对比增强能谱乳腺X线摄影量化评分对定性乳腺病灶的价值

The Value of Contrast-Enhanced Spectral Mammography Quantification Score in Thedifferential Diagnosis of Breast Lesions

目的探讨对比增强能谱乳腺X线摄影(CESM)量化评分对定性乳腺病变的价值。方法回顾性分析2017年8月至2019年3月本院临床或超声检查怀疑有乳腺病变,并在术前一周内行CESM检查的患者资料。两名经验丰富的乳腺诊断放射科医师共同对同一患者的低能图进行乳腺影像报告和数据系统(BI-RADS)评分,对减影图进行病灶强化程度分级,计算CESM综合评分。通过与病理对照,使用受试者工作特征(ROC)曲线比较低能图BI-RADS评分、减影图病灶强化程度分级和CESM综合评分鉴别诊断乳腺良、恶性病变的效能。结果检出190个乳腺病灶,其中良性病灶97个,恶性病灶93个。低能图BI-RADS评分、减影图病灶强化程度分级和CESM综合评分判别病灶良、恶性的曲线下面积(AUC)分别为0.83、0.87、0.95;CESM综合评分与低能图BI-RADS评分、减影图病灶强化程度分级的AUC有统计学差异(P均<0.0001),后两者的AUC间无统计学差异(P=0.34);三者判别乳腺病灶为恶性的诊断敏感度分别为84.95%、92.47%、89.25%,特异度分别为71.13%、67.01%、93.81%。结论综合低能图及减影图的CESM综合评分提高了定性乳腺病变的诊断效能。

Objective To explore the value of contrast-enhanced spectral mammography(CESM)quantification score in the differential diagnosis breast lesions.Methods Patients who were suspected of breast disease by clinical or ultrasound examination in our hospital from August 2017 to March 2019 were prospectively collected.All patients underwent CESM examinations one week before surgery.Two experienced radiologists performed BI-RADS classifications on the low-energy(LE)images of the same patient in turn,and then graded the lesions on the subtraction images,and finally obtained the CESM score.Using pathology results as the gold standard,the diagnostic efficacy of LE,subtraction images and CESM were analyzed by ROC curve.Results A total of 190 breast lesions were detected,including 97 benign lesions and 93 malignant lesions.The areas under ROC curves(AUC)of LE,subtraction images and CESM were 0.83,0.87 and 0.95,respectively.There was significant difference of AUC between CESM and LE,so did the CESM and subtraction images(P<0.0001),but there was not significant difference between LE and subtraction images(P=0.34).The diagnostic sensitivity of LE,subtraction images and CESM were 84.95%,92.47%and 89.25%,specificity was 71.13%,67.01%,93.81%,respectively.Conclusion CESM which includes LE,subtraction images improves the differential diagnostic efficacy of benign and malignant breast lesions.