results of mammography and conventional US in benign and malignant categories
因素 良性 恶性 MG与超声诊断不一致时 11 7 MG≥4B且超声≤4A 6 3 超声≥4B且MG≤4A 5 4 MG与超声诊断一致时 29 38 BI-RADS≤4A 25 5 BI-RADS≥4B 4 33
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