DWI联合超声在乳腺癌筛查中的临床价值

The Clinical Value of DWI Combined with Ultrasound in Breast Cancer Screening

目的:探讨乳腺弥散加权成像(diffusion weighted imaging,DWI)联合超声作为无创、非增强组合在乳腺癌筛查中的临床价值。方法:回顾性分析病理证实的109个乳腺病变,用ROC曲线确定ADC、超声阈值,对比DWI、超声单独和联合应用对乳腺恶性病变检出效能。结果:109个病灶,恶性77个,良性32个。ROC曲线确定乳腺恶性病变ADC阈值1.08×10^(-3)mm^(2)/s,超声BI-RADS分类阈值4 b。超声、DWI及二者并联、串联诊断乳腺病变灵敏度分别为79.22%、92.21%、96.1%、75.32%,特异度分别为75%、71.88%、46.88%、100%;超声与DWI、超声与并联组灵敏度和超声与串联组、DWI与串联组特异度差异均有统计学意义(P<0.05),DWI与并联组灵敏度差异无统计学意义(P=0.25)。结论:DWI并联超声提高乳腺病变检出灵敏度,串联提高特异度,联合应用增加乳腺癌筛查检出率,可作为无创、非增强筛查组合。

Objective To explore the clinical value of diffusion weighted imaging(DWI)combined with ultrasound as a non-invasive and non-enhanced approach in breast cancer screening.Methods A retrospective analysis of 109 breast lesions confirmed by pathology was performed.The ROC curve was used to determine the ADC and ultrasound thresholds,and the efficacy of DWI and ultrasound alone and in combination in detecting malignant breast lesions was compared.Results There were 77 malignant and 32 benign lesions in 109 cases.The ADC value threshold of breast malignant lesion was 1.08×10^(-3) mm^(2)/s and the ultrasonic classification threshold was BI-RADS 4 b.The sensitivity of ultrasound,DWI,their parallel and tandem group diagnosis in breast cancer detection were 79.22%,92.21%,96.1%and 75.32%respectively,and the speci⁃ficity was 75%,71.88%,46.88%and 100%respectively.There were significant differences in sensitivity and specificity between ultrasound and DWI,ultrasound and parallel group,ultrasound and series group,DWI and series group(P<0􀆰05),but there was no significant difference in sensitivity between DWI and parallel group(P=0.25).Conclusion DWI combined with ultrasound can be used as a non-invasive and non-enhanced screening approach to improve the sensitivity and specificity of breast cancer detection by parallel and tandem analysis.