钼靶、断层摄影、超声和磁共振在乳腺癌诊断中的对比

Comparison of digital mammography,digital breast tomosynthesis,ultrasound and MRI in the diagnosis of breast cancer

目的 比较数字化乳腺X射线摄影(钼靶,DM)、断层摄影(DBT)、超声检查(US)和磁共振成像(MRI)在乳腺癌中的诊断价值。方法 回顾性分析2018年1月至12月于南京医科大学附属肿瘤医院行乳腺手术的123例患者共128个病灶,术前均行DM、DBT、US和MRI检查,分析其影像学特征,与病理结果对比,比较四种检查方法对乳腺癌的敏感性、特异性和诊断准确率,并对各方法进行Kappa一致性检验。结果 DM、DBT、US和MRI对乳腺癌的敏感性、特异性及准确性分别为63.1%、59.6%和61.7%,88.1%、75.0%和82.8%,86.8%、76.9%和82.8%,93.4%、80.8%和88.3%,DBT、US和MRI对乳腺癌的敏感性和准确率高于DM,差异均有统计学意义(P<0.05)。DBT、US和MRI对乳腺癌的的敏感性和准确率差异均没有统计学意义(P>0.05)。MRI的特异性高于DM,差异有统计学意义(P<0.05)。DM、DBT和US对乳腺癌的特异性差异无统计学意义(P>0.05)。DM、DBT、US和MRI的 Kappa值分别为0.639、0.694、0.682、0.828。致密乳腺中65个非钙化性病变中,DM的诊断效能降低,敏感性和准确率分别是42.4%和50.8%。结论 DBT、US和MRI对乳腺癌的诊断效能高于DM,DBT和MRI具有更高的优势。

Objective To investigate and compare the diagnostic value of digital mammography(DM),digital breast tomosynthesis(DBT),ultrasound(US) and MRI in breast cancer.Methods A total of 123 patients(128 lesions) received breast surgery in the Affiliated Cancer Hospital of Nanjing Medical University from January to December 2018 were retrospectively analyzed.All patients were received with DM,DBT,US and MRI examination before the operation.The imaging features were analyzed and compared with the pathological results.The sensitivity,specificity and diagnostic accuracy of the four methods for breast cancer were compared,and kappa consistency test was performed for each method.Results The sensitivity,specificity and accuracy of DM,DBT,US and MRI in breast cancer were 63.12%,59.6% and 61.72%,88.15%,75.0% and 82.81%,86.84%,76.9% and 82.81%,93.4%,80.8% and 88.3%,respectively.The sensitivity and accuracy of DBT,US and MRI in breast cancer were higher than those in DM(P<0.05).The specificity of MRI was higher than that of DM(P<0.05).There was no significant difference in sensitivity and accuracy of DBT,US and MRI in breast cancer(P>0.05).There was no significant difference in the specificity of DM,DBT and US in breast cancer(P>0.05).Kappa values of DM,DBT,US and MRI were 0.639,0.694,0.682 and 0.828,respectively.The sensitivity and accuracy of DM were 42.4% and 50.8%,respectively.Conclusion The diagnostic efficiency of DBT,US and MRI is higher than that of DM.DBT and MRI have higher advantages in the diagnosis of breast cancer.