常规超声与MRI对乳腺X线摄影阴性乳腺癌诊断价值的对比研究

Comparison of diagnostic value between ultrasound and MRI in breast cancer with negative mammography

目的:比较常规超声与MRI对乳腺X线摄影阴性乳腺癌的诊断价值。方法:收集上海交通大学医学院附属新华医院乳腺X线摄影检查阴性,并接受常规超声及MRI检查的乳腺疾病患者257例共305个病灶,以术后病理为对照,回顾性分析常规超声与MRI检查对乳腺X线摄影阴性乳腺病灶的检出率及诊断价值。结果:常规超声和MRI对乳腺X线摄影阴性乳腺病灶的总检出率分别为97.38%和90.49%。MRI对导管内病灶的检出率高于常规超声(98.21%和75.00%,P<0.05),两种方法对肿块型病灶的检出率无统计学差异(97.19%和93.98%,P>0.05)。常规超声和MRI对乳腺X线摄影阴性乳腺癌诊断的灵敏度、特异度、准确率分别为85.37%、74.62%、76.07%,90.24%、58.71%、62.95%,常规超声对乳腺X线摄影阴性乳腺癌的诊断特异度和准确率高于MRI(P<0.001)。常规超声和MRI诊断乳腺X线摄影阴性乳腺癌的受试者工作特征(receive operating characteristic,ROC)曲线下面积分别为0.800和0.745,无统计学差异(P>0.05)。结论:常规超声和MRI对乳腺X线摄影阴性乳腺病灶均具有较高的检出率,其中MRI对导管内病灶的检出率优于常规超声,但常规超声与MRI对乳腺X线摄影阴性乳腺癌的诊断效能相仿,因此常规超声可作为乳腺X线摄影阴性患者的首选检查方法。

Objective： To compare the diagnostic value of ultrasound and magnetic resonance imaging（MRI） in breast cancer with negative mammography. Methods： A total of 305 lesions from 257 mammography-negative patients who underwent ultrasound and MRI examinations were retrospectively analyzed. All cases were confirmed by pathology after surgery. The differences in the detection rate for mammography-negative breast lesions and the diagnostic value for mammography-negative breast cancer between ultrasound and MRI were analyzed. Results： The detection rate of MRI and ultrasound for all mammographynegative lesions was 97.38% and 90.49%, respectively. MRI had the higher detection rate than ultrasound for intraductal lesions（98.21% vs. 75.00%, P〈0.05）, and there was no significant difference between the two methods in the detection rate of mass-like lesions（97.19% vs. 93.98%, P〈0.05）. The sensitivity, specificity and accuracy of ultrasound and MRI in diagnosing breast cancer were 85.37%, 74.62%, 76.07% and 90.24%, 58.71%, 62.95%, respectively. The specificity and accuracy of ultrasound were higher than MRI（P〈0.001）. The area under receiver operating characteristic（ROC） curves of ultrasound and MRI was 0.800 and 0.745, respectively, and there was no significant difference between the two methods（P〈0.05）. Conclusion： Both ultrasound and MRI have a high detection rate of mammography-negative breast lesions, and MRI is superior to ultrasound in detection of mammographynegative introductal lesions. The diagnostic value of ultrasound in mammography-negative breast cancer is similar to MRI, therefore, ultrasound should be the preferred method for screening.