磁共振成像鉴别肿块型乳腺硬化性腺病与浸润性导管癌

Magnetic Resonance Imaging to.Differentiate Sclerosing Adenosis of Breast from Infiltrating Ductal Carcinoma

目的 探讨磁共振成像(MRI)在鉴别肿块型乳腺硬化性腺病与浸润性导管癌中的价值。方法 回顾性收集分析经病理证实的31例乳腺硬化性腺病和72例浸润性导管癌的MRI资料。所有患者术前均行乳腺DCE-MRI和DWI扫描,比较两组的年龄、肿块大小、ADC值、T2信号、形态、边缘、内部强化、早期强化、时间-信号强度曲线(TIC)等特征;计量资料两组间的比较采用独立样本t检验,分类变量组间比较采用卡方检验或Fisher确切概率法,多因素分析采用二元logistic回归,将单因素分析结果P<0.1的自变量纳入二元logistic回归方程中,所有统计学分析的检验水准ɑ=0.05。结果 硬化性腺病和浸润性导管癌的肿块型(MLE)病变在患者年龄、肿块大小、ADC值、形态、边缘、内部强化、早期强化、TIC曲线及腋下淋巴结肿大中差异有统计学意义(P<0.05)。多因素分析结果显示年龄、肿块大小、ADC值和强化方式是鉴别肿块型硬化性腺病和浸润性导管癌的影响因素。对回归方程预测值绘制受试者工作特征曲线,曲线下的面积AUC=0.949(0.888-0.982),有统计学意义(Z=19.301,P=<0.0001),Youden指数=0.7956,临界值为0.14889,灵敏度为96.67%(82.8%-99.9%),特异度为82.89%(72.5%-90.6%),阳性预测值为69.0%(57.5%-78.6%),阴性预测值为98.4%(90.1%-99.8%)。结论 通过动态增强磁共振成像联合DWI构建诊断模型,可以鉴别肿块型乳腺硬化性腺病和浸润性导管癌。

Objective To investigate the value of magnetic resonance imaging(MRI)in differentiating sclerosing adenosis of breast from infiltrating ductal carcinoma.Methods MRI data of 31 cases of breast sclerosing adenosis and 72 cases of infiltrating ductal carcinoma confirmed by pathology were retrospectively collected and analyzed.All patients underwent breast DCE-MRI and DWI scanning before surgery.Age,mass size,ADC value,T2 signal,morphology,edge,internal enhancement,early enhancement,and time-signal intensity curve TIC were compared between the two groups.Chi-square test or Fisher's exact probability method was used for inter-group comparison.Multivariate analysis adopted binary logistic regression,and independent variables with P<0.1 as the result of univariate analysis were included in the binary logistic regression equation.The test level of all statistical analyses wasɑ=0.05.Results Mass like enhancement MLE lesions:There were statistically significant differences in age,mass size,ADC value,shape,margin,internal enhancement,early enhancement,TIC curve and axillary lymph node enlargement between sclerosive adenosis and infiltrating ductal carcinoma(P<0.05).Multivariate analysis showed that age,mass size,ADC value,and enhancement pattern were influential factors in differentiating mass sclerotic adenosis from infiltrating ductal carcinoma.Plot a subject work characteristic curve forprediction of regression equation predictive values。The AUC of the area under the curve was 0.949(0.888-0.982),which was statistically significant(Z=19.301,P=<0.0001),Youden index was 0.7956,the critical value was 0.14889,and the sensitivity was 96.67%(82.8%-99.9%).The specificity was 82.89%(72.5%-90.6%),the positive predictive value was 69.0%(57.5%-78.6%),and the negative predictive value was 98.4%(90.1%-99.8%).Conclusion Dynamic contrast-enhanced magnetic resonance imaging combined with DWI can differentiate lump-type sclerosing adenosis of breast from invasive ductal carcinoma.