MRI对BI-RADS3～4类单纯微钙化良、恶性病变的鉴别诊断价值

The differential diagnosis value of MRI for benign and malignant breast lesions in patients with BI-RADS 3-4 pure mammography micro- calcifications

目的探讨MRI对乳腺X摄影BI-RADS3-4类单纯微钙化良、恶性病变的鉴别诊断价值。方法搜集2013年8月-2015年3月遵义市第一人民医院乳腺X线摄影BI-RADS3-4类单纯微钙化66例70个病灶,术前应用1.5T磁共振平扫及动态增强,乳腺X线引导下钩丝定位手术切除,对手术标本行乳腺X线摄影,观察病变是否完整切除;以病理结果为金标准,分析MRI表现与病理的相关性。结果 66例70个病灶,乳腺X线检查BI-RADS3类24个,4类46个;MRI检查评估为BI-RADS-MRI 1类26个,2类1个,3类15个;4类14个,5类14个;病理诊断：良性54个,恶性16个;乳腺X线摄影对BI-RADS3-4类单纯微钙化阳性预测值及准确性均为22.9%;MRI检查对BI-RADS3-4类单纯微钙化恶性病变阴性预测值为100%,敏感性为100%,特异性77.8%,准确性82.8%,阳性预测值57.1%。其阳性预测值及准确性均明显高于X线,二者之间差异有统计学意义（χ^2=10.69,P〈0.01及χ^2=50.57,P〈0.01）。结论 MRI检查对BI-RADS3-4类单纯微钙化良、恶性病变有较好的鉴别诊断价值,可避免不必要的活检,提高乳腺疾病活检的阳性率。

Objective To analyze the differential diagnosis value of MRI for benign and malignant breast lesions in patients with BI - RADS 3 - 4 pure mammography micro - calcifications. Methods 70 lesions in 66 cases with BI -RADS 3 -4 pure mammography micro -calcifications were collected from August 2013 to March 2015 from First peopleg Hospital of Zunyi City, Noncontrast and dynamic enhancement breast 1.5 T MRI scan were performed before surgical resect guided by the mammography hook wire localization. With pathological diagnosis as the gold standard, analyze the correlation between MRI findings and histological results. Results There were 66 patients with 70 lesions in our study. Mammography identified 24 BI - RADS 3 and 46 BI - RADS 4 lesions, while MRI identified 26 BI -RADS 1 lesions, 1 BI -RADS 2 lesion, 15 BI -RADS 3 lesions, 4 BI -RADS 4 lesions and 14 BI -RADS 5 lesions, Pathological results demonstrated 16 malignant lesions and 54 benign lesions. The positive predictive value and the accuracy of mammography BI - RADS 3 - 4 pure micro - calcifications were both 22.9%, the negative prediction value, sensitivity, specificity, accuracy and positive prediction value of MRI were 100%, 100% , 77.8%, 82.8%, 57.1% , respectively. The positive prediction value and accuracy based on MRI were higher than those of mammography, which showed a statistically significant difference （ χ^2 = 10.69, P 〈 0.01 and χ^2 = 50.57, P 〈 0.01 ）. Conclusion MRI is a reliable method for differential diagnosis of benign and malignant lesions in patients with BI - RADS 3 -4 pure mammography micro - calcifications, which can avoid unnecessary biopsies and improve the positive biopsy rate of breast disease .