简体中文

论著-头颈部

动态增强MRI与钼靶X线评估乳腺癌患者保乳术的临床价值

作者:张 琼

所属单位:郑州人民医院医学影像科(河南 郑州 450003)

PDF

摘要

目的探讨动态增强MRI扫描与钼 靶X线摄影联合评估乳腺癌患者能否行保 乳术的临床价值。方法 选择2016年1月至 2017年8月在我院行乳腺癌根治手术的患 者资料进行回顾性分析,术前同时接受动 态增强MRI、钼靶检查,观察动态增强MRI 和钼靶X线评估患者能否行保乳术的临床 价值。结果 钼靶X线和动态增强MRI检测 主癌灶个数、长径相比较差异无统计学意 义(P>0.05);钼靶X线子灶检出个数、距 乳晕距离、乳晕侵犯、砂粒样钙化、胸肌 侵犯、淋巴结转移个数与动态增强MRI相 比,较均有统计学差异(P<0.05)。动态增 强MRI预测保乳术的特异性、敏感度、符 合率和AUC均高于钼靶X线;动态增强MRI 和钼靶X线阳性预测保乳术的特异性均高 于单纯动态增强MRI和钼靶X线;动态增强 MRI或钼靶X线之一阳性预测保乳术的敏感 度高于单纯动态增强MRI和钼靶X线。结论 动态增强MRI与钼靶X线均是评估保乳术重 要检查手段,二者各有优缺点,临床可根 据实际情况灵活运用。

Objective To investigate the dynamic enhanced MRI scanning and mammography combined assessment of clinical value of breast conserving surgery or breast cancer patients. Methods Data from January 2016 to August 2017 in patients with radical surgery in our hospital for breast cancer were retrospectively analyzed. The preoperative and dynamic contrast-enhanced MRI, mammography, observation the clinical value of dynamic contrast-enhanced breast conserving surgery can MRI and mammography were evaluated. Results Mammography and dynamic enhanced MRI in the detection of the main tumor number, there was no significant difference between long diameter (P>0.05), mammography sub foci number, distance from the areola Areola, invasion, calcification, muscle invasion, lymph node metastasis and the number of dynamic enhanced MRI were statistically significant (P<0.05). Dynamic enhanced MRI predictive specificity, the sensitivity of breast conserving surgery, and the coincidence rate of AUC was higher than that of mammography, dynamic enhanced specificity of breast conserving surgery and MRI molybdenum target X line positive predictive was higher than that of dynamic enhanced MRI and mammography; sensitivity is higher than that of pure molybdenum target X-ray dynamic enhanced MRI and dynamic enhanced MRI or positive predictive mammography in breast conserving surgery. Conclusion Dynamic contrast-enhanced MRI and mammography are evaluation of breast conserving surgery for an important examination method, two Each has its own advantages and disadvantages, and it can be applied flexibly according to the actual situation.

【关键词】乳腺癌;保乳根治术;动态增强MRI;钼靶X线摄影

【中图分类号】R737.9;R445.2;R445.4

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.10.029

前言

乳腺癌居我国女性恶性肿瘤发病率第1位,发病率逐年升高,且 呈年轻化趋势,外科手术切除为主的综合治疗是乳腺癌的主要治疗方 式[1]。乳腺癌手术方式包括Halsted根治术、扩大根治术、改良根治术 和保乳手术等方式,近年来随着乳腺癌发病年龄的降低和对生活质量 要求的提高,乳腺癌患者对治疗的关注已经不仅局限于肿瘤病灶的切 除,保留乳房提高自尊和自信亦成为关注的热点,保乳术的临床应用 越来越多[2]。保乳术治疗的原则为在根治的基础上尽可能保存乳房的 功能、外形,首要目标为保证癌变组织的根除,对病例选择具有严格 的要求,影像学检查对肿瘤位置、大小、数量等检查的准确性直接影 响手术方案的设计和预后[3]。该研究对281例乳腺癌患者进行回顾性分 析,探讨动态增强MRI扫描与钼靶X线摄影联合评估乳腺癌患者能否行 保乳术的临床价值,现将结果报告如下。