乳腺X线摄影及MRI结合临床特征对乳腺高危病变诊断价值

目的探讨乳腺X线摄影及MRI征象结合临床特征预测乳腺高危病变恶性升级的价值。方法回顾性分析复旦大学附属肿瘤医院2017年1月至2018年3月经病理证实为乳腺高危病变,且活检前行乳腺X线摄影和MRI检查的230例患者。分析乳腺病变X线摄影及MRI征象,并以病理结果为金标准,评估高危病变升级率与临床及影像特征的关系。采用独立样本t检验与χ2检验比较升级组与未升级组患者临床及影像特征的差异,采用受试者操作特征(ROC)曲线比较乳腺X线和MRI对乳腺高危病变升级率的诊断效能,采用Binary logistic回归分析比较高危病变升级率与临床、影像学征象之间的关系。结果230例患者病灶均为单发。47例在后续再手术中升级为恶性病变,升级率为20.4%(47/230)。未升级组与升级组乳腺高危病变患者的年龄、病灶最大径以及绝经状态差异有统计学意义(P<0.05)。未升级组和升级组患者间的乳腺X线摄影征象的差异无统计学意义(P>0.05),乳腺MRI征象和MRI背景实质强化的差异有统计学意义(P<0.05)。乳腺X线摄影和MRI评估高危病变升级为恶性病变的ROC曲线下面积分别为0.606、0.913,MRI诊断优于乳腺X线摄影(Z=6.919,P<0.01)。单因素分析结果显示,年龄、病灶最大径、中重度背景强化为预测高危病变升级的正相关因素,已绝经、MRI诊断阴性为预测高危病变升级的负相关因素(P<0.05);多因素分析显示,年龄以及MRI背景实质强化是预测乳腺高危病变升级的独立因素(P<0.01)。结论MRI对高危病变升级的诊断效能优于乳腺X线,年龄越大,MRI背景实质强化中重度可提示高危病变的恶性升级。

The diagnostic value of both mammography and MRI in combination with clinical features in high-risk breast lesions

Objective To evaluate the value of mammography and MRI combined with clinical features in predicting upgrade to malignancy in high-risk breast lesions.Methods Data from 230 patients who were diagnosed with high-risk breast lesions and underwent both mammography and MRI examinations before biopsy were analyzed retrospectively from Jan 2017 to Mar 2018 in Fudan University Shanghai Cancer Hospital.The imaging features of both mammography and MRI were analyzed,and the association between mammography,MRI and clinical features were evaluated using pathology as the gold standard.Independent t test andχ2 test were used to compare the difference of clinical and imaging features between upgrade and non-upgrade groups,using receiver operating characteristic(ROC)curve to test the diagnostic value between mammography and MRI.Binary logistic regression was used to evaluate the correlation between upgrade and clinical,imaging findings.Results Two hundred and thirty patients had 230 lesions,and 47 cases had atypia upgrade to malignancy during second surgery(upgrade rate was 20.4%).There were statistically significant differences in age,maximum diameter of lesion,and menopausal status between the upgraded and non-upgraded groups(P<0.05).There was no statistically significant difference in mammographic features between two groups(P>0.05),while there was statistically significant difference in breast MRI features and background parenchymal enhancement(P<0.05).For the diagnostic value in predicting upgrade of high-risk lesions,MRI was better than mammography(the areas under ROC curve were 0.913 and 0.606,Z=6.919,P<0.01).Single factor analysis showed that age,lesion size,menopausal status,MRI negative and background parenchymal enhancement on MRI were significantly different for upgrade to malignancy(P<0.05).Multiple factors analysis showed age and background parenchymal enhancement on MRI were independent factors for predicting upgrade(P<0.01).Conclusion For the upgrade to malignancy in high-risk lesions,the diagnostic value of MRI is better than mammography.The elder age and moderate or marked background parenchymal enhancement on MRI may serve as useful predictors of upgrade.