乳腺X线摄影联合DW-MRI在致密性乳腺肿瘤筛查中的应用价值

The value of mammography combined with DW-MRI in dense breast screening

目的探讨DW-MRI(diffusion-weighted magnetic resonance imaging,DW-MRI)作为乳腺X线摄影(mammography,MMG)筛查乳腺癌的补充方式在致密性乳腺中的诊断效能,并对比分析与动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)诊断价值的差异。方法回顾性分析病理确诊的82例乳腺癌患者及41例健康或病理证实为良性病变的阴性病例作为模拟筛查人群,分析其MMG及DWI、MMG/DWI、DCE-MRI影像学资料,比较4种检查技术对乳腺疾病诊断的敏感性和特异性。结果MMG、DWI、MMG/DWI及DCE-MRI诊断的敏感性分别为52.44%、76.83%、85.37%、93.90%;特异性分别为51.22%、65.85%、78.05%、85.36%。MMG与DWI联合检查的敏感性及特异性显著高于MMG单独检查(P<0.01),但仍低于DCE-MRI(P>0.05)。MMG/DWI的受试者工作特性(receiver operating characteristic,ROC)曲线下面积(AUC)(AUC 0.817)虽然低于DCE-MRI(AUC 0.896),但与单独的MMG(AUC 0.518)相比,MMG和DWI-MRI的组合具有更高的敏感度(85.37%)。结论在乳腺组织致密的女性中,DWI和MMG相结合可明显提高诊断的敏感性和特异性。DW-MRI可作为一种快速辅助筛查乳腺癌的工具。

Objective To investigate the diagnostic efficacy of DW-MRI as a supplementary method of Mammography MMG screening for breast cancer in dense breast,and to compare the diagnostic value difference between MMG/DWI and DCE-MRI.Methods 82 patients with breast cancer diagnosed pathologically in the retrospective data and 41 negative groups with healthy or pathologically confirmed benign lesions were set as screening model.The MMG,DWI,MMG/DWI,DCE-MRI imaging data were analyzed.The sensitivity and specificity of 4 examination techniques were compared for breast disease diagnosis.Results The diagnostic sensitivities of MMG,DWI,MMG/DWI and DCE-MRI were 52.44%,76.83%,85.37%,and 93.90%;the specificities were 51.22%,65.85%,78.05%,and 85.36%.The sensitivity and specificity of MMG and DWI combined examination were significantly higher than those of MMG alone examination(P<0.01),but still lower than DCE-MRI(P>0.05).Although the area under the receiver operating characteristic curve(AUC)(AUC 0.817)of MMG/DWI was lower than DCE-MRI(AUC 0.896),compared to MMG alone(AUC 0.518),MMG and DWI-MRI combination had higher sensitivity(85.37%).Conclusion For women with dense breast,the combination of DWI and MMG can significantly improve the sensitivity and specificity of diagnosis.DWI-MRI can be used as a rapid supplemental screening method for breast cancer.