乳腺专用磁共振成像、乳腺X线摄影及超声检查对乳腺癌诊断价值的对照研究

The Diagnostic Value of Dedicated Breast Magnetic Resonance Imaging in Breast Cancer: Comparative Study with Digital Mammography and Ultrasound

目的回顾性比较研究乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)、超声(ultrasound,US)及乳腺X线摄影(mammography,MG)3种检查方法对乳腺癌的诊断价值。方法搜集我院行手术治疗并于术前同时行DBMRI、MG及US 3种检查的患者共612例,剔除36例于检查时已行新辅助化疗的患者,共576例患者纳入本研究,所有入组患者均以病理学结果作为金标准。数据分析与统计采用SPSS 13.0统计软件。以P<0.05为差异有统计学意义。结果 DBMR对乳腺癌病灶检出的敏感性为97.1%,高于MG(77.6%)(χ2=53.904,P=0.000)及US(91.0%)(χ2=10.370,P=0.001);MG对乳腺癌病灶检出的特异性为88.8%,高于DB-MR(82.8%)(χ2=3.925,P=0.048)及US(82.5%)(χ2=4.383,P=0.036)。对于导管内癌,DBMRI检出的敏感性为97.9%,高于US(77.8%)(χ2=29.445,P=0.000)及MG(71.1%)(χ2=9.680,P=0.002)。在致密型乳腺中,DBMRI诊断灵敏度高为96.0%,高于MG(66.7%)(χ2=35.806,P=0.000);US诊断敏感性为92.1%,高于MG(66.7%)(χ2=24.812,P=0.000)。在非致密型乳腺中,DBMR诊断敏感性为97.9%,高于MG(85%)(χ2=19.684,P=0.000)及US(90.4%)(χ2=19.684,P=0.002)。DBMRI、MG、US对伴钙化的乳腺癌检出的敏感性分别为98.3%、94.0%和94.8%。结论 DBMRI对乳腺癌的检出敏感性高,但特异性较低;对于导管内癌的诊断,DBMRI具有显著优势;在致密型乳腺乳腺癌的检出中,DBMRI与US均具有高敏感性,优于MG。

Objective To retrospectively analyze the diagnostic value of dedicated breast Magnetic Resonance Imaging （DBMRI） in diagnosing breast cancer by comparing with Mammography（MG） and ultrasound（US）. Methods A total of 612 patients underwent preoperative DBMRI, MG, and US examination were collected and 36 cases received neoadjuvant chemotherapy before the examination were excluded. The remaining 576 cases were included to be analyzed using pathological consequences as the golden criteria. Statistical analysis was performed using SPSS 13.0 for Windows. P value less than 0.05 indicated statistical significance. Results For detecting breast cancinoma, DBMRI had higher sensitivity （97.1% ） than MG（77.6% ） （ χ2 = 53. 904,P = 0. 000） and US （91.0%） （ χ2 = 10. 370, P = 0. 001 ）. MG had higher specificity （ 88.8% ） than DBMRI （ 82.8% ） （χ2 = 3. 925, P = 0. 048 ） and US （ 82.5% ） （ χ2 = 4. 383, P = 0. 036 ）. For detecting DCIS, DBMRI had higher sensitivity（97.9% ） than US（77.8% ） （ χ2 = 29. 445 ,P = 0. 000） and MG（71.1% ） （ χ2 = 9. 680 ,P = 0. 002）. For detecting breast carcinoma in dense breast patients, the sensitivity of DBMRI （96.0%） and US （92.1%） was higher than MG（66.7% ）. For detecting breast carcinoma in non dense breast patients, the sensitivity of DBMRI （97.9%） was higher than MG（85% ） （χ2 = 19. 684,P =0. 000） and US（90.4% ） （χ2 = 19. 684,P =0. 002）. The sensitivity of DBMRI, MG, and US in detecting breast cancer with calcifications was 98.3% , 94.0%, and 94.8%.Conclusion Compared with MG and US, DBMRI has a higher sensitivity and lower specificity in detecting breast cancer. It has more valuable than MG and US in diagnosing DCIS. DBMRI and US have a higher sensitivity in detecting breast cancer in dense breasts than MG.