对比增强能谱X线摄影增强参数对乳腺病变的诊断效能研究

The diagnostic value of enhancement parameters of contrast enhanced spectral mammography for breast lesions

目的:比较常规乳腺BI-RADS分类与对比增强能谱X线摄影(CESM) BI-RADS再分类对乳腺病变及不同病理类型病变的诊断价值。方法:回顾性分析201例乳腺病变患者的病理及CESM图像。采用卡方检验分析强化程度及曲线对乳腺癌的诊断价值。采用卡方检验和Kappa值分析常规乳腺BI-RADS分类与CESM BI-RADS再分类对乳腺癌的诊断效能及一致性。比较乳腺BI-RADS分类与CESM BI-RADS再分类对乳腺各病理类型的诊断敏感度。结果:71.68%的乳腺癌呈明显强化,80.68%的良性病变中无强化或弱强化(P<0.001)。乳腺良、恶性病变中Ⅰ型分别占63.64%和6.19%,Ⅱ型为26.14%和17.70%,Ⅲ型为10.23%和76.11%(P<0.001)。CESM BI-RADS再分类对乳腺癌诊断效能优于乳腺BI-RADS分类(P<0.001),敏感度依次为94.69%、78.76%,特异度为89.77%、53.41%,符合率为92.54%、67.66%。浸润性乳腺导管癌、乳腺腺病、乳腺纤维腺瘤及乳腺导管内乳头状瘤亚组中,CESM BI-RADS再分类的诊断敏感度高于乳腺BI-RADS分类(97.80%vs.83.52%,P=0.001;81.82%vs.50.00%,P=0.016;93.33%vs.60.00%,P<0.001;85.71%vs.35.71%,P=0.016)。结论:CESM BI-RADS再分类综合乳腺病变形态学及功能学特征,明显提高钼靶对乳腺病变的诊断效能,对浸润性乳腺导管癌、乳腺腺病、乳腺纤维腺瘤及乳腺导管内乳头状瘤的诊断更有优势。

Objective:To compare the diagnostic efficiency of conventional mammography BI-RADS classification and contrast-enhanced spectral mammography(CESM) BI-RADS reclassification for breast lesions and pathological subtypes.Methods:The pathological and CESM images of 201 cases with breast lesions were retrospectively analyzed.Chi-square tests were used to evaluate the diagnostic accuracy of enhancement degree and pattern of breast lesions.Kappa index and chi-square test were used to analyze the consistency and diagnostic efficiency of conventional BI-RADS classification and CESM BI-RADS reclassification for breast lesions.The diagnostic sensitivity of various histological subtypes was compared between the two groups.Results:71.68% of breast malignant lesions presented strong enhancement,no or weak enhancement can be seen in 80.68% of the benign lesion(P<0.001).Among the benign and malignant breast neoplasms,there were 63.64% vs 6.19% in pattern Ⅰ,26.14% vs.17.70% in pattern Ⅱ,and 10.23% vs.76.11% in pattern Ⅲ(P<0.001,respectively).The diagnostic efficiency of CESM BI-RADS was significantly higher than those of conventional BI-RADS(P<0.001),the sensitivity was 94.69% and 78.76%,specificity was 89.77% and 53.41%,accuracy was 91.33% and 67.66%,respectively.The diagnostic sensitivity of CESM BI-RADS was higher than that of conventional BI-RADS in the subgroups of invasive ductal carcinoma,adenopathy,fibroadenoma,and intraductal papilloma(97.80% vs.83.52%,P=0.001;81.82% vs.50.00%,P=0.016;93.33% vs.60.00%,P<0.001;85.71% vs.35.71%,P=0.016).Conclusion:CESM BI-RADS can integrate morphological and functional characteristics of breast lesions,and effectively improve the diagnostic efficiency of mammography for invasive ductal carcinoma,adenopathy,fibroadenoma,and intraductal papilloma.