数字乳腺断层融合摄影及磁共振评估乳腺癌肿块大小与病理的一致性研究

Consistency of DBT,MRI and Pathology in Diagnosing the Size of Breast Cancer

目的:对比数字乳腺断层融合摄影(digital breast tomosynthesis, DBT)与全数字化乳腺X线摄影(full-field digital mammography, FFDM)、平扫及增强磁共振成像(magnetic resonance imaging, MRI)检查对术前乳腺癌的诊断准确率及与病理测量肿瘤大小的一致性,以探讨其术前评估肿瘤及大小的价值。方法:前瞻性纳入女性乳腺癌患者84例,经病理证实病灶总数目91枚,术前均行FFDM、DBT及MRI检查。由两位高年资放射诊断医师分别记录癌灶位置、数目及其最大径,比较各项检查方法的诊断灵敏度和特异度,使用Bland-Altman相关分析评估FFDM、DBT、平扫MRI、增强MRI测量肿瘤最大径与病理结果的一致性。结果:平扫、增强MRI和DBT的诊断灵敏度接近(97.80%~100%),FFDM灵敏度最低(87.91%);平扫MRI特异度最高(100%),其次为DBT和FFDM(均为66.67%),增强MRI特异度最低(33.33%),FFDM、DBT、增强MRI和平扫MRI的诊断灵敏度和特异度比较差异无统计学意义(P>0.05)。4种检查均检出的病灶80枚,两位医师测量的肿瘤大小与术后病理学检查结果一致性较好(ICC=0.81~0.94),其中增强MRI、平扫MRI与病理结果的一致性最高,其次为DBT,而FFDM最低。平扫MRI所测肿瘤最大径较病理测量值略偏小,增强MRI测量值略偏大,而DBT、FFDM测量值偏小。病灶越大,影像和病理测量值差异越大。结论:DBT术前评估乳腺癌肿块大小的能力优于FFDM,在乳腺癌术前分期中有良好的应用前景。平扫和增强MRI评估乳腺肿瘤大小与病理一致性近似,平扫MRI能缩短检查时间,减少造影剂相关风险,提高术前应用乳腺MRI的可行性。

Objective:To compare the consistence of digital breast tomosynthesis(DBT),full-field digital mammography(FFDM),unenhanced magnetic resonance imaging(UMRI),contrast-enhanced magnetic resonance imaging(CEMRI)and pathology in the preoperative diagnosis of breast cancer size.Methods:A total of 84 women(91 foci)with pathologically confirmed breast cancer were enrolled in this study.All patients underwent FFDM,DBT and magnetic resonance imaging(MRI)before surgical treatment.Two senior radiologists recorded the location,number and maximum diameter of foci,and compared the sensitivity and specificity of varied diagnostic methods.The consistency of FFDM,DBT,UMRI,CEMRI and pathology in diagnosing the maximum diameter of cancer was assessed by Bland-Altman analysis.Results:DRT resembled UMRI and CEMRI in the sensitivity of diagnosis(97.80%-100%),while FFDM showed the lowest sensitivity(87.91%).UMRI(100%)led DBT and FFDM(66.67%)in specificity,and CEMRI(33.33%)showed the lowest specificity.Differences in sensitivity and specificity were not significant(P>0.05).A total of 80 lesions were identified.Tumor size diagnosed by the four imaging methods were consistent with that by pathological diagnosis(ICC=0.81-0.94),in which CEMRI and UMRI showed the best consistency with pathological findings,followed by DBT and FFDM.The maximum diameter of tumors measured by UMRI was slightly smaller than pathological finding,and that of CEMRI was slightly larger than pathological finding,and those of DBT and FFDM were smaller than pathological finding.The larger a focus was,the greater the difference between imaging and pathological measurements was.Conclusion:DBT is superior to FFDM in the preoperative assessment of breast tumor size,thus has a good clinical application prospect in preoperative staging of breast cancer.UMRI and CEMRI are consistent with pathology in the assessment of tumor size.UMRI is feasible in preoperative diagnosis of breast cancer for its shorten examination time and lower contrast agent-related risks.