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无定形钙化良恶性判断的影响因素

王慧 王思奇 娄鉴娟 邹启桂 王守巨

王慧, 王思奇, 娄鉴娟, 邹启桂, 王守巨. 无定形钙化良恶性判断的影响因素[J]. 分子影像学杂志, 2023, 46(3): 381-388. doi: 10.12122/j.issn.1674-4500.2023.03.01
引用本文: 王慧, 王思奇, 娄鉴娟, 邹启桂, 王守巨. 无定形钙化良恶性判断的影响因素[J]. 分子影像学杂志, 2023, 46(3): 381-388. doi: 10.12122/j.issn.1674-4500.2023.03.01
WANG Hui, WANG Siqi, LOU Jianjuan, ZOU Qigui, WANG Shouju. Factors affecting the diagnostic performance of suspicious amorphous calcification[J]. Journal of Molecular Imaging, 2023, 46(3): 381-388. doi: 10.12122/j.issn.1674-4500.2023.03.01
Citation: WANG Hui, WANG Siqi, LOU Jianjuan, ZOU Qigui, WANG Shouju. Factors affecting the diagnostic performance of suspicious amorphous calcification[J]. Journal of Molecular Imaging, 2023, 46(3): 381-388. doi: 10.12122/j.issn.1674-4500.2023.03.01

无定形钙化良恶性判断的影响因素

doi: 10.12122/j.issn.1674-4500.2023.03.01
基金项目: 国家自然科学基金优秀青年科学基金项目(82022034);江苏省自然科学基金杰出青年基金项目(BK20200032)
详细信息
    作者简介:

    王慧,在读硕士研究生,主治医师,E-mail: bhqyhuihui@163.com

    通讯作者:

    王守巨,博士,主任医师,博士生导师,E-mail: Shouju.wang@gmail.com

Factors affecting the diagnostic performance of suspicious amorphous calcification

Funds: Supported by National Natural Science Foundation of China-Outstanding Youth Science Foundation (82022034)
  • 摘要:   目的  探讨影响可疑无定形钙化诊断正确性的因素,并通过定量分析评估各影响因素的诊断性能。  方法  回顾性研究2019年6月1日~2021年6月1日进行乳腺X线检查的118例患者(120个病灶),患者均为女性,年龄46.7±9.7岁,中位年龄46岁。由2位工作10年以上从事乳腺影像诊断的医师对所有病例进行双盲诊断,入组病例依照2013年第5版乳腺影像报告和数据系统(BI-RADS)作为诊断标准进行描述分类,以病理结果为金标准,通过诊断试验评价指标及ROC曲线分析确定各种影响因素对可疑无定形钙化良恶性结果判断的诊断性能。  结果  乳腺动态增强磁共振(DCE-MRI)对可疑无定形钙化敏感性、特异性、阳性预测值和阴性预测值分别为100%、71.4%、71.4%、100%,曲线下面积为0.857(95% CI:0.782~0.914)。DCE-MRI检出了所有的恶性病变,点状强化病例在DCE-MRI显示的3种强化类型中诊断特异性最高,为94.4%,曲线下面积最大,为0.972(95% CI:0.785~1.000,P < 0.05)。在全体入组病例中,可疑无定形钙化恶性率为41.7%;而在无伴随征象的纯钙化组中,可疑无定形钙化的恶性率则降为24%。在钙化分布类型中,集群及区域分布的可疑无定形钙化恶性率在BI-RADS 4B等级,曲线下面积分别为0.895(95% CI:0.798~0.955)、0.815(95%CI:0.650~0.924),区域分布病例的恶性率最低为25%,在其中的纯钙化组中,恶性率则降至8%。  结论  乳腺DCE-MRI具有高敏感度,检测出所有的恶性病灶,其中点状强化病灶诊断特异性最高。在影响可疑无定形钙化诊断的诸多因素中,纯钙化组比有伴随征象组诊断特异性明显提高,对可疑无定形钙化良恶性的判断有很大的价值。钙化分布中,区域分布的纯钙化组恶性率最低,可以选择定期临床随访,从而避免一些不必要的活检或手术。

     

  • 图  1  本研究数据流程图

    Figure  1.  Flowchart shows the data in this study. BI-RADS: Breast imaging-reporting and data system.

    图  2  可疑无定形钙化各影响因素ROC曲线图

    Figure  2.  ROC curve of each factor affecting suspicious amorphous calcification. AUC: Area under the curve; DCE-MRI: Dynamic con-trast-enhanced magnetic resonance imaging.

    图  3  经乳腺DCE-MRI判断为恶性可疑无定形钙化病例

    Figure  3.  The case which was diagnosed malignant suspicious amorphous calcification by DCE- MRI. A: Craniocaudal; B: Mediolateral oblique and local magnification of suspected amorphous calcification (3×magnification); C: Axial T1WI sequence; D: Axial TIRM sequence; E: Axial DWI sequence; F: Axial DCE sequence; G: Sagittal DCE sequence.

    图  4  经乳腺DCE-MRI判断为良性可疑无定形钙化病例

    Figure  4.  The case which was diagnosed benign suspicious amorphous calcification by DCE-MRI. A: Craniocaudal and local magnification of suspected amorphous calcification (3×magnification); B: Mediolateral oblique; C: Axial T1WI sequence; D: Axial TIRM sequence; E: Axial DWI sequence; F: Axial DCE sequence; G: Sagittal DCE sequence.

    表  1  患者一般资料

    Table  1.   General data of patients [n(%)]

    General data Total (n=118) Benign (n=68) Malignant (n=50) P
    Age (years, Mean±SD) 46.7±9.7 45.2±8.3 48.7±10.9 0.060
    Menopausal status 0.017
          Premenopausal 89(75.4) 57(83.8) 32(64.0)
          Postmenopausal 29(24.6) 11(16.2) 18(36.0)
    Family history of breast cancer 0.464
          Yes 8(6.8) 6(8.8) 2(4.0)
          No 110(93.2) 62(91.2) 48(96.0)
    Personal history of breast cancer 0.073
          Yes 3(2.5) 0 3(6.0)
          No 115(97.5) 68(100.0) 47(94)
    下载: 导出CSV

    表  2  120例病灶BI-RADS分类和病理对照

    Table  2.   Classification and pathologic comparison of BI-RADS in 120 cases [n(%)]

    Pathology Clinical management BI-RADS 1(n=29) BIRADS 2/3(n=21) BI-RADS 4(n=66) BI-RADS 5(n=4)
    Benign Biopsy 24(82.8) 21(100.0) 19(28.8) 0
    Follow-up 5(17.2) 0 1(1.5) 0
    Malignant Biopsy 0 0 46(69.7) 4(100.0)
    Follow-up 0 0 0 0
    下载: 导出CSV

    表  3  定量分析可疑无定形钙化良恶性判断的影响因素

    Table  3.   Quantitative evaluation of the benign and malignant factors of suspicious amorphous calcification.

    Classification Total(n) Malignant(n) PPV (%) AUC 95% CI P
    Calcification distribution
           Grouped 70 32 45.7 0.895 0.798-0.955 < 0.001
           Regional 36 9 25.0 0.815 0.650-0.924 < 0.001
           Linear 3 3 100.0 - - -
           Segmental 11 6 54.6 0.800 0.463-0.971 0.014
    Associated features
           No 75 18 24.0 0.904 0.813-0.960 < 0.001
           Yes 45 32 71.1 0.654 0.497-0.789 0.021
    DCE-MRI enhancement
           No 30 0 0 - - -
           Focus and foci 20 2 10.0 0.972 0.785-1.000 < 0.001
           Masses 38 29 76.3 0.611 0.440-0.765 0.131
           NME 32 19 59.4 0.538 0.354-0.715 0.317
    NME: Nonmass-like enhancement; PPV: Positive predictive value.
    下载: 导出CSV

    表  4  有无伴随征象对区域及集群分布可疑无定形钙化DCE-MRI诊断性能的影响

    Table  4.   The influence of associated features on the diagnostic performance of DCE- MRI in suspicious amorphous calcification with regional and grouped distribution

    Distribution Lesion classification Pathology PPV (%) Sensibility(%) Specificity(%) Detail
    Regional Total (n=36) Benign (n=27) 25 100 63 15FC; 1FT; 8OB;
    3 follow-up
    Malignant (n=9) 1IDC; 1OM
    1DCIS; 6IDC with DCIS
    Calcifications without associated features (n=23) Benign (n=21) 8 100 76.1 13FC; 1FT; 4OB;
    3 follow-up
    Malignant (n=2) 1DCIS; 1OM
    Grouped Total (n=70) Benign (n=38) 45 100 79 28FC; 3FT; 4OB;
    3 follow-up
    Malignant (n=32) 3IDC;
    2OM
    12DCIS;
    15IDC with DCIS;
    Calcifications without associated features (n=43) Benign (n=31) 27.9 100 87.1 23FC; 1FT; 4OB;
    3 follow-up
    Malignant (n=12) 10DCIS; 1OM;
    1IDC with DCIS
    FC: Fibrocystic change; FT: Fibroepithelial tumors; OB: Other benign tumors; IDC: Invasive ductal carcinoma; DCIS: Ductal carcinoma in situ; OM: Other malignant tumors.
    下载: 导出CSV
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  • 收稿日期:  2023-02-15
  • 网络出版日期:  2023-06-15
  • 刊出日期:  2023-05-20

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