病理性乳头溢液：乳腺导管造影与MRI的对比研究.pdf

经验交流Experience Exchange磁共振成像 2023年6月第14卷第6期 Chin J Magn Reson Imaging,Jun,2023,Vol.14,No.6http:/病理性乳头溢液：乳腺导管造影与MRI的对比研究申霞，莫荣广，周志琴，蒋国元*作者单位：贵州省遵义市第一人民医院（遵义医科大学第三附属医院）乳腺甲状腺中心，遵义 563000*通信作者：蒋国元，E-mail：中图分类号：R445.2；R655.8 文献标识码：A DOI：10.12015/issn.1674-8034.2023.06.012本文引用格式：申霞,莫荣广,周志琴,等.病理性乳头溢液：乳腺导管造影与MRI的对比研究J.磁共振成像,2023,14(6):75-81.摘要 目的比较乳腺导管造影（galactography,GL）与MRI对病理性乳头溢液（pathological nipple discharge,PND）患者的诊断价值以及对良、恶性病变的鉴别诊断价值。材料与方法回顾性分析45例48个有乳头溢液的患乳，溢液性质为血性25个、黄色或淡黄色10个、浆液性7个、水样4个、褐色2个。所有病例均进行了GL和乳腺MRI，以病理结果为金标准，分别以包括乳腺癌、导管乳头状瘤、不典型增生为阳性发现时，以乳腺影像报告和数据系统（Breast Imaging Reporting and Data System,BI-RADS）45类定为阳性发现时，以BI-RADS 5类定为阳性发现时，比较两种检查技术对PND诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度。结果45例48个患乳，病理结果显示恶性病变7个，均为单侧，包括浸润性导管癌2个，导管原位癌并微浸润5个；良性病变41个；GL对PND（乳腺癌、导管乳头状瘤、不典型增生）诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为97.05%、28.57%、76.74%、80.00%、77.08%，MRI分别为91.17%、50.00%、81.57%、70.00%、79.16%；以BI-RADS 45类定为阳性发现时，GL诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为100.00%、12.19%、16.27%、100.00%、25.00%，MRI分别为100.00%、24.39%、18.42%、100.00%、35.41%；以BI-RADAS 5类定为阳性发现时，GL诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为42.85%、97.56%、75.00%、90.90%、89.58%，MRI分别为85.71%、95.12%、75.00%、97.50%、93.75%；总体间率的比较采用2检验，二者之间差异均没有统计学意义（P0.05）；但针对乳腺癌 MRI 敏感度（85.71%）明显高于 GL（42.85%），其准确度分别为93.75%和89.58%。结论GL与MRI对PND诊断均有较高的准确度，MRI对乳腺癌的评估优于GL。关键词 病理性乳头溢液；乳腺癌；鉴别诊断；乳腺导管造影；磁共振成像Pathological nipple discharge:A comparative study of galactography and MRISHEN Xia,MO Rongguang,ZHOU Zhiqin,JIANG Guoyuan*Breast Thyroid Center,the First Peoples Hospital of Zunyi,Guizhou Province(the Third Affiliated Hospital of Zunyi Medical University),Zunyi 563000,China*Correspondence to:Jiang GY,E-mail:Received 18 Oct 2022,Accepted 18 May 2023;DOI:10.12015/issn.1674-8034.2023.06.012Cite this article as:SHEN X,MO R G,ZHOU Z Q,et al.Pathological nipple discharge:A comparative study of galactography and MRIJ.Chin J Magn Reson Imaging,2023,14(6):75-81.Abstract Objective:To compare the diagnostic value of galactography(GL)and MRI in patients with pathological nipple discharge(PND)and differential for benign and malignant lesions.Materials and Methods:Forty-eight breasts with nipple discharge in 45 cases were analyzed retrospectively.The discharge was bloody in 25 cases,yellow or yellowish in 10 cases,serous in 7 cases,watery in 4 cases,brown in 2 cases.GL and MRI were performed in all cases,and pathological findings were used as the gold standard.When breast cancer,ductal papilloma and atypical hyperplasia,Breast Imaging Reporting and Data System(BI-RADS)4-5,BI-RADS 5 were selected as positive findings,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the two diagnostic techniques for PND were compared.Results:There were 48 breast lesions in 45 cases.The pathological results showed that there were 7 cases of malignant lesions,all of which were unilateral,including 2 cases of invasive ductal carcinoma,5 cases of ductal carcinoma in situ with microinvasion and 41 cases of benign lesions.GL for the accury diagnosis of PND(breast cancer,ductal papilloma,dysplasia),sensitivity,specificity,positive predictive value,negative predictive value was 97.05%,28.57%,76.74%,80.00%and 77.08%;MRI were 91.17%,50.00%,81.57%,70.00%and 79.16%.When BI-RADS category 4-5 was designated as a positive finding,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of GL diagnosis were 100.00%,12.19%,16.27%,100.00%,25.00%;MRI was 100.00%,24.39%,18.42%,100.00%,35.41%.When BI-RADS category 5 was designated as a positive finding,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of GL diagnosis were 42.85%,97.56%,75.00%,90.90%,89.58%;MRI was 85.71%,95.12%,75.00%,97.50%,93.75%.The 2 test was used for the comparison of rates between populations,and the difference between the two was not statistically significant(P0.05).However,the sensitivity of MRI for breast cancer(85.71%)was significantly higher than that of GL(42.85%),and its accuracy was 93.75%and 89.58%.Conclusions:GL and MRI have high accuracy in the diagnosis of PND,and MRI is better than GL in the evaluation of breast cancer.Key words pathological nipple discharge;breast cancer;differential diagnosis;galactography;magnetic resonance imaging0前言乳腺癌是女性常见的恶性肿瘤之一，发病率位居女性恶性肿瘤首位，2020年全球乳腺癌新发病变已达226万，已取代肺癌成为全球第一大癌症，其死亡人数亦居全球女性恶性肿瘤死亡人数首位，严重危害妇女的身心健康及生命1；而乳腺癌最有效的治疗策略是“早期发现、早期诊断、早期治疗”，由此可见，对乳腺癌的早期发现和诊断尤为重要。病理性乳头溢液（pathological nipple discharge,PND）是 乳 腺疾病常见的临床症状，多为导管内病变引起，包括良收稿日期：2022-10-18 接受日期：2023-05-1875磁共振成像 2023年6月第14卷第6期 Chin J Magn Reson Imaging,Jun,2023,Vol.14,No.6http:/经验交流Experience Exchange性及恶性病变2-3，常见的疾病有导管内乳头状瘤、乳腺增生、乳腺导管扩张症和乳腺癌4；乳腺导管造影（galactography,GL）是评估PND的标准成像技术5-7，但对良恶性病变的鉴别诊断有一定困难，难以同时观察导管外病变；乳腺MRI是一种具有较高敏感度及特异度的乳腺恶性肿瘤检查方法，对PND也有较高的敏感度和阴性预测值8-10，并越来越多地被用来代替GL11-13；但对2种检查方法的对比研究国内未见文献报道，国外研究亦较少14，并且研究中不是所有研究对象都同时进行了GL和MRI检查，且研究结果不一定适合中国人群。因此，本研究对GL和MRI对PND的诊断价值和对良、恶性病变的鉴别诊断价值进行对比研究，所有研究对象都进行了GL和MRI检查，对GL和MRI对PND诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度进行对比。其目的旨在提高我国PND恶性病变的术前检出率及良、恶性病变的鉴别诊断能力，