目的 探讨多参数MRI在鉴别乳腺影像报告和数据系统（BI-RADS）4类乳腺病变良恶性中的应用。方法 回顾性分析2022年1月—2024年12月于同济大学附属东方医院庐江分院行乳腺MRI检查为BI-RADS 4类且病理结果明确肿瘤的病例268例，其中良性组166例（包括乳腺纤维腺瘤93例，导管内乳头状瘤39例，乳腺囊性增生24例，乳腺分叶状肿瘤2例，浆细胞性乳腺炎8例），恶性组102例（包括浸润性导管癌89例，浸润性小叶癌6例，黏液癌2例，炎性乳腺癌5例）。对比分析单一序列和多序列联合诊断BI-RADS 4类乳腺病变良、恶性的效能；绘制基于多参数MRI受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）、特异度和灵敏度，量化多序列对于BI-RADS 4类乳腺病变良恶性的诊断效能。结果 基于多参数MRI联合诊断效能最高（AUC：0.912，95%CI：0.871~0.953），特异度为0.922，灵敏度为0.902；基于ADC值评估BI-RADS 4类乳腺病变最佳截断值为0.84×10-3 mm2 /s，且均具有统计学意义（P＜0.05）。结论 基于多参数MRI能够有效诊断BI-RADS 4类乳腺病变的良、恶性，为乳腺外科疾病进一步诊疗提供影像学诊断依据。
Objective To explore the application of multiparametric MRI in differentiating benign and malignant lesions classified as BI-RADS category 4 in breast imaging．Methods A total of 268 cases of breast MRI classified as BI-RADS category 4 with confirmed tumor pathology were retrospectively analyzed from January 2022 to December 2024 at the Tongji University Oriental Hospital Lujiang Branch. Among them，166 cases were categorized as benign lesions（including 93 cases of breast fibroadenoma，39 cases of intraductal papilloma，24 cases of cystic hyperplasia，2 cases of lobular tumor，and 8 cases of plasma cell mastitis），while 102 cases were categorized as malignant lesions（including 89 cases of invasive ductal carcinoma，6 cases of invasive lobular carcinoma，2 cases of mucinous carcinoma，and 5 cases of inflammatory breast cancer）．The efficacy of single-sequence versus combined multiple-sequence imaging in diagnosing benign and malignant BI-RADS category 4 breast lesions was compared and analyzed．The diagnostic efficacy of the multiparametric MRI sequences was quantified by plotting a receiver operating characteristic curve and calculating the area under the curve（AUC），as well as the specificity and sensitivity．Results The combined diagnostic efficacy of multiparametric MRI yielded the highest performance，with an AUC of 0.912（95%CI：0.871-0.953），demonstrating a specificity of 0.922 and a sensitivity of 0.902．The optimal cutoff value for differentiating BI-RADS category 4 breast lesions based on apparent diffusion coefficient values was determined to be 0.84×10-3 mm2 /s，with all results being statistically significant（P＜0.05）．Conclusions Multiparametric MRI can effectively diagnose benign and malignant lesions classified as BI-RADS category 4，providing a reliable imaging basis for further diagnosis and treatment in breast surgery．
目的 探究数字乳腺三维断层融合摄影技术(DBT)联合MR波谱在乳腺高危病灶诊断中的应用。方法 选取2020年6月—2021年6月来我院进行乳腺钼靶X线摄影并诊断为BI-RADS 4级及以上的100例乳腺高危病灶患者为研究对象,对入选患者行MR波谱及DBT检查,分析MR波谱征象及DBT乳腺病变摄影特征,以病理结果为标准,评价MR波谱与DBT及两者联用对乳腺高危病灶的诊断疗效。结果 DBT敏感度、特异度、阳性预测值、阴性预测值均高于MR波谱;DBT漏诊率、误诊率均低于MR波谱漏诊率、误诊率,2组诊断方法比较(P<0.05)。MR波谱及DBT对≥2 cm恶性病变的病理诊断结果符合率比较,差异均无统计学意义(P＞0.05)。MR波谱及DBT对乳腺良性病变、恶性病变＜2 cm诊断结果符合率比较,DBT对乳腺高危患者的病理诊断结果符合率高于MR波谱(P＜0.05)。结论 乳腺高危病灶诊断中选择DBT可对乳腺高危病灶诊断中做出准确的分析和判断,对乳腺高危病灶诊断更具有应用价值,值得临床采纳。
Objective To explore the application of digital breast tomosynthesis (DBT) combined with MR wave in the diagnosis of high-risk breast lesions. Methods A total of 100 patients with breast high-risk lesions diagnosed as BI-RADS 4 or above by mammography in our hospital from June 2020 to June 2021 were selected as the research objects. The selected patients were examined by MR spectrum and DBT. The signs of MR spectrum and the photographic characteristics of DBT breast lesions were analyzed. Based on the pathological results, the diagnostic efficacy of MR spectrum, DBT and their combination in the diagnosis of breast high-risk lesions was evaluated. Results The sensitivity, specificity, positive predictive value and negative predictive value of DBT were higher than those of MR spectrum; the missed diagnosis rate and misdiagnosis rate of DBT were lower than those of MR spectrum (P<0.05). There was no significant difference in the coincidence rate of MR spectrum and DBT in the pathological diagnosis of malignant lesions ≥ 2 cm (P>0.05). The coincidence rate of MR spectrum and DBT in the diagnosis of benign and malignant breast lesions<2 cm was higher than that of MR spectrum (P<0.05). Conclusions Selecting DBT in the diagnosis of breast high-risk lesions can make accurate analysis and judgment in the diagnosis of breast high-risk lesions. It has higher application value in the diagnosis of breast high-risk lesions and is worthy of clinical adoption.
