CAJ | 학술논문

目的探讨MRI诊断乳腺X线摄影检出的乳腺微钙化病变的价值.方法回顾性分析经病理证实,行乳腺X线摄影发现乳腺影像报告和数据系统(BI-RADS)3～5类微钙化,且行乳腺MRI检查的84例患者.参照BI-RADS标准,对乳腺X线摄影和MR图像进行BI-RADS分类.以病理结果为金标准,计算2种检查方法诊断不同乳腺X线摄影BI-RADS分类病变的敏感度、特异度和准确度,并采用x2检验或Fisher精确检验进行比较.采用ROC曲线评价不同检查方法的诊断效能.结果病理示84例患者共91个病灶,良性病灶49个、恶性病灶42个.BI-RADS 3类病灶共21个,乳腺X线摄影和MRI诊断的特异度分别为100.0％ (21/21)和95.2％ (20/21),差异无统计学意义(P=1.000).BI-RADS 4类病灶共51个,乳腺X线摄影诊断的敏感度、特异度和准确度分别为100.0％(23/23)、0和45.1％(23/51),MRI分别为91.3％(21/23)、82.1％(23/28)和86.3％(44/51),敏感度差异无统计学意义(x2=0.523,P=0.470),特异度和准确度差异有统计学意义(x2值分别为30.030和19.182,P均＜0.01).BI-RADS 5类病灶共19个,均为恶性病灶,2种方法均正确诊断.对于上述91个病灶,乳腺X线摄影诊断的敏感度、特异度和准确度分别为100.0％(42/42)、42.9％(21/49)和69.2％(63/91);MRI分别为95.2％(40/42)、87.8％(43/49)及91.2％(83/91).2种方法诊断敏感度的差异无统计学意义(x2=0.512,P=0.474);特异度和准确度的差异有统计学意义(x2值分别为21.798和13.851,P均＜0.05).乳腺X线摄影和MRI诊断钙化良、恶性的ROC曲线下面积分别为0.844、0.945(P均＜0.01).结论较乳腺X线摄影,乳腺MRI可提高BI-RADS 4类微钙化病变诊断的特异度及准确度,但对于BI-RADS 3类及5类微钙化病变的定性诊断,MRI无明显优势.
목적 탐토MRI진단유선X선섭영검출적유선미개화병변적개치.방법 회고성분석경병리증실,행유선X선섭영발현유선영상보고화수거계통(BI-RADS)3～5류미개화,차행유선MRI검사적84례환자.삼조BI-RADS표준,대유선X선섭영화MR도상진행BI-RADS분류.이병리결과위금표준,계산2충검사방법진단불동유선X선섭영BI-RADS분류병변적민감도、특이도화준학도,병채용x2검험혹Fisher정학검험진행비교.채용ROC곡선평개불동검사방법적진단효능.결과 병리시84례환자공91개병조,량성병조49개、악성병조42개.BI-RADS 3류병조공21개,유선X선섭영화MRI진단적특이도분별위100.0％ (21/21)화95.2％ (20/21),차이무통계학의의(P=1.000).BI-RADS 4류병조공51개,유선X선섭영진단적민감도、특이도화준학도분별위100.0％(23/23)、0화45.1％(23/51),MRI분별위91.3％(21/23)、82.1％(23/28)화86.3％(44/51),민감도차이무통계학의의(x2=0.523,P=0.470),특이도화준학도차이유통계학의의(x2치분별위30.030화19.182,P균＜0.01).BI-RADS 5류병조공19개,균위악성병조,2충방법균정학진단.대우상술91개병조,유선X선섭영진단적민감도、특이도화준학도분별위100.0％(42/42)、42.9％(21/49)화69.2％(63/91);MRI분별위95.2％(40/42)、87.8％(43/49)급91.2％(83/91).2충방법진단민감도적차이무통계학의의(x2=0.512,P=0.474);특이도화준학도적차이유통계학의의(x2치분별위21.798화13.851,P균＜0.05).유선X선섭영화MRI진단개화량、악성적ROC곡선하면적분별위0.844、0.945(P균＜0.01).결론 교유선X선섭영,유선MRI가제고BI-RADS 4류미개화병변진단적특이도급준학도,단대우BI-RADS 3류급5류미개화병변적정성진단,MRI무명현우세.
Objective To investigate the diagnostic value of breast MRI in patients presenting with microcalcifications on mammography.Methods Eight four patients were retrospectively analyzed,who had mammographically detected BI-RADS (breast imaging reporting and data system) 3 to 5 microcalcifications and underwent breast MRI before surgical biopsy.All mammography and MR images were reviewed with BI-RADS.With histopathological diagnosis as golden standard,the sensitivity,specificity and accuracy of the two methods were calculated and compared with x2 test or Fisher exact test.The diagnostic efficacy of the two methods was compared with ROC curve.Results Pathologic examination revealed 91 lesions in 84 patients including 49 benign lesions and 42 malignant lesions.For 21 lesions of category 3 microcalcifications,the specificity of mammography and MR was 100.0％ (21/21) and 95.2％ (20/21),which had no significant difference (P=1.000).For 51 lesious of category 4,sensitivity,specificity and accuracy of mammography were 100.0％(23/23),0 and 45.1％(23/51).The corresponding values for MR were 91.3％(21/23),82.1％ (23/28) and 86.3％ (44/51).The difference for specificity and accuracy between the two methods was statistical significant(x2 value was 30.030 and 19.182,respectively,with P＜0.01),but not for sensitivity(x2=0.523,P=0.470).Nineteen lesions of category 5 were all correctly diagnosed on mammography and MRI.For all the 91 lesions,the sensitivity,specificity and accuracy of mammography were 100.0％(42/42),42.9％(21/49) and 69.2％(63/91),respectively.The corresponding values for MRI were 95.2 ％(40/42),87.8％(43/49) and 91.2％(83/91).There was significant difference for specificity and accuracy between the two methods (x2 value was 21.798 and 13.851,respectively,with P＜0.05),but not for sensitivity (x2=0.512,P=0.474).The areas under ROC curve for mammography and MR were 0.844,0.945(P＜0.01),for the estimation of the benign and the malignent.Conclusions Compared with mammography,breast MRI significantly improved the diagnosis of category 4 microcalcifications with increased specificity and accuracy.But for microcalcifications of category 3 and 5,MR didn't improve the diagnostic effect.