X线、CT和乳腺磁共振在乳腺癌诊断和保乳术前评估中的应用研究

The application of X-ray, CT and breast magnetic resonance in the diagnosis of breast cancer and the preoperative assessment of breast-conserving surgery

目的分析X线、CT和乳腺磁共振在乳腺癌诊断和保乳术前评估中应用价值。方法回顾性分析2014年9月~2017年10月医院乳腺外科收治的乳腺手术患者入组,良性患者25例,病灶26个,恶性患者25例,病灶27个,其中最终保乳手术治疗11例、根治手术14例。对比X线、CT和乳腺磁共振良恶性肿瘤的定性诊断效用,评价保乳手术风险预测效果。结果 X线、CT和乳腺MR检查的灵敏度、特异度、阳性预测值、阴性预测值、符合率分别为72.0%、64.0%、66.7%、69.6%、68.0%,92.0%、92.0%、92.0%、92.0%、92.0%,92.0%、88.0%、88.5%、91.7%、90.0%,X线特异度、阳性预测值、阴性预测值、符合率低于CT、MR,差异有统计学意义(P<0.05)。保乳术的绝对禁忌证及相对禁忌证情况:广泛性病变11例,无法完整切除12例,最终切缘阳性10例,肿瘤直径>5 cm 9例。MR检查检出根治手术阳性特征92.9%(39/42),高于X线45.2%(19/42)、CT 71.4%(30/42),差异有统计学意义(P<0.05)。结论X线、CT和乳腺MR都可作为乳腺癌的诊断技术,CT、MR价值相对更高;在保乳术的禁忌证评估方面,MR的价值更大,可用于评估保乳术的难度而获益。

Objective To analyze the value of X-ray, CT, and breast magnetic resonance imaging in the diagnosis of breast cancer and the preoperative assessment of breast-conserving surgery. Methods A retrospective analysis was performed in patients admitted to the hospital for breast surgery from September 2014 to October 2017. There were 25 benign cases with 26 lesions and 25 malignant cases with 27 lesions including 11 cases of breast-conserving surgery and 14 cases of radical surgery. We compared the qualitative diagnostic utility of benign and malignant tumors and evaluate the predictive effect on breast-conserving surgery of X-ray, CT, and breast magnetic resonance. Results The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of X-ray, CT and breast MR examinations were 72.0%, 64.0%, 66.7%, 69.6%, 68.0%, 92.0%, 92.0%, 92.0%, 92.0%, 92.0%, 92.0%, 88.0%, 88.5%, 91.7%, 90.0%, respectively. The specificity, positive predictive value, negative predictive value and coincidence rate of X-ray were lower than CT and MR, the differences were statistically significant（P〈0.05）. Absolute contraindications and relative contraindications of breast-conserving surgery： 11 cases of extensive lesions, 12 cases of non-complete resection, 10 cases of positive incisal edge, 9 cases with tumor diameter 〉Scm. The positive result of radical surgery was 92.9%（39/42） in MR examination, which was more than 45.2%（19/42） in X-ray and 71.4%（30/42） in CT, the differences were statistically significant（P〈0.05）. Conclusion X-ray, CT, and mammary MR can all be used as a diagnostic technique for breast cancer, while CT and MR have relatively high value. In the assessment of contraindications in breast-conserving surgery, MR has greater value and can be used to evaluate the difficulty of breast-conserving surgery.