乳腺血供不对称性增加及邻近血管征鉴别诊断乳腺良恶性病变

目的 探讨乳腺血供不对称性增加及邻近血管征在鉴别乳腺良恶性病变中的价值。方法 回顾性分析经病理证实的102例乳腺病变患者的MR增强3D最大密度投影图像,比较乳腺血供不对称性增加、邻近血管征、上述两种征象均为阳性及其中任意一种征象为阳性在不同最大径病变及良恶性病变中的出现率;评价其鉴别乳腺良恶性病变的价值。结果 102例患者中,恶性病变58例,良性44例。乳腺血供不对称性增加及邻近血管征在恶性病变中的出现率高于良性病变,在最大径>2 cm病灶中的出现率高于最大径≤2 cm的病灶。以乳腺血供不对称性增加鉴别同侧乳腺良恶性病变的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及ROC曲线下面积(AUC)分别为56.89%(33/58)、79.54%(35/44)、78.57%(33/42)、58.33%(35/60)及0.68;以邻近血管征诊断同侧乳腺恶性病变的上述指标分别为56.89%(33/58)、93.18%(41/44)、91.67%(33/36)、62.12%(41/66)及0.75;以上述两种征象均为阳性诊断恶性病变的敏感度、特异度、PPV、NPV及AUC分别为46.55%(27/58)、93.18%(41/44)、90.00%(27/30)、56.94%(41/72)及0.70;以其中任一征象阳性诊断恶性病变的敏感度、特异度、PPV、NPV及AUC分别为68.97%(40/58)、81.82%(36/44)、83.33%(40/48)、66.67%(36/54)及0.75。结论 乳腺血供不对称性增加及邻近血管征在鉴别乳腺良恶性病变中具有一定的参考价值。

Asymmetric increase in breast vascularity and adjacent vessel sign in differential diagnosis of benign and malignant breast lesions

Objective To estimate the value of asymmetric increase in breast vascularity (AIBV) and adjacent vessel sign (AVS) in the differential diagnosis of benign and malignant breast lesions. Methods The dynamic contrast-enhanced MR 3D maximum intensity projection images of 102 patients with breast lesions confirmed by histopathology were analyzed retrospectively, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and areas under the ROC (AUC) of AIBV and AVS in the differential diagnosis of benign and malignant breast lesions were evaluated. Results The 102 patients included 58 patients with malignant breast lesions and 44 patients with benign ones. The occurrence of AIBV and AVS were higher in the malignant lesions and in >2 cm lesions. The sensitivity, specificity, PPV, NPV, and AUC of AIBV in the differential diagnosis of benign and malignant breast lesions were 56.89% (33/58), 79.54% (35/44), 78.57% (33/42), 58.33% (35/60) and 0.68, respectively, while those of AVS were 56.89% (33/58), 93.18% (41/44), 91.67% (33/36), 62.12% (41/66) and 0.75, respectively, when the sensitivity, specificity, PPV, NPV, and AUC of the combination of AIBV and AVS were 46.55% (27/58), 93.18% (41/44), 90.00% (27/30), 56.94% (41/72) and 0.70, respectively; which were 68.97% (40/58), 81.82% (36/44), 83.33% (40/48), 66.67% (36/54) and 0.75 in diagnosis malignant breast lesions either AIBV or AVS positivity. Conclusion AIBV and AVS can be used to discriminate the malignant breast lesions from the benign ones.