1 Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
2 Dipartimento di Radiodiagnostica, Unità Operativa Senologia Clinica e Screening Mammografico, Azienda Provinciale per i Servizi Sanitari Provincia Autonoma di Trento, Trento, Italy.
AJR Am J Roentgenol. 2017 Aug;209(2):465-471. doi: 10.2214/AJR.16.16682. Epub 2017 May 24.
The objective of our study was to perform a systematic review of the literature of the diagnostic accuracy of MRI compared with galactography in women with pathologic nipple discharge.
A systematic literature search was performed (MEDLINE, Embase, Web of Science) for articles evaluating the diagnostic performance of MRI and galactography in patients with pathologic nipple discharge and with histologic verification or clinical follow-up. Distinction between any abnormality and cancer was made. Two independent readers selected eligible articles published until December 2015. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data analyses were performed using the bivariate model.
Ten articles were analyzed for a total of 921 patients. The study quality was high, with a low risk of bias and low concerns regarding applicability. The pooled sensitivity for any abnormality was significantly higher for MRI, with 92% (95% CI, 85-96%), than for galactography, with 69% (95% CI, 59-78%) (p < 0.001). The pooled specificity was 76% (95% CI, 49-92%) for MRI versus 39% (95% CI, 16-69%) for galactography (p < 0.001). The pooled sensitivity and specificity for cancer detection were calculated for MRI only and were 92% (95% CI, 74-98%) and 97% (95% CI, 80-100%), respectively.
This meta-analysis shows a higher diagnostic performance of MRI compared with that of galactography in the detection of any kind of lesion in patients with pathologic nipple discharge. Moreover, high sensitivity and very high specificity for cancer by MRI could be confirmed in this clinical setting. If mammography and ultrasound are negative, MRI should be preferred over galactography for further evaluation.
本研究旨在对经病理证实乳头溢液患者的 MRI 与乳管造影术诊断准确性的文献进行系统评价。
对评估经病理证实乳头溢液患者的 MRI 和乳管造影术诊断性能的文献进行了系统检索（MEDLINE、Embase、Web of Science），并对有组织学验证或临床随访的患者进行了研究。对任何异常和癌症进行了区分。两名独立的读者选择了截止到 2015 年 12 月发表的合格文章。使用 QUADAS-2 工具评估研究质量。使用双变量模型进行数据分析。
10 篇文章共分析了 921 例患者。研究质量高，偏倚风险低，应用相关性低。MRI 对任何异常的汇总敏感性明显高于乳管造影术，为 92%（95%CI，85-96%），而乳管造影术为 69%（95%CI，59-78%）（p<0.001）。MRI 的汇总特异性为 76%（95%CI，49-92%），而乳管造影术为 39%（95%CI，16-69%）（p<0.001）。仅计算 MRI 对癌症检测的汇总敏感性和特异性，分别为 92%（95%CI，74-98%）和 97%（95%CI，80-100%）。
本荟萃分析显示，与乳管造影术相比，MRI 对病理证实乳头溢液患者的任何病变的诊断性能更高。此外，在这种临床环境下，MRI 对癌症的高敏感性和极高特异性也得到了证实。如果乳腺钼靶和超声检查均为阴性，MRI 应优先于乳管造影术用于进一步评估。
