锥光束乳腺CT对乳腺疾病的诊断效能及术前评估价值

Diagnostic efficiency and preoperative evaluation value of cone-beam breast CT in breast diseases

目的:探讨锥光束乳腺CT(CBBCT)对乳腺疾病的诊断效能及在乳腺癌术前评估中的价值。方法:回顾性分析2019年10月-2021年10月在本院经手术病理证实且在术前行CBBCT及乳腺MRI检查的68个乳腺病变的影像特征。其中,恶性病灶46个,良性21个,交界性1个。比较病灶在两种图像上影像学特征的差异,计算两种检查方法对乳腺病变的检出率,并采用ROC曲线分析其诊断效能。结果:CBBCT平扫和增强扫描及乳腺MRI检查对乳腺病灶的检出率分别为76.5%、98.5%及100%。平扫联合增强(CBBCT)和乳腺MRI诊断乳腺恶性病变的ROC曲线下面积(AUC)分别为0.921(95%CI:0.861~0.982)和0.929(95%CI:0.862~0.996),敏感度为95.7%和97.8%,特异度为76.2%和71.4%。CBBCT与乳腺MRI在显示肿块的形态、边缘和内部强化特征以及非肿块样强化的分布和内部强化特征方面的一致性均非常好(Kappa均>0.75,P均<0.001)。CBBCT及乳腺MRI测量的病灶最大径和病灶距乳头距离的一致性较高(ICC分别为0.972及0.976,P均<0.001)。结论:CBBCT对乳腺疾病的诊断效能和对病灶范围的评估准确性与乳腺MRI相当,在乳腺癌诊断及术前评估等方面可作为乳腺MRI检查的一种替代检查手段,能准确指导临床诊疗决策。

Objective:To explore the diagnostic efficacy of cone beam breast CT(CBBCT)in breast diseases and the value of preoperative evaluation of breast cancer.Methods:The imaging features of 68 breast lesions confirmed by postoperative pathology and examined by CBBCT and MRI before operation in our hospital from October 2019 to October 2021 were retrospectively analyzed.Among them,46 were malignant,21 were benign and 1 was borderline.The features of the breast lesions on the CBBCT and MR images were analyzed and compared,and the detection rate of breast lesions by the two examination methods was calculated,and the diagnostic efficacy was analyzed using ROC curve.Results:The detection rates of non-contrast CBBCT,contrast-enhanced CBBCT and breast MRI enhanced lesions were 76.5%,98.5%and 100%,respectively.The area under curve(AUC)of non-contrast and contrast-enhanced(CBBCT)and MRI for diagnosis of breast malignant lesions were 0.921(95%CI:0.861~0.982)and 0.929(95%CI:0.862~0.996),the sensitivity were 95.7%and 97.8%,and the specificity were 76.2%and 71.4%,respectively.There was good agreement between CBBCT and breast MRI in terms of demonstrating mass morphology,margins and internal strengthening features,as well as in terms of the distribution and internal strengthening features of non-mass enhancement(all Kappa>0.75,all P<0.001).The interclass correlation coeffiient(ICC)of maximum diameter of lesion and the lesion to nipple distance measured on CBBCT and breast MRI was 0.972 and 0.976(both P<0.001),respectively.Conclusion:CBBCT examination has the same diagnostic efficacy and the potential to evaluate lesion dimensions as breast MRI examination,and can be used as an alternative examination method for breast MRI examination in breast cancer diagnosis and preoperative eva-luation.And then,it is be expected to be novel method for guaranteeing clinical accurate diagnosis and guiding treatment decision.