不同影像学方法对乳腺肿瘤诊断的对比分析

Comparison of different imaging methods in diagnosis of breast tumor

目的采用不同影像学方法对乳腺肿瘤进行诊断比较。方法选取2014年1月至2017年12月在温岭市第一人民医院乳甲外科就诊的242例(患乳共计484个)疑似双侧乳腺癌肿瘤患者为研究对象,对所有患者均行超声、钼靶X线、磁共振成像(MRI)检查,对检出的肿块、毛刺征和钙化情况进行统计分析,以比较不同影像学检查方法对乳腺肿瘤的大小及精准度的诊断情况。结果超声检查对肿块敏感度较高,但对毛刺征及钙化漏诊率较高;钼靶X线对肿块和钙化敏感度较高,但毛刺征漏诊率较高;MRI检查对肿块及毛刺征敏感度较高,但钙化漏诊率较高。在346个恶性病灶中,超声检查误诊和不确定性病灶52个,钼靶X线检查误诊和不确定性病灶40个,MRI检查误诊和不确定性病灶12个,MRI检查误诊与不确定性病灶数明显低于超声及钼靶X线检查,经比较差异有统计学意义(χ~2=105.803,P<0.05);超声、钼靶X线和MRI等影像学检查方法对病变特点的敏感度比较,均具有统计学意义(χ~2值分别为130.399、36.630、210.463,均P<0.05)。钼靶X线的ROC曲线下面积为0.734,95%CI:0.704~0.795,P<0.001;超声的ROC曲线下面积为0.892,95%CI:0.865~0.922,P<0.001;MRI的ROC曲线下面积为0.933,95%CI:0.918~0.957,P<0.001。超声、钼靶X线测量值明显低于病理标本测量值,而MRI测量值明显高于病理标本测量值,经比较差异具有统计学意义(F=83.600,P<0.05)。结论超声、钼靶X线及MRI检查对乳腺肿瘤大小预估具有一定误差,超声与钼靶X线会低估肿瘤的大小,而MRI会高估肿瘤的大小;钼靶X线及B超操作简易且费用较低,但准确率偏低。联合使用钼靶和B超可提高乳腺肿瘤诊断的敏感性,MRI检查准确率较高,且能显示乳腺肿瘤的具体情况,适用于临床对患者制定治疗方案。

Objective To compare different imaging methods in diagnosing of breast tumor.Methods Altogether 242 patients (484 lesions) with suspected bilateral breast carcinoma treated in breast surgery department of The First People’s Hospital of Wenling from January 2014 to December 2017 were selected as study objects.All patients received B-ultrasonography,mammography and magnetic resonance imaging (MRI) check.Detected mass,spiculation and calcification were analyzed to compare accuracy of different imaging methods in tumor size determination.Results B-ultrasonography had a high sensitivity in mass detection,but its misdiagnosis rate of microcalcification and spiculation was high.Mammography had a high sensitivity in mass and microcalcification detection,but its misdiagnosis rate of spiculation was high.MRI was highly sensitive to mass and spiculation,but its misdiagnosis rate of microcalcification was high.Total number of misdiagnosed and uncertain lesions by B-ultrasonography,mammography and MRI were 52,40 and 12,respectively among 346 malignant lesions.Number of misdiagnosed and uncertain lesions by MRI check was lower than that by B-ultrasonography and mammography,and difference had statistical significance (χ^2=105.803,P<0.05).There were also significant differences in sensitivity of lesions with different features by ultrasonography,mammography and MRI (χ^2 value was 130.399,36.630 and 210.463,respectively,all P<0.05.).Area under ROC curve of mammography was 0.734 and 95%CI ranged 0.704 to 0.795 (P<0.001).Area under ROC curve of B-ultrasonography was 0.892 and 95%CI ranged 0.865 to 0.922 (P<0.001).Area under ROC curve of MRI was 0.933 and 95%CI ranged 0.918 to 0.957 (P<0.001).Measured values by B-ultrasonography and mammography were obviously lower than those measured by specimens,while measured values by MRI were significantly higher than measured values by specimens,and all differences had statistical significance (F=83.600,P<0.05).Conclusion B-ultrasonography,mammography and MRI have certain errors in predicting tumor size of breast cancer.B-ultrasonography and mammography will underestimate tumor size,while MRI will overestimate tumor size.B-ultrasonogaphy and mammography are easy to operate and cheap,while their detection accuracy is relatively low.The combined application of these two methods may improve diagnosis sensitivity for tumor.MRI can show actual status of breast tumor,so it is more helpful for therapy determination.