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中华乳腺病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (03) : 155 -160. doi: 10.3877/cma.j.issn.1674-0807.2016.03.007

论著

MRI 快速检查法对致密型乳腺中乳腺癌检出的应用价值
陈双庆1,(), 黄敏1, 沈玉英1, 蔡庆1, 许传虓1, 刘晨鹭1, 游小慧1   
  1. 1.215001 南京医科大学附属苏州医院影像科
  • 收稿日期:2015-10-29 出版日期:2016-06-01
  • 通信作者: 陈双庆

Abbreviated protocol of magnetic resonance imaging for detecting breast cancer in dense breasts

Shuangqingi Chen,1(), Min Huang1, Yuying Shen1, Qing Cai1, Chuanxiao Xu1, Chenlu Liu1, Xiaohu You1   

  1. 1.Department of Radiology, Suzhou Hospital, Nanjing Medical University, Suzhou 215001, China
  • Received:2015-10-29 Published:2016-06-01
  • Corresponding author: Shuangqingi Chen
引用本文:

陈双庆, 黄敏, 沈玉英, 蔡庆, 许传虓, 刘晨鹭, 游小慧. MRI 快速检查法对致密型乳腺中乳腺癌检出的应用价值[J/OL]. 中华乳腺病杂志(电子版), 2016, 10(03): 155-160.

Shuangqingi Chen, Min Huang, Yuying Shen, Qing Cai, Chuanxiao Xu, Chenlu Liu, Xiaohu You. Abbreviated protocol of magnetic resonance imaging for detecting breast cancer in dense breasts[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2016, 10(03): 155-160.

目的

探讨MRI 快速检查法(AP)在致密型乳腺中对乳腺癌检出的应用价值。

方法

回顾性收集2014 年9 月至2015 年6 月在南京医科大学附属苏州医院就诊的患者资料,对172 例X 线摄影(MG)检查符合致密型乳腺的患者行MRI 动态增强检查[AP 和常规检查法(FDP)]及穿刺活组织检查,AP 仅仅读取首次增强减影及最大密度投影图像,FDP 读取全部MRI 动态增强图像,分别计算MG、AP 及FDP 三种方法在致密型乳腺中对乳腺癌检出的敏感度、特异度、阳性似然比(PLR)和阴性似然比(NLR)。 采用受试者工作特征(ROC)曲线比较三者对乳腺癌的诊断能力。

结果

172 例致密型乳腺中共检出56 例乳腺癌,病理结果显示,DCIS 12 例,浸润性导管癌37 例,浸润性小叶癌2 例,髓样癌3 例,黏液癌2 例。 其中MG 检出19 例,AP 检出53 例,FDP 检出55 例,敏感度分别为33.9%(19/56)、94.6%(53/56)及98.2% (55/56),特异度分别为49.1% (57/116)、79.3% (92/116)及91.4 %(106/116),PLR 分别为0.67、4.57 及11.42,NLR 分别为1.35、0.07 及0.02。 ROC 曲线结果显示:MG、AP 及FDP 曲线下面积分别为0.679±0.053、0.930±0.026 及0.948±0.023,95%置信区间分别为0.574 ~0.784、0.881 ~0.980 及0.900 ~0.994。 Z 检验结果显示,AP 及FDP 曲线下面积较MG 差异均有统计学意义(Z=3.031、3.497,P 均<0.050),而AP 和FDP 之间差异无统计学意义(Z=1.114,P>0.050)。

结论

AP 及FDP 对致密型乳腺中乳腺癌的诊断效能明显高于MG,AP 有望成为一种值得推广的乳腺癌筛查模式。

Objective

To evaluate the application of an abbreviated protocol (AP) of MRI for detecting breast cancer in patients with dense breast tissue.

Methods

In this study, we retrospectively analyzed the clinical data of patients in Suzhou Hospital, Nanjing Medical University from September 2014 to June 2015. Totally 172 patients with dense breast tissue screened in mammography (MG) received dynamic contrast-enhanced MRI [AP and full diagnostic protocol (FDP) ] and needle biopsy. AP consisted of the first postcontrast subtraction and the maximum-intensity projection; FDP consisted of all MRI dynamic enhanced images. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) of MG,AP and FDP for breast cancer detection were calculated in dense breasts. The diagnostic capabilities of the three methods were compared using the receiver operating characteristic (ROC) curve.

Results

Totally 56 cases of breast cancer were detected in 172 patients with dense breasts, including 12 cases of DCIS,37 invasive ductal carcinoma,2 invasive lobular carcinoma, 3 medullary carcinoma and 2 colloid carcinoma.Nineteen cases were detected with breast cancer by MG, 53 cases by AP and 55 cases by FDP, with the sensitivity of 33.9%(19/56),94.6%(53/56) and 98.2% (55/56),the specificity of 49.1% (57/116),79.3% (92/116) and 91.4 % (106/116), PLR of 0.67,4.57 and 11.42, and NLR of 1.35, 0.07 and 0.02, respectively. ROC curves showed that area under the curve was 0.679±0.053 in MG,0.930±0.026 in AP and 0.948±0.023 in FDP, with 95% confidence interval of 0.574-0.784, 0.881-0.980 and 0.900-0.994 respectively. The area under the curve of AP or FDP was significantly by bigger than that of MG (Z=3.031,3.497,bothP<0.050), while no significant difference was found between AP and FDP (Z=1.114,P>0.050).

Conclusion

AP and FDP have higher diagnostic capability for detecting breast cancer in dense breasts compared with MG, and AP may be applied in breast cancer screening.

表1 乳腺MG、MRI AP 及MRI FDP 三种检查方法与乳腺病理组织学诊断对照(例)
图1 42 岁左乳DCIS 患者影像检查结果 注:a 图为X 线摄影,显示双乳呈致密型,未见明显结节;b、c、d 图为该患者MRI 快速检查法结果,图中箭头示左乳外上象限5 mm 强化结节,b 图为TlWI+抑脂图像,c 图为首次增强减影图像,d 图为最大密度投影图像;WI 表示加权像
图2 50 岁左乳DCIS 患者影像检查结果 注:a 图显示X 线摄影示双乳致密型乳腺,未见明显结节;b、c、d 图为该患者MRI 快速检查法结果,图中箭头示左乳外下象限10 mm 强化结节,b 图为TlWI+抑脂图像,c 图为首次增强减影图像,d 图为最大密度投影图像;WI 表示加权像
图3 MG、MRI AP 及MRI FDP 三种方法诊断乳腺癌的ROC 曲线图 注:ROC 曲线结果显示,MG、MRI AP 及MRI FDP 曲线下面积分别为0.679±0.053、0.930±0.026 及0.948±0.023,95%置信区间分别为0.574 ~0.784、0.881 ~0.980 及0.900 ~0.994,表明AP 与FDP 诊断乳腺癌的效能明显高于MG;MG为X 线摄影;AP 为快速检查法;FDP 为常规检查法;ROC 为受试者工作特征
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