CAJ | 학술논문

目的在乳腺导管原位癌(DCIS)、DCIS伴微浸润(DCIS-MI)的患者中分别比较乳腺X线检查(MG)及乳腺MRI诊断的敏感度.方法 2009年8月至2011年11月,接受手术治疗的122例连续病例被纳入此项研究,其中包括72例DCIS及50例DCIS-MI.患者均为女性,平均年龄分别为52.6岁和54.4岁.收集患者术前乳腺影像学诊断报告(MG及MRI),以术后石蜡病理诊断为金标准,分析这两种诊断方式的敏感度.结果乳腺MRI检测DCIS及DCIS-MI的敏感度分别为84.7％和94.0％(x2=2.500,P=O.114).多因素分析提示乳腺MRI的诊断敏感度与肿瘤分化程度相关(OR =3.471,P=0.031).MG检测DCIS及DCIS-MI的敏感度分别42.4％和80.0％(x2=16.555,P=0.000).MG诊断敏感度与钙化相关(OR=11.287,P=0.001).在DCIS及DCIS-MI患者中,乳腺MRI均较MG有更高的敏感度(x2=27.028和4.540P =0.000和0.040).结论乳腺MRI较MG能更敏感地诊断DCIS及DCIS-MI病灶.MG诊断敏感度与是否存在钙化相关,而患者临床特征及肿瘤生物学特征并不影响MRI的诊断敏感度,且MRI对分化差的DCIS及DCIS-MI肿瘤具有更高的敏感度.
목적 재유선도관원위암(DCIS)、DCIS반미침윤(DCIS-MI)적환자중분별비교유선X선검사(MG)급유선MRI진단적민감도.방법 2009년8월지2011년11월,접수수술치료적122례련속병례피납입차항연구,기중포괄72례DCIS급50례DCIS-MI.환자균위녀성,평균년령분별위52.6세화54.4세.수집환자술전유선영상학진단보고(MG급MRI),이술후석사병리진단위금표준,분석저량충진단방식적민감도.결과 유선MRI검측DCIS급DCIS-MI적민감도분별위84.7％화94.0％(x2=2.500,P=O.114).다인소분석제시유선MRI적진단민감도여종류분화정도상관(OR =3.471,P=0.031).MG검측DCIS급DCIS-MI적민감도분별42.4％화80.0％(x2=16.555,P=0.000).MG진단민감도여개화상관(OR=11.287,P=0.001).재DCIS급DCIS-MI환자중,유선MRI균교MG유경고적민감도(x2=27.028화4.540P =0.000화0.040).결론 유선MRI교MG능경민감지진단DCIS급DCIS-MI병조.MG진단민감도여시부존재개화상관,이환자림상특정급종류생물학특정병불영향MRI적진단민감도,차MRI대분화차적DCIS급DCIS-MI종류구유경고적민감도.
Objectives To compare the sensitivity of mammogram and breast dedicated MRI in detecting ductal carcinoma in situ with microinvaion (DCIS-MI) and ductal carcinoma in situ (DCIS) lesions,and to further investigate the independent predictive factors of mammogram and MRI sensitivity.Methods From August 2009 to November 2011,122 consecutive confirmed breast cancer patients who had received operations were recruited for this clinical research.These patients were divided into two groups including DCIS (72 cases) and DCIS-MI (50 cases) based on pathologic reports.All the patients were female,with mean ages of 52.6 years and 54.4 years.Preoperative bilateral breast mammogram,breast dedicated MRI depictions and reports as well as histopathological reports were collected.Results Sensitivity of MRI outstood mammogram in each subgroups:84.7％ vs.42.4％ in DCIS (x2 =27.028,P =0.000),94.0％ vs.80.0％ in DCIS-MI group (x2 =4.540,P =0.040).And further analysis showed that MRI was more sensitive to high nuclear grade DCIS and DCIS-MI lesions than low nuclear grade ones (OR =3.471,P =0.031).Results of logistic regression analysis proved microcalcification was an independent predictive factor of mammogram sensitivity (OR =1 1.287,P =0.001).Conclusions Sensitivity of breast dedicated MRI is superior to mammogram in detecting DCIS and DCIS-MI groups.Lesions with microcalcifiation is an independent predictive marker which meant that mammogram would achieve high detection rate in cancers presented calcification on mammogram image when compared with non-calcification.Diagnostic performance of breast MRI is less affected by clinical and pathological characteristics of the early stage breast cancer patients but further increased detection rate is observed in DCIS and DCIS-MI with high nuclear grade lesions which indicated that MRI could detect more early stage cancers with relative more aggression biological behaviour and provide these patients with early surgical interventions before possible progression to invasive breast cancers.