对比增强超声联合常规超声与磁共振成像对恶性非肿块型乳腺病变的诊断价值比较。

Comparison of the diagnostic value of contrast-enhanced ultrasound combined with conventional ultrasound versus magnetic resonance imaging in malignant non-mass breast lesions.

机构信息

Departmentof Ultrasound, Shanghai General Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.

出版信息

Br J Radiol. 2023 Oct;96(1150):20220880. doi: 10.1259/bjr.20220880. Epub 2023 Jul 3.

DOI:10.1259/bjr.20220880

PMID:37393540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10546433/

Abstract

OBJECTIVE

To compare the diagnostic value of contrast-enhanced ultrasound (CEUS)+conventional ultrasound MRI for malignant non-mass breast lesions (NMLs).

METHODS

A total of 109 NMLs detected by conventional ultrasound and examined by both CEUS and MRI were retrospectively analysed. The characteristics of NMLs in CEUS and MRI were noted, and agreement between the two modalities was analysed. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and area under the curve (AUC) of the two methods for diagnosing malignant NMLs were calculated in the overall sample and subgroups of different sizes(<10 mm, 10-20 mm, >20 mm).

RESULTS

A total of 66 NMLs detected by conventional ultrasound showed non-mass enhancement in MRI. Agreement between ultrasound and MRI was 60.6%. Probability of malignancy was higher when there was agreement between the two modalities. In the overall group, the sensitivity, specificity, PPV, and NPV of the two methods were 91.3%, 71.4%, 60%, 93.4% and 100%, 50.4%, 59.7%, 100%, respectively. The diagnostic performance of CEUS+conventional ultrasound was better than that of MRI (AUC: 0.825 0.762, = 0.043). The specificity of both methods decreased as lesion size increased, but sensitivity did not change. There was no significant difference between the AUCs of the two methods in the size subgroups ( > 0.05).

CONCLUSION

The diagnostic performance of CEUS+conventional ultrasound may be better than that of MRI for NMLs detected by conventional ultrasound. However, the specificity of both methods decrease significantly as lesion size increases.

ADVANCES IN KNOWLEDGE

This is the first study to compare the diagnostic performance of CEUS+conventional ultrasound that of MRI for malignant NMLs detected by conventional ultrasound. While CEUS+conventional ultrasound appears to be superior to MRI, subgroup analysis suggests that diagnostic performance is poorer for larger NMLs.

摘要

目的

比较超声造影（CEUS）+常规超声与 MRI 对恶性非肿块型乳腺病变（NML）的诊断价值。

方法

回顾性分析 109 例经常规超声和 CEUS+MRI 检查的 NML 患者。观察 NML 在 CEUS 和 MRI 中的特征，并分析两种方法的一致性。计算两种方法在整体样本及不同大小（<10mm、10-20mm、>20mm）亚组中诊断恶性 NML 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。

结果

常规超声检出的 66 例 NML 在 MRI 上呈非肿块样强化，两种方法的一致性为 60.6%。两种方法一致时恶性概率更高。在整体组中，两种方法的敏感性、特异性、PPV、NPV 分别为 91.3%、71.4%、60%、93.4%和 100%、50.4%、59.7%、100%。CEUS+常规超声的诊断效能优于 MRI（AUC：0.825 vs. 0.762，=0.043）。两种方法的特异性均随病变大小的增加而降低，而敏感性未发生变化。在病变大小亚组中，两种方法的 AUC 无显著差异（>0.05）。