摘要
目的评估乳腺增强MRI对乳腺X线检查为BI-RADS 4类微钙化灶的管理价值。方法回顾性分析2017年2月至2019年6月在四川省妇幼保健院行乳腺X线检查引导下金属导丝定位活组织检查的87例BI-RADS 4类乳腺微钙化灶患者资料,评价此部分患者在术前接受增强MRI检查的临床意义。增强MRI与病理诊断对乳腺癌检出率的差异比较采用McNemar检验,增强MRI与乳腺X线检查对乳腺癌检出敏感度的差异比较采用Fisher确切概率法,增强MRI与乳腺X线检查对乳腺癌检出特异度、阳性预测值、阴性预测值的差异比较采用χ2检验。结果87例患者中病理组织学检查结果为良性者71例,DCIS 6例,浸润性导管癌(IDC)10例。BI-RADS为4A、4B和4C的患者,病理组织学检查为恶性的比例分别为2.4%(1/42),24.3%(9/37)和6/8。乳腺增强MRI对乳腺X线检查为BI-RADS 4类的微钙化灶判断的敏感度、特异度、阳性预测值、阴性预测值和诊断正确率分别为14/16、74.7%(53/71)、43.8%(14/32)、96.4%(53/55)和77.0%(67/87)。增强MRI的诊断特异度高于乳腺X线检查[74.7%(53/71)比57.8%(41/71),χ2=4.532,P=0.033],74.7%(53/71)的良性病灶可通过增强MRI检查避免活组织检查,但有2/16的恶性病灶被增强MRI误判为阴性。结论乳腺增强MRI有助于降低乳腺X线检查为BI-RADS 4类微钙化灶的活组织检查比例,可有效避免乳腺恶性肿瘤的漏诊,有利于临床医师根据患者具体情况对BI-RADS 4类微钙化灶进行合理的诊疗。
Objective To evaluate the role of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)in clinical management of breast lesions with BI-RADS 4 microcalcifications at mammography.Methods We retrospectively analyzed the clinical data of 87 patients who underwent wire-guided biopsy and showed BI-RADS 4 microcalcifications at mammography in the Sichuan Provincial Maternity and Child Health Care Hospital from February 2017 to January 2019.The necessity of preoperative DCE-MRI of those patients was evaluated.The McNemar test was used to compare the detection rates of breast cancer between MRI and pathology.The Fisher exact test was used to compare the sensitivity and theχ2 test was used to compare the specificity,positive and negative predictive values between mammography and MRI in the diagnosis of breast cancer.Results Histopathologic results confirmed 71 cases of benign microcalcifications,6 DCIS and 10 invasive ductal carcinomas(IDC).Malignancy rates were 2.4%(1/42),24.3%(9/37)and 6/8 in the BI-RADS 4A,4B and 4C patients,respectively.The sensitivity,specificity,positive,negative predictive values and diagnostic accuracy of DCE-MRI in the diagnosis of BI-RADS 4 microcalcifications were(14/16),74.7%(53/71),43.8%(14/32),96.4%(53/55)and 77.0%(67/87),respectively.The specificity of DCE-MRI was significantly higher than that of mammography[74.7%(53/71)vs 57.8%(41/71),χ2=4.532,P=0.033].Totally 53 out of 71 benign cases(74.7%)could avoid unnecessary biopsies based on the findings of DCE-MRI,but two out of 16 malignant cases(12.5%)was diagnosed negative by DCE-MRI.Conclusion DCE-MRI can avoid unnecessary biopsies of BI-RADS 4 microcalcifications at mammopraphy,reduce missed-diagnosis of malignant tumors and help to make rational clinical decisions in patients with BI-RADS 4 microcalcifications.
作者
冯金燕
万航宇
罗静
杨枫
Feng Jinyan;Wan Hangyu;Luo Jing;Yang Feng(Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu 610000, China)
出处
《中华乳腺病杂志（电子版）》
CAS
CSCD
2020年第6期337-341,共5页
Chinese Journal of Breast Disease(Electronic Edition)
