MIBI断层双时相显像诊断乳腺癌的临床价值

The clinical value of dual-phase ^99Tc^m-MIBI SPECT in diagnosis of breast lesions

目的探讨^99Tc^m-甲氧基异丁基异腈（MIBI）乳腺断层双时相显像诊断乳腺癌的临床价值。方法采用自制乳腺断层显像装置对26名健康对照者和93例乳腺肿块患者行^99Tc^m-MIBI乳腺断层双时相显像，分别计算健康对照者两侧对应部位及乳腺肿块患者早期相和延迟相肿瘤与健侧对应部位的放射性（T／NT）比值，并与术后或活组织病理检查结果对照。结果（1）^99Tc^m-MIBI乳腺断层双时相显像示，健康对照组乳腺早期和延迟相T／NT比值为1．09±0．18和1．08±0．19，差异无统计学意义（t=1．443，P〉0．05）；乳腺肿块良性病变组早期和延迟相T／NT比值为2．08±2．85和1．69±3．05，差异有统计学意义（t=2．814，P〈0．05）；乳腺癌组早期和延迟相T／NT比值为5．00±4．34和6．79±11．94，差异无统计学意义（t=-0．884，P〉0．05）；健康对照组、良性病变组和乳腺癌组间早期相T／NT比值差异有统计学意义（t值分别为2．912，2．412和3．940；P均〈0．05）。（2）^99Tc^m-MIBI乳腺肿块断层双时相显像诊断乳腺病变的灵敏度为97．1％，特异性为79．3％，准确性为86．0％，阳性预测值为73．9％，阴性预测值为97．9％，总的诊断符合率为86．0％。在乳腺癌组中诊断准确性为97．1％，在乳腺良性病变组中诊断准确性为79．3％。（3）乳腺癌肿块直径〈2cm、2—5cm及〉5cm组^99Tc^m-MIBI乳腺断层双时相显像的灵敏度分别为5／6，100％（21／21）和8／8。结论^99Tc^m-MIBI乳腺断层双时相显像是一种高灵敏度和特异性的乳腺癌检测方法，对鉴别乳腺良恶性病变有较高的临床价值。

Objective ^99Tc^m-methoxyisobutylisonitrile （MIBI） had been widely reported for breast cancer imaging. However, most of the reports used to be static imaging. The aim of this study was to validate the clinical value of dual-phase ^99Tc^m-MIBI SPECT in diagnosis of breast lesions. Methods In all, 119 subjects were included. Twenty-six were normal and 93 had breast lesions. All underwent dual-phase ^99Tc^m-MIBI SPECT and the imaging device was self-designed. Tumors to non-tumor radioactivity ratios （T/NT） were calculated at early （5 min） and delayed （180 min） phases. Moreover, the validity of the breast lesions among all patients was based on the results from histopathology. Results Malignant lesions had the highest uptake of MIBI, followed by benign lesions and normal in beth early and delayed phases. No statistical differences were noted between the T/NT at early and delayed phases in normal breasts and malignant tumors （ 1.09 ± 0.18 vs 1.08 ±0.19, t = 1.443,P〉0.05; 5.00 ±4.34 vs 6.79 ± 11.94, t = -0. 884,P〉0.05）. Interestingly, significant difference was noted between the T/NT at early and delayed phases in benign tumors （2.08 ± 2.85 vs 1.69 ± 3.05, t = 2. 814,P 〈 0.05 ）. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of dual-phase ^99Tc^m-MIBI SPECT in diagnosis of breast lesions were 97.1%, 79.3%, 86.0%, 73.9% and 97.9%, respectively. The pooled diagnostic coincidence ratio was 86.0%. The diagnostic accuracy was 97.1% in malignant tumors, and 79.3% in begin lesions. If the detectability of dual-phase ^99Tc^m-MIBI SPECT was considered with the tumor size, the sensitivity was 5/6 for tumor diameter of 〈2 cm and was 100% （29/29） for those ≥2 cm. Conclusion This self-design device was optimal to detect breast tumor with ^99Tc^m-MIBI, especially combined with a dual-phase study.