全数字化乳腺X线摄影在乳腺恶性病变诊断中的临床价值

Clinical study of fully digital mammography in the diagnosis of benign and malignant breast nodules

目的分析全数字化乳腺X线摄影(FFDM)在乳腺恶性病变诊断中的临床价值。方法回顾性分析上海市普陀区妇婴保健院2019年6月至2020年6月接诊的170例乳腺结节患者资料,均给予FFDM检查,将病理诊断结果作为本研究金标准,统计FFDM检出率、诊断准确率、灵敏度、特异度,Kappa检验FFDM影像诊断评估结果与金标准的一致性,对比乳腺良、恶性结节组FFDM影像学征象。结果病理诊断恶性23例,良性147例;FFDM检出良性151例,恶性19例。FFDM诊断准确率是95.3%,灵敏度是73.9%,特异度是98.6%,Kappa检验FFDM影像诊断评估结果与金标准的一致性较好(Kappa值=0.79),P<0.05。恶性组肿块边缘毛刺率(95.6%)、肿块形态不规则率(43.5%)、钙化分布簇状(56.5%)、导管性分布率(30.4%)、钙化形态线形分支型率(47.8%)、细沙状率(47.8%)、血管增粗率(78.3%)均高于良性组(0.7%、0.7%、23.1%、0.7%、2.7%、0.7%、14.3%),差异有统计学意义(P<0.05)。结论FFDM在乳腺恶性病变的诊断准确率、灵敏度、特异度及肿块形态、边缘、钙化等影像学征象方面,值得临床参考与借鉴。

Objective To analyze the clinical value of fully digital mammography(FFDM)in the diagnosis of benign and malignant breast nodules.Methods A retrospective analysis was implemented on 170 patients with breast nodules admitted to Shanghai Maternal and Infant Health Hospital from June 2019 to June 2020,all patients were given FFDM examination,and the results of surgical and pathological diagnosis were used as the gold standard for this study,and FFDM detection was counted.Calculate diagnostic accuracy,sensitivity,specificity,Kappa test was used to analyze the consistency of FFDM with the gold standard,and compare FFDM imaging signs between benign and malignant breast nodules.Results Pathological diagnosis confirmed malignant lesions in 23 cases and benign in 147 cases,while FFDM deteded 151 cases with benign lesions and 19 cases with malignant lesions.The diagnostic accuracy of FFDM was 95.3%,the sensitivity was 73.9%,and the specificity was 98.6%.The Kappa test showed that FFDM imaging diagnostic evaluation results were in good agreement with the gold standard(Kappa value=0.79)(P<0.05).In the malignant group,the rate of burr on the edge of the tumor(95.6%),the rate of irregular shape of the tumor(43.5%),the distribution of calcification in clusters(56.5%),the rate of ductal distribution(30.4%),the rate of linear branching of calcification morphology(47.8%),the rate of fine sand(47.8%)and the rate of thickening of blood vessels(78.3%)were higher than those of the benign group(0.7%,0.7%,23.1%,0.7%,2.7%,0.7%,14.3%)with statistical significance(P<0.05).Conclusion FFDM can improve the accuracy,sensitivity and specificity of differential diagnosis of benign and malignant breast nodules,and provide imaging features such as tumor shape and edge,which is worthy of reference.