对比增强能谱乳腺X线摄影低能图与全屏数字化乳腺X线摄影诊断效能的比较

Comparison of Diagnostic Efficacy on Low Energy Contrast-Enhanced Spectral Mammography and Full-Field Digital Mammography

目的比较对比增强能谱乳腺X线摄影(CESM)低能图与全屏数字化乳腺X线摄影(FFDM)对乳腺有可疑病变患者的诊断效能,为临床乳腺X线检查技术的选择提供参考依据。方法纳入同时接受CESM和FFDM检查的可疑乳腺病变患者的临床资料。两名放射科医师根据乳腺影像报告和数据系统(BI-RADS)分类,回顾性分析CESM低能图与FFDM所检出病灶的影像征象,运用卡方检验进行比较。对CESM低能图和FFDM观察进行BI-RADS分类,以组织学检查或随访结果作为参考标准,采用McNemar检验和绘制受试者工作特征(ROC)曲线两种方法,比较CESM低能图与FFDM的诊断效能。结果共71例患者,77个可疑乳腺病灶纳入本研究。CESM低能图与FFDM描述腺体类型、钙化形态、钙化分布、腋下淋巴结肿大及伴随征象等影像特征一致;在描述肿块型病变与非肿块型病变影像征象中,CESM低能图与FFDM对比无显著性差异(P>0.05)。肿块型病变中,CESM低能图与FFDM描述肿块的形态、边缘及密度等影像征象,差异无显著性(P>0.05)。CESM低能图敏感度为95.8%,特异度为81.1%,准确率为85.7%;FFDM敏感度为91.7%,特异度为83.0%,准确率为85.7%。敏感度(P>0.05)和特异度(P>0.05)差异无统计学意义。CESM低能图和FFDM诊断乳腺病变的ROC曲线下面积(AUC)分别为0.885和0.873。结论CESM低能图与FFDM有相同的诊断效能;对比使用FFDM诊断,使用CESM低能图诊断可得出敏感度略高,特异度略低的结果。

Objective The purpose of this study was to compare the diagnostic efficacy of low energy contrast-enhanced spectral mammography(CESM)and full-field digital mammography(FFDM)in patients with suspicious findings in breast,in order to provide basis of selecting mammography for clinical.Methods The clinical data of patients with suspected breast lesions who underwent both CESM and FFDM tests was included in the study.According to the BI-RADS,two radiologists retrospectively analyzed the imaging signs of the observed lesions of low energy CESM and FFDM using double-blind method.The chi-square test was used for comparison.The observation of low energy CESM and FFDM was revealed by BIRADS with histological or follow-up results as the reference standard.Mcnemar test and ROC curve drawing were used to compare the diagnostic efficiency of low energy CESM and FFDM.Results A total of 71 patients with 77 suspected breast lesions were included in this study.Low energy CESM was consistent with FFDM depicting features such as breast composition,morphology and distribution of calcification,enlargement of lymph nodes and accompanying signs.There was no significant difference between low energy CESM and FFDM in describing the imaging signs of mass lesions and non-mass lesions(P>0.05).In mass lesions,low energy CESM and FFDM showed no significant difference in depicting signs such as morphology,edge and density(P>0.05).The sensitivity,specificity and accuracy of low energy CESM were 95.8%,81.1%and 85.7%respectively.The sensitivity,specificity and accuracy of FFDM were 91.7%,83.0%and 85.7%respectively.There was no significant difference in sensitivity(P>0.05)and specificity(P>0.05).The area under ROC curve of low energy CESM and FFDM for breast lesions were 0.885 and 0.873.Conclusion Low energy CESM has the same diagnostic efficacy as FFDM.Compared with FFDM,low energy CESM has slightly higher sensitivity and slightly lower specificity.