对比增强能谱X线摄影评估乳腺癌肿瘤大小的准确性研究

Accuracy Study on the Precision of Tumor Sizing for Breast Cancer with Contrast-Enhanced Spectral Mammography

目的评估对比增强能谱X线摄影(CESM)测量乳腺癌肿瘤大小的准确性,并对可能影响测量准确性的相关因素进行分析评价。方法回顾性分析71个乳腺癌病灶的临床病理资料。以手术病理结果为金标准,评估CESM测量乳腺癌肿瘤大小的准确性。采用Spearman相关分析和Bland-Altman图行CESM与病理测量肿瘤大小的相关性与一致性检验,采用Logistic回归分析影响CESM测量准确性的相关因素。结果病理、CESM测量乳腺癌肿瘤大小[中位数(四分位数间距)]分别为1.8 cm(1.3 cm,3.0 cm)、1.9 cm(1.4 cm,2.7 cm),二者所测肿瘤大小值存在统计学差异(P=0.007)。CESM与病理所测肿瘤大小的Spearman相关系数为0.816(P<0.001)。Bland-Altman分析示CESM与病理所测肿瘤大小的差值均值为0.32 cm(95%一致性界限:-1.54 cm~2.18 cm)。多因素Logistic分析显示CESM所测肿瘤大小值(OR=5.866,P=0.031)、含导管原位癌(DCIS)(OR=10.249,P=0.041)及淋巴结转移(OR=15.810,P=0.008)是影响CESM测量乳腺癌肿瘤大小准确性的独立危险因素。结论CESM评估乳腺癌肿瘤大小的准确性较高,测量准确性受CESM所测肿瘤大小值、是否含DCIS及腋窝淋巴结转移情况的影响。

Objective To evaluate the precision of tumor size for breast cancer with contrast-enhanced spectral mammography(CESM),and discuss factors influencing this precision.Methods The clinicopathological data of 71 breast cancer lesions were analyzed retrospectively.The largest diameter of tumors at pathology was chosen as reference standard and evaluated the efficacy of CESM in predicting tumor size.The correlation and agreement between CESM and histopathologic tumor size were evaluated by Spearman’s Rho correlation analysis and Bland-Altman analysis.Results The median of tumor size at pathology was 1.8 cm,while at CESM it was 1.9 cm.Spearman’s correlation coefficient was 0.816(P<0.001).For size difference,the mean for histopathology vs CESM was 0.32 cm,the 95%limits of agreement were-1.54 cm to 2.18 cm,respectively.Tumor size determined by CESM,ductal carcinoma in situ(DCIS)and nodal involvement were the factors significantly associated with CESM-pathology discordance in logistic regression analysis(OR=5.866,P=0.031;OR=10.249,P=0.041;OR=15.810,P=0.008).Conclusion CESM is good to predict quality of tumor size.The tumor size measured by CESM,DCIS and nodal involvement are strongly associated with discordance between CESM and pathology sizing of breast cancer.