超声、数字化X线摄影及MRI诊断乳腺良恶性病变的临床价值

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摘要目的探讨超声、数字化X线摄影（DM）、MRI及三者联合诊断乳腺良、恶性病变的临床价值。方法回顾性分析2015年4月~2018年3月东莞市第八人民医院及福建医科大学附属闽东医院53例患者共56个病灶的乳腺超声、DM、MRI及临床资料，进行BI-RADS分类并与病理对照，应用受试者工作特征曲线并计算曲线下面积（AUC），分析各自及联合检查的诊断效能。结果 53例患者共56个病灶，良性38个病灶，恶性18个病灶。38个良性病灶中，超声诊断Ⅱ类3例，Ⅲ类23例，Ⅳa类9例，Ⅳb类3例；DM诊断0类5例，Ⅰ类2例，Ⅱ类8例，Ⅲ类12例，Ⅳa类7例，Ⅳb类4例；MRI诊断Ⅱ类7例，Ⅲ类17例，Ⅳa类11例，Ⅳb类2例，Ⅳc类1例。18个恶性病灶中，超声诊断0类2例，Ⅲ类1例，Ⅳa类6例，Ⅳb类4例，Ⅳc类4例，Ⅴ类1例；DM诊断0类2例，Ⅲ类2例，Ⅳa类3例，Ⅳb类2例，Ⅳc类2例，Ⅴ类7例；MRI诊断Ⅳa类1例，Ⅳb类4例，Ⅴ类13例。三者联合及MRI、DM和超声AUC分别为0.987、0.976、0.809、0.779，三者联合检查和MRI的诊断效能优于超声和DM（P < 0.05），而联合检查与MRI比较差异无统计学意义（P > 0.05）。结论乳腺良、恶性病变具有一定的超声、DM及MRI征象，多种影像学方法的综合运用，可以提高诊断效能。

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	赖伟1 冼云开2 陈芳3 刘丽珍1 李登辉1 蒋双兰2 刘建新1 郭庆禄4▲

关键词 ：超声, 数字化X线摄影, 磁共振成像, 乳腺, 良恶性, 诊断

Abstract：Objective To investigate the clinical diagnostic value of ultrasound, digital mammography (DM), MRI and combined diagnosis of benign and malignant breast lesions. Methods The breast ultrasound, DM, MRI features and clinical data of 56 lesions in 53 patients in Dongguan Eighth People′s Hospital and Affiliated Mindong Hospital of Fujian Medical University were retrospectively analyzed form April 2015 to March 2018. Based on the BI-RADS, benign and malignant lesions were classified and compared with pathology. The ROCs were plotted and the area under the curve (AUC) were calculated, and the diagnostic efficacy of each and combined examinations were analyzed. Results There were 56 lesions in 53 patients, 38 located in benign and 18 located in malignant. In the 38 benign lesions group, according to the ultrasound dignosis, there were 3 cases of type Ⅱ, 23 cases of type Ⅲ, 9 cases of type Ⅳa and 3 cases of type Ⅳb; according to the DM dignosis, there were 5 cases of type 0, 8 cases of type Ⅱ, 12 cases of type Ⅲ, 7 cases of type Ⅳa and 4 cases of type Ⅳb; according to the MRI dignosis, there were 7 cases of type Ⅱ, 17 cases of type Ⅲ, 11 cases of type Ⅳa, 2 cases of type Ⅳb, and 1 case of type Ⅳc. In the 18 malignant lesions group, according to the ultrasound dignosis, there were 2 cases of type 0, 1 case of type Ⅲ, 6 cases of type Ⅳa, 4 cases of type Ⅳb, 4 cases of type Ⅳc and 1 case of type Ⅴ; according to the DM dignosis, there were 2 cases of type 0, 2 cases of type Ⅲ, 3 cases of type Ⅳa, 2 cases of type Ⅳb, 2 cases of type Ⅳc and 7 cases of type Ⅴ; according to the MRI dignosis, there were 1 case of type Ⅳa, 4 cases of type Ⅳb and 13 cases of type Ⅴ. The AUC of combination of three techniques and MRI, DM, ultrasound were 0.987, 0.976, 0.809, 0.779 respectively, the three combined examination and MRI diagnostic efficacy superior to ultrasound and DM (P < 0.05), and the combined examination and MRI no significant difference(P = 0.308). Conclusion There have some ultrasound, DM and MRI had features in benign and malignant breast disease, a variety of imaging methods of comprehensive utilization can improve the diagnostic performance.

Key words： Ultrasound Mammography Magnetic resonance imaging Breast Benign and malignant Diagnosis

基金资助: 广东省东莞市社会科技发展（一般）项目（20175 0715028111）。

通讯作者: ▲通讯作者

引用本文:

赖伟1 冼云开2 陈芳3 刘丽珍1 李登辉1 蒋双兰2 刘建新1 郭庆禄4▲. 超声、数字化X线摄影及MRI诊断乳腺良恶性病变的临床价值[J]. 中国医药导报, 2018, 15(22): 127-130,138.
LAI Wei1 XIAN Yunkai2 CHEN Fang3 LIU Lizhen1 LI Denghui1 JIANG Shuanglan2 LIU Jianxin1 GUO Qinglu4▲. The clinical value of ultrasound, digital mammography and MRI in diagnosis benign and malignant breast diseases. 中国医药导报, 2018, 15(22): 127-130,138.

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