【摘要】：目的:評(píng)價(jià)結(jié)合MRI和X線分類對(duì)乳腺X線篩查為BI-RADS 4類腫塊的良惡性評(píng)估價(jià)值,探討B(tài)I-RADS 4類腫塊新的處理建議。方法:X線篩查為BI-RADS 4a類(105個(gè))、4b類(42個(gè))和4c類(19個(gè))的151例共166個(gè)乳腺腫塊,在活檢前行MRI。動(dòng)態(tài)增強(qiáng)結(jié)合擴(kuò)散加權(quán)成像(DWI)進(jìn)行MRI BI-RADS分類。結(jié)合X線與MRI分類提出新的良惡性評(píng)估法。統(tǒng)計(jì)X線與MRI診斷乳腺癌的敏感度、特異度及診斷符合率;繪制兩者的ROC曲線,Z檢驗(yàn)比較曲線下面積;統(tǒng)計(jì)結(jié)合MRI和X線的新的良惡性評(píng)估法發(fā)現(xiàn)乳腺癌的敏感性、診斷符合率和對(duì)良性病變檢出率。結(jié)果:2名X線診斷醫(yī)師和2名MRI診斷醫(yī)師的BI-RADS分類的Kappa值分別為0.70和0.76,一致性較好。166個(gè)腫塊,惡性41個(gè),占24.7%。X線BI-RADS 4a類105個(gè):惡性12個(gè),MRI分類為4、5類12個(gè);良性93個(gè),MRI為2、3類81個(gè)。X線BIRADS 4b類42個(gè):惡性16個(gè),MRI分類為4、5類15個(gè);良性26個(gè),MRI為2、3類16個(gè)。X線BI-RADS 4c類19個(gè):惡性13個(gè),MRI分類為4、5類12個(gè);良性6個(gè),MRI為3類2個(gè)。X線診斷敏感度、特異度為70.7%、74.4%,診斷符合率為73.5%。MRI診斷敏感度、特異性及診斷符合率為95.1%、79.2%和83.1%。X線及MRI診斷乳腺癌的ROC曲線下面積分別為0.749及0.927,兩者差異有統(tǒng)計(jì)學(xué)意義(Z=2.282,P0.05)。新的良惡性評(píng)估法發(fā)現(xiàn)乳腺癌的敏感度為100%,診斷符合率為77.7%,良性病變檢出率為53.0%。結(jié)論:MRI對(duì)乳腺X線篩查為BI-RADS 4類腫塊有較高的診斷價(jià)值。結(jié)合X線及MRI分類進(jìn)行新的良惡性評(píng)估,能減少良性腫塊不必要的活檢。
[Abstract]:Objective: to evaluate the value of combining MRI and X-ray classification in the evaluation of benign and malignant breast X-ray screening as BI-RADS 4 masses and to explore the new management suggestions for BI-RADS 4 type masses. Methods: BI-RADS 4a (105 cases), 4b (42 cases) and 4c (19 cases) were screened by X-ray for 166 breast masses. MRI. was performed before biopsy. Dynamic enhancement combined with diffusion weighted imaging (DWI) was used to classify MRI BI-RADS. A new method of benign and malignant evaluation was proposed by combining X ray and MRI classification. The sensitivity, specificity and diagnostic coincidence rate of X-ray and MRI in the diagnosis of breast cancer were statistically analyzed, and the ROC curves were drawn, and the area under the curve was compared by Z test. The sensitivity, diagnostic coincidence rate and detection rate of benign and malignant lesions in breast cancer were statistically analyzed by new benign and malignant evaluation method combined with MRI and X ray. Results: the Kappa values of the BI-RADS classification of 2 X-ray diagnostics and 2 MRI diagnostics were 0.70 and 0.76, respectively, which were consistent with 166 masses and 41 malignant tumors, accounting for 24.70.105 of BI-RADS 4a: 12 malignant. MRI was classified into 4 5 categories and 12; There were 93 benign cases and 81 MRI types. X-ray BIRADS 4b type 42 malignant 16, MRI 5 15, benign 26, MRI 23 3 16. X ray BI-RADS 4c 19 malignant 13, MRI 45 5 12, X ray BI-RADS 4c 19 malignant 13, MRI 4 5 12, X ray BI-RADS 4c 19, malignant 13, MRI 4 5 12, benign 26, MRI 23 3, MRI 16, X ray BI-RADS 4c 19, malignant 13, MRI 4 5 12. The diagnostic sensitivity and specificity of MRI were 70.7 and 74.4, respectively. The diagnostic coincidence rate was the sensitivity of 73.5%.MRI, the specificity and the diagnostic coincidence rate were 95.1, respectively. The area under the ROC curve of 79.2%, 83.1% and 83.1% and MRI in diagnosis of breast cancer were 0.749 and 0.927, respectively. The difference was statistically significant (P 0.05). The sensitivity of the new method was 100, the diagnostic coincidence rate was 77.7%, and the detection rate of benign lesions was 53.0%. Conclusion: MRI has a high diagnostic value in the screening of BI-RADS type 4 masses by mammography. Combined with X-ray and MRI classification, new benign and malignant evaluation can reduce unnecessary biopsy of benign masses.
【作者單位】： 南方醫(yī)科大學(xué)附屬深圳市婦幼保健院放射科;
【基金】：廣東省醫(yī)學(xué)科學(xué)技術(shù)研究面上基金項(xiàng)目(2016110212723500)
【分類號(hào)】：R445.2;R737.9
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本文編號(hào)：2332840