CESM量化特征联合形态学对BI-RADS 3~5类乳腺单发肿块的诊断价值

徐维敏; 郑博文; 潘德润; 文婵娟; 汪思娜; 曾辉; 何子龙; 秦耿耿; 陈卫国

doi:10.19732/j.cnki.2096-6210.2022.02.007

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CESM量化特征联合形态学对BI-RADS 3~5类乳腺单发肿块的诊断价值

论著 | 更新时间：2025-12-15

- CESM量化特征联合形态学对BI-RADS 3~5类乳腺单发肿块的诊断价值
- Diagnostic value of quantitative features of CESM combined with morphology for single breast masses in BI-RADS category 3 to 5　
- 肿瘤影像学 2022年31卷第2期页码：146-153
- 作者机构：
- 作者简介：
- 基金信息：
  
  国家自然科学基金项目（82171929）;广东省自然科学基金项目（2019A1515011168）;广东省医学科研基金项目（A2021391，B2020095，B2021043）;南方医科大学南方医院临床研究专项（2020CR009）
- DOI：10.19732/j.cnki.2096-6210.2022.02.007
  中图分类号：
- 网络出版：2022-04-28，
  
  纸质出版：2022-04-28
- 稿件说明：
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徐维敏,郑博文,潘德润,等. CESM量化特征联合形态学对BI-RADS 3~5类乳腺单发肿块的诊断价值[J]. 肿瘤影像学, 2022, 31(2): 146-153 https://doi.

org/10.19732/j.cnki.2096-6210.2022.02.007
徐维敏,郑博文,潘德润,等. CESM量化特征联合形态学对BI-RADS 3~5类乳腺单发肿块的诊断价值[J]. 肿瘤影像学, 2022, 31(2): 146-153 https://doi. DOI： 10.19732/j.cnki.2096-6210.2022.02.007.

org/10.19732/j.cnki.2096-6210.2022.02.007 DOI：

摘要

目的：

探讨对比增强能谱乳腺摄影（contrast enhancement spectral mammography，CESM）量化特征联合形态学对乳腺单发肿块的诊断价值。

方法：

回顾并分析2018年1月2020年12月行CESM检查的乳腺影像报告和数据系统（Breast Imaging Reporting and Data System，BI-RADS）3~5类乳腺单发肿块。所有患者均行头尾（craniocaudal，CC）位（早期，T1）、内外斜（mediolateral oblique，MLO）位（晚期，T2）摄影，随后测量减影图病灶的强化灰度值（lesion grey value，LGV）。并根据LGV在两个时相的变化量评估病灶的动态强化特点。同时分析病灶CESM低能图及减影图形态学特征。最后以病理学检查结果为金标准，评价CESM（低能图及减影图）、LGV

+LGV

+动态强化、CESM+LGV

+LGV

、CESM+动态强化、CESM+LGV

+LGV

+动态强化对乳腺单发肿块的诊断效能。

结果：

160例患者全为女性，共检出160个肿块，恶性病灶118个，良性肿块42个。CESM、LGV

+LGV

+动态强化、CESM+LGV

+LGV

、CESM+动态强化及CESM+LGV

+LGV

+动态强化的曲线下面积（area under curve，AUC）分别为0.917、0.748、0.922、0.919及0.927。单独CESM诊断的灵敏度、特异度、阳性预测值、阴性预测值及准确度均高于LGV

+LGV

+动态强化（分别为91.5%

75.4%、83.3%

64.2%、93.9%

85.5%、77.7%

48.2%和89.3%

72.5%）。而CESM+LGV

+LGV

+动态强化的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为96.6%、80.9%、93.4%、89.4%、92.5%。

结论：

CESM（低能图+减影图）形态学、病灶的LGV及动态强化特征综合判断可提高BI-RADS 3~5类乳腺单发肿块的诊断效能，在一定程度上降低良性肿块的活检率。

Abstract

Objective:

To find out the benefits of adding morphology and quantitative analysis onto contrast enhancement spectral mammography (CESM) in diagnosis of single breast masses.

Methods:

All patients found with Breast Imaging Reporting Data System (BI-RADS) category 3-5 breast mass-like lesions by CESM from January 2018 to December 2020 were retrospective analyzed. All cases were performed craniocaudal (CC) view (early phase

T1) and mediolateral oblique (MLO) view (later phase

T2). The quantitative enhanced lesion gray value (LGV) was measured within each phases recombined image. Based on their changes

the kinetic enhancement pattern was assessed among the two phases. And the diagnostic performance was subsequently measured.

Results:

A total of 160 breast masses were found in 160 female patients

and 118 masses were malignant and 42 masses were benign. The areas under curves (AUC) of CESM

LGV

+LGV

+kinetic enhancement

CESM+LGV

+LGV

CESM+kinetic enhancement

and CESM+LGV

+LGV

+kinetic enhancement was 0.917

0.748

0.922

0.919 and 0.927

respectively. By evaluatingthe diagnostic value

sensitivity

specificity

positive predictive value

negative predictive value

and accuracy from morphological categorization were all higher than those of the LGV combined with kinetic enhancement (91.5%

75.4%

83.3%

64.2%

93.9%

85.5%

77.7%

48.2%

and 89.3%

72.5%). While

the sensitivity

specificity

positive predictive value

negative predictive value

and accuracy of the CESM+LGV

+LGV

+kinetic enhancement were 96.6%

80.9%

93.4%

89.4% and 92.5%

respectively.

Conclusion:

For the BI-RADS 3-5 breast masses

adding the CESM quantitative ana

lysis with the CESM morphology can improve confidence level

and reduce the biopsy rate of benign masses.

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