以MRI为参照评价乳腺X线摄影的病灶检出效能

Efficacy of X-ray mammography in breast diseases detection using MRI as reference

目的数字化乳腺X线摄影(digital X-ray mammography,DMG)判读的个体差异较大,对一些病灶的判读缺乏病理实证措施。该研究以MRI为参照,通过前瞻性和回顾性的DMG阅片对比分析,比较DMG与MRI对乳腺病变检出及分类定性的一致性。材料与方法收集316例接受乳腺MRI和DMG检查的病例,以DMG独立的BI-RADS分类作为DMG的前瞻性诊断(the prospective BI-RADS categorization of DMG,pDMG),以受MRI辅助的BI-RADS分类作为回顾性诊断(the retrospective BI-RADS categorization of DMG,rDMG),比较前瞻性和回顾性DMG判读的一致性和与MRI的差别。结果pDMG和rDMG对病灶的BI-RADS分类(Ⅱ~Ⅳ)的一致性为69.66%(163/234),Spearman相关系数r=0.813,P<0.05;pDMG和MRI对病灶Ⅱ~Ⅴ分类评价的一致性为36.41%(79/217),Spearman相关系数r=0.435,P<0.05。rDMG和MRI对病灶Ⅱ~Ⅴ分类评价的一致性为44.22%(134/303),Spearman相关系数r=0.546,P<0.05;以MRI报告的病灶数量为参照,pDMG的检出率66.42%(269/405),rDMG检出率74.81%(303/405)。DMG表现为钙化、肿块、不对称密度的病灶与MRI的肿块、非肿块强化和BPE等不构成对应关系。结论DMG判读具有较大的个体间差异,MRI和DMG在病灶的检出数量和分类诊断都缺乏很好的一致性,其影像表现也缺乏一一对应的关系。

Objective:Digital X-ray mammography(DMG)interpretation shows reader’s discrepancy and lacks pathological confirmation for some cases.In this study,we used MRI as a reference to investigate DMG in detection and categorization of breast lesions in a prospective and retrospective readings.Materials and Methods:A total of 316 patients underwent breast MRI and DMG were enrolled in this study.The prospective BI-RADS categorization of DMG(pDMG)was independent of MRI,while the retrospective BI-RADS categorization of DMG(rDMG)was MRI-assisted.The detection and categorization between DMG and MRI were compared.Results:The consistency between pDMG and rDMG in BI-RADS categoryⅡ—Ⅳwas 69.66%(163/234),where Spearman r=0.813 and P<0.05.Their consistency between pDMG and MRI in BI-RADS categoryⅡ—Ⅴwas 36.41%(79/217),where Spearman r=0.435 and P<0.05.The consistency between rDMG and MRI in BI-RADS categoryⅡ—Ⅴwas 44.22%(134/303),where Spearman r=0.546,P<0.05.Using MRI as reference,the DMG had a detection rate of 66.42%(269/405)prospectively and 74.81%(303/405)retrospectively.The imaging findings of calcification,mass and asymmetric density on DMG were not consistent with the mass,non-mass-enhancement or background parenchymal enhancement on MRI.Conclusions:DMG is reader dependent in the lesions detection and categorization.MRI and DMG lack a satisfactory consistency in the lesions detection and BI-RADS categorization.Their imaging findings also lack any sort of one-to-one correspondence.