动态增强MRI对乳腺FFDM检出的BI-RADS 4-5类非肿块型微钙化病灶的诊断价值

doi:10.3969/j.issn.1006-6233.2020.06.024

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Abstract Objective:To investigate the diagnostic value of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of BI-RADS 4-5 non-mass microcalcification lesions on full-field digital mammography (FFDM). Methods: Conduct retrospective analysis of 148 patients with 152 lesions, who were examined by bilateral breast DCE-MRI and all had pathological results,from January 2017 to August 2019. Plot the receiver operator characteristic curve (ROC) of the two diagnostic methods, and verify the best diagnostic threshold according to the most approximate index, which was used to judge the benign and malignant boundary of the BI-RADS classification of breast lesions. With histopathological results as the golden standard, the sensitivity, specificity and positive predictive value (PPV), negative predictive value (NPV) and accuracy of the two methods for different BI-RADS classification were calculated and compared with χ² test or Fisher exact test, and the area under the ROC curve (AUC) of the two diagnostic methods were compared with Z test. Results: There were 152 lesions in 148 patients including 62 benign lesions and 90 malignant lesions confirmed by pathological biopsy. The ROC curves of the two diagnostic methods were plotted, and the best diagnostic threshold was 4b, the BI-RADS below 4b was benign and the BI-RADS 4b or above was malignant of the two diagnostic methods. For 152 cases of breast BI-RADS 4-5 non-mass microcalcification lesions on FFDM, the sensitivity, specificity, PPV, NPV and accuracy of FFDM were 86.7%, 53.2%, 72.9%, 73.3%, 73.0%, DCE-MRI was 93.3%, 83.9%, 89.4%, 89.7%, 89.5%, respectively. The sensitivity of the two methods was not significantly different (χ²=2.222, P>0.05), and the specificity, PPV, NPV and accuracy of the two methods were statistically significantly different (χ²=13.503, 8.674, 4.681, 13.495,respectively, all P<0.05). For 125 cases of breast BI-RADS 4 non-mass microcalcification lesions on FFDM, the sensitivity, specificity, PPV, NPV and accuracy of FFDM were 82.4%, 57.9%, 70.0%, 73.3%, 71.2%, DCE-MRI was 92.6%, 86.0%, 88.7%, 90.7%, 89.6%, respectively. The sensitivity of the two methods was not significantly different (χ²=3.294, P>0.05), the specificity, PPV, NPV and accuracy of the two methods were statistically significantly different (χ²=11.122, 7.903, 5.299, 13.428, respectively, all P<0.05). For 27 cases of breast BI-RADS 5 non-mass microcalcification lesions on FFDM, the sensitivity, specificity, PPV, NPV and accuracy of FFDM were 100.0%, 0, 81.5%, 0, 81.5%, DCE-MRI was 95.5%, 60.0%, 91.3%, 75.0%, 88.9%, respectively. The sensitivity specificity, PPV and accuracy of the two methods were not significantly different (all P＞0.05). For breast BI-RADS 4-5 non-mass microcalcification lesions on FFDM, the areas under the ROC curve (AUC) of FFDM and DCE-MRI diagnostic methods were 0.752 and 0.907, respectively. The difference between the two AUC was statistically significant. (Z=4.068, P＜0.0001, 95% confidence interval CI was 0.0804~0.230). Conclusion: For breast BI-RADS 4-5 non-mass microcalcification lesions on FFDM, DCE-MRI can effectively improve the diagnostic efficiency of lesions; for breast BI-RADS 4-5 non-mass microcalcification lesions on FFDM, DCE-MRI has no obvious advantage.

Key words： Full digital mammography Dynamic contrast enhancement Magnetic resonance imaging Non-mass microcalcification

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2020.06.024 OR http://www.hbyxzzs.cn/EN/Y2020/V26/I6/988

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