SPECT/CT和乳腺专用伽玛显像对乳腺癌诊断价值的对比研究

 目的  通过与SPECT/CT显像进行比较,探讨乳腺专用伽玛显像(breast specific gamma imaging,BSGI)仪诊断乳腺癌的临床应用价值。方法  回顾性研究74例因乳腺肿块或乳头溢液接受手术治疗的患者。所有患者均在术前15天内完成BSGI和SPECT/CT检查,其显像资料与术后病理结果进行对照,分别计算这两种检查方法诊断乳腺癌的灵敏度、特异性、准确性、阳性预测值和阴性预测值,诊断效能比较采用配对Fisher确切概率法,P<0.05为差异有统计学意义。同时计算这两种检查方法对于癌灶最大径为3～15 mm和>15 mm诊断的灵敏度,以及诊断腋窝淋巴结转移的灵敏度。结果  BSGI和SPECT/CT显像对乳腺癌诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为91.8%(45/49)、80.0%(20/25)、87.8%(65/74)、90.0%(45/50)、83.3%(20/24)和77.6%(38/49)、80.0%(20/25)、78.4%(58/74)、88.4%(38/43)及64.5%(20/31),且诊断乳腺癌的效能差异有统计学意义(χ2=5.44,P=0.039 1)。BSGI显像对于癌灶最大径为3～15 mm和>15 mm诊断的灵敏度分别为80.0%(12/15)和97.1%(33/34),相应的SPECT/CT显像灵敏度为60.0%(9/15)和85.3%(29/34);BSGI和SPECT/CT显像诊断腋窝淋巴结转移的灵敏度分别为18.8%(3/16)和37.5%(6/16)。结论  相对于SPECT/CT显像,BSGI提高了乳腺癌诊断的灵敏度,但其诊断腋窝淋巴结转移灵敏度较低。  

Comparative study of SPECT/CT and breast specific gamma imaging in the diagnosis of breast cancer

Objective  To compare the efficiency of breast specific gamma imaging (BSGI) and SPECT/CT for the diagnosis of breast cancer. Methods  Seventy-four patients with palpable breast mass or nipple discharge underwent both BSGI and SPECT/CT within 15-day interval before surgery,and the result diagnoses were verified with histological examination in retrospective study. The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of BSGI and SPECT/CT for diagnosing breast carcinoma were calculated respectively. Fisher exact probabilities in 2×2 table was applied for statistical analysis, P<0.05 regarded as statistical difference. The sensitivity of BSGI and SPECT/CT for diagnosing the maximum diameter of breast cancer lesion in 10-15 mm and more than 15 mm, and for diagnosing axillary metastatic lymph nodes was calculated respectively. Results  The sensitivity,specificity, accuracy, positive predictive value and negative predictive value of BSGI and SPECT/CT was 91.8% (45/49), 80.0% (20/25), 87.8% (65/74), 90.0% (45/50), 83.3% (20/24) and 77.6% (38/49), 80.0% (20/25), 78.4% (58/74), 88.4% (38/43), 64.5% (20/31), respectively, and there was significant difference between the two methods (χ²=5.44, P=0.039).And the sensitivity of BSGI for diagnosing the maximum diameter of breast cancer lesion in 3-15 mm and more than 15 mm was 80.0% (12/15) and 97.1% (33/34) respectively. The sensitivity for axillary metastatic lymph nodes was 18.8% (3/16) by BSGI, while SPECT/CT was 60.0% (9/15) and 85.3% (29/34) respectively, and 37.5% (6/16)  by SPECT/CT.
Conclusions Compared with SPECT/CT,BSGI is a useful adjunct imaging modality with higher sensitivity for the diagnosis of breast cancer. However, it has relatively low sensitivity for diagnosing axillary metastatic lymph node.