结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的处理体会
发布时间：2018-11-15 09:00
【摘要】：目的:评价结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的良恶性评估价值,探讨BI-RADS 4类肿块新的处理建议。方法:X线筛查为BI-RADS 4a类(105个)、4b类(42个)和4c类(19个)的151例共166个乳腺肿块,在活检前行MRI。动态增强结合扩散加权成像(DWI)进行MRI BI-RADS分类。结合X线与MRI分类提出新的良恶性评估法。统计X线与MRI诊断乳腺癌的敏感度、特异度及诊断符合率;绘制两者的ROC曲线,Z检验比较曲线下面积;统计结合MRI和X线的新的良恶性评估法发现乳腺癌的敏感性、诊断符合率和对良性病变检出率。结果:2名X线诊断医师和2名MRI诊断医师的BI-RADS分类的Kappa值分别为0.70和0.76,一致性较好。166个肿块,恶性41个,占24.7%。X线BI-RADS 4a类105个:恶性12个,MRI分类为4、5类12个;良性93个,MRI为2、3类81个。X线BIRADS 4b类42个:恶性16个,MRI分类为4、5类15个;良性26个,MRI为2、3类16个。X线BI-RADS 4c类19个:恶性13个,MRI分类为4、5类12个;良性6个,MRI为3类2个。X线诊断敏感度、特异度为70.7%、74.4%,诊断符合率为73.5%。MRI诊断敏感度、特异性及诊断符合率为95.1%、79.2%和83.1%。X线及MRI诊断乳腺癌的ROC曲线下面积分别为0.749及0.927,两者差异有统计学意义(Z=2.282,P0.05)。新的良恶性评估法发现乳腺癌的敏感度为100%,诊断符合率为77.7%,良性病变检出率为53.0%。结论:MRI对乳腺X线筛查为BI-RADS 4类肿块有较高的诊断价值。结合X线及MRI分类进行新的良恶性评估,能减少良性肿块不必要的活检。
[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.
【作者单位】： 南方医科大学附属深圳市妇幼保健院放射科;
【基金】：广东省医学科学技术研究面上基金项目(2016110212723500)
【分类号】：R445.2;R737.9
，
本文编号：2332840
[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.
【作者单位】： 南方医科大学附属深圳市妇幼保健院放射科;
【基金】：广东省医学科学技术研究面上基金项目(2016110212723500)
【分类号】：R445.2;R737.9
，
本文编号：2332840
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