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Article(id=1208516103035285511, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208516099369464789, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.01.0053, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1620144000000, receivedDateStr=2021-05-05, revisedDate=null, revisedDateStr=null, acceptedDate=1629734400000, acceptedDateStr=2021-08-24, onlineDate=1766062292106, onlineDateStr=2025-12-18, pubDate=1643299200000, pubDateStr=2022-01-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766062292106, onlineIssueDateStr=2025-12-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766062292106, creator=13701087609, updateTime=1766062292106, updator=13701087609, issue=Issue{id=1208516099369464789, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='1', pageStart='1', pageEnd='101', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766062291230, creator=13701087609, updateTime=1766062975431, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208518969208738485, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208516099369464789, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208518969208738486, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208516099369464789, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=53, endPage=57, ext={EN=ArticleExt(id=1208516104096444449, articleId=1208516103035285511, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Comparison of magnetic resonance imaging and mammography for the diagnosis of cluster calcification of breast lesions, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) and mammography (MG)in clustered calcification of breast lesions. Methods The imaging and pathological data of 62 patients with clustered calcification breast lesions in the Chinese PLA General Hospital was retrospectively analyzed to compare the diagnostic efficacy of MRI and MG. Results Of 62 clustered calcification lesions, 20 were benign according to pathologic result, and 42 were malignant. In MRI examination, 14 cases (22.6%) were classified as 1-3, 11 cases (17.7%) as 4, and 37 cases (59.7%) as 5. In MG examination, 10 cases (16.1%) were classified as 1-3, 30 cases (48.4%) as 4, and 22 cases (35.5%) as 5. The consistency between MRI and MG was poor (Kappa=0.346). The diagnostic efficacy of MRI (AUC=0.940, 95%CI 0.850-1.000) was higher than that of MG (AUC=0.800,95%CI 0.686-0.914), and the sensitivity, accuracy, positive predictive value, negative predictive value of MRI (85.7%, 88.7%, 97.3%,76.0%) were higher than those of MG (50.0%, 64.5%, 95.5%, 47.5%). Conclusion For clustered calcification of breast lesions, the diagnostic value of MRI is higher than that of MG.

, correspAuthors=Ning Xing, Jian-Dong Wang, authorNote=null, correspAuthorsNote=
* Wang Jian-Dong, E-mail: ;
Xing Ning, E-mail:
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目的 比较磁共振成像(MRI)与乳房X线摄影(MG)对乳腺簇状钙化病变的诊断价值。方法 回顾性分析2009年1月－2018年5月于解放军总医院就诊的62例乳腺簇状钙化病变患者的影像学和病理资料。以术后病理结果为诊断金标准，比较MRI与MG对乳腺簇状钙化病变的诊断效能及对肿块样病变的检出能力。结果 术后病理结果显示，62例簇状钙化病变中，良性20例，恶性42例。MRI检查诊断为1－3类14例(22.6%)，4类11例(17.7%)，5类37例(59.7%)；MG检查诊断为1－3类10例(16.1%)，4类30例(48.4%)，5类22例(35.5%)。MRI与MG检查的诊断一致性较差，Kappa值为0.346。MRI的诊断效能(AUC=0.940，95%CI 0.850~1.000)高于MG(AUC=0.800，95%CI 0.686~0.914)。MRI诊断的敏感度、准确率、阳性预测值、阴性预测值分别为85.7%、88.7%、97.3%、76.0%，均高于MG(分别为50.0%、64.5%、95.5%、47.5%)。结论 对于乳腺簇状钙化病变，MRI的诊断价值较MG高。

, correspAuthors=邢宁, 王建东, authorNote=null, correspAuthorsNote=
王建东，E-mail：;
邢宁，E-mail：
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马金平，医学硕士，主治医师，主要从事乳腺疾病诊治方面的研究

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马金平，医学硕士，主治医师，主要从事乳腺疾病诊治方面的研究

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马金平，医学硕士，主治医师，主要从事乳腺疾病诊治方面的研究

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Jiangsu Med J, 2017, 43(15): 1090-1092., articleTitle=Diagnostic value of mri dynamic contrast enhancement combined with diffusion weighted imaging in breast cancer, refAbstract=null), Reference(id=1209074243128652474, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, doi=null, pmid=null, pmcid=null, year=2017, volume=43, issue=15, pageStart=1090, pageEnd=1092, url=null, language=null, rfNumber=[19], rfOrder=23, authorNames=周阳阳, 石太峰, 侯卓, journalName=江苏医药, refType=null, unstructuredReference=[周阳阳, 石太峰, 侯卓, 等. 磁共振动态对比增强联合弥散加权成像对乳腺癌的诊断价值[J]. 江苏医药, 2017, 43(15): 1090-1092.], articleTitle=磁共振动态对比增强联合弥散加权成像对乳腺癌的诊断价值, refAbstract=null), Reference(id=1209074243204149947, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, doi=null, pmid=null, pmcid=null, year=2017, volume=283, issue=3, pageStart=692, pageEnd=701, url=null, language=null, rfNumber=[20], rfOrder=24, authorNames=Bennani-Baiti B, Baltzer PA, journalName=Radiology, refType=null, unstructuredReference=Bennani-Baiti B, Baltzer PA. MR imaging for diagnosis of malignancy in mammographic microcalcifications: A systematic review and meta-analysis[J]. Radiology, 2017, 283(3): 692-701., articleTitle=MR imaging for diagnosis of malignancy in mammographic microcalcifications: A systematic review and meta-analysis, refAbstract=null), Reference(id=1209074243325784764, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, doi=null, pmid=null, pmcid=null, year=2017, volume=12, issue=11, pageStart=e0188679, pageEnd=null, url=null, language=null, rfNumber=[21], rfOrder=25, authorNames=Bennani-Baiti B, Dietzel M, Baltzer PA, journalName=PLoS One, refType=null, unstructuredReference=Bennani-Baiti B, Dietzel M, Baltzer PA. MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications[J]. PLoS One, 2017, 12(11): e0188679., articleTitle=MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications, refAbstract=null), Reference(id=1209074243392893629, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, doi=null, pmid=null, pmcid=null, year=2015, volume=274, issue=2, pageStart=343, pageEnd=351, url=null, language=null, rfNumber=[22], rfOrder=26, authorNames=Strobel K, Schrading S, Hansen NL, journalName=Radiology, refType=null, unstructuredReference=Strobel K, Schrading S, Hansen NL, et al. Assessment of BI-RADS category 4 lesions detected with screening mammography and screening US: Utility of MR imaging[J]. 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MG. 乳房X线摄影；MRI. 磁共振成像

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Summary of BI-RADS, pathological morphology and mass nature of 62 patients with clustered calcification breast lesions (n)

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BI-RADS分类病变性质恶性*良性
MGMRIMGMRI
1类肿块0000
非肿块1+0001
2类肿块0000
非肿块0041
3类肿块0014
非肿块0+11+037
4类肿块1+0034
非肿块3+153+282
5类肿块0+141+2501
非肿块2+52+810
合计肿块1+141+2549
非肿块6+216+101611
), ArticleFig(id=1209074239672545950, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, language=CN, label=表1, caption=

62例乳腺簇状钙化病变患者的BI-RADS分类、病变性质与病理结果(例)

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BI-RADS分类病变性质恶性*良性
MGMRIMGMRI
1类肿块0000
非肿块1+0001
2类肿块0000
非肿块0041
3类肿块0014
非肿块0+11+037
4类肿块1+0034
非肿块3+153+282
5类肿块0+141+2501
非肿块2+52+810
合计肿块1+141+2549
非肿块6+216+101611
), ArticleFig(id=1209074239739654815, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, language=EN, label=Tab.2, caption=

Comparison of diagnostic consistency between MG and MRI in duster calcification of breast lesions (n)

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MGMRI合计
1－3类4类5类
1－3类63110
4类781530
5类102122
合计14113762
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MG与MRI检查诊断乳腺簇状钙化病变的一致性(例)

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MGMRI合计
1－3类4类5类
1－3类63110
4类781530
5类102122
合计14113762
), ArticleFig(id=1209074239915815585, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, language=EN, label=Tab.3, caption=

Comparison of diagnostic efficacy of MG and MRI in duster calcification of breast lesions [%(n1/n2)]

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检查敏感度特异度准确率阳性预测值阴性预测值
MG50.0(21/42)95.0(19/20)64.5(40/62)95.5(21/22)47.5(19/40)
MRI85.7(36/42)95.0(19/20)88.7(55/62)97.3(36/37)76.0(19/25)
), ArticleFig(id=1209074239995507362, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208516103035285511, language=CN, label=表3, caption=

MG与MRI检查对乳腺簇状钙化病变的诊断效能比较[%(n1/n2)]

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检查敏感度特异度准确率阳性预测值阴性预测值
MG50.0(21/42)95.0(19/20)64.5(40/62)95.5(21/22)47.5(19/40)
MRI85.7(36/42)95.0(19/20)88.7(55/62)97.3(36/37)76.0(19/25)
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磁共振成像与乳房X线摄影对乳腺簇状钙化病变的诊断价值比较
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马金平 1, 2 , 朱荔 1 , 刘紫朦 1 , 杨丽 1, 3 , 刘丰源 1 , 鲍宝石 1 , 邢宁 1, * , 王建东 1, *
解放军医学杂志 | 临床研究 2022,47(1): 53-57
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解放军医学杂志 | 临床研究 2022, 47(1): 53-57
磁共振成像与乳房X线摄影对乳腺簇状钙化病变的诊断价值比较
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马金平1, 2, 朱荔1, 刘紫朦1, 杨丽1, 3, 刘丰源1, 鲍宝石1, 邢宁1, * , 王建东1, *
作者信息
  • 1解放军总医院第一医学中心普通外科医学部，北京 100853
  • 2烟台市蓬莱人民医院普外一科，山东烟台 265600
  • 3北京市顺义区医院普通外科，北京 101300

    • 马金平，医学硕士，主治医师，主要从事乳腺疾病诊治方面的研究

通讯作者:

王建东，E-mail：;
邢宁，E-mail：
Comparison of magnetic resonance imaging and mammography for the diagnosis of cluster calcification of breast lesions
Jin-Ping Ma1, 2, Li Zhu1, Zi-Meng Liu1, Li Yang1, 3, Feng-Yuan Liu1, Bao-Shi Bao1, Ning Xing1, * , Jian-Dong Wang1, *
Affiliations
  • 1Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • 2Department of General Surgery, Yantai Penglai People's Hospital, Yantai, Shandong 265600, China
  • 3Department of General Surgery, Beijing Shunyi Hospital, Beijing 101300, China
出版时间: 2022-01-28 doi: 10.11855/j.issn.0577-7402.2022.01.0053
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摘要
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目的 比较磁共振成像(MRI)与乳房X线摄影(MG)对乳腺簇状钙化病变的诊断价值。方法 回顾性分析2009年1月－2018年5月于解放军总医院就诊的62例乳腺簇状钙化病变患者的影像学和病理资料。以术后病理结果为诊断金标准，比较MRI与MG对乳腺簇状钙化病变的诊断效能及对肿块样病变的检出能力。结果 术后病理结果显示，62例簇状钙化病变中，良性20例，恶性42例。MRI检查诊断为1－3类14例(22.6%)，4类11例(17.7%)，5类37例(59.7%)；MG检查诊断为1－3类10例(16.1%)，4类30例(48.4%)，5类22例(35.5%)。MRI与MG检查的诊断一致性较差，Kappa值为0.346。MRI的诊断效能(AUC=0.940，95%CI 0.850~1.000)高于MG(AUC=0.800，95%CI 0.686~0.914)。MRI诊断的敏感度、准确率、阳性预测值、阴性预测值分别为85.7%、88.7%、97.3%、76.0%，均高于MG(分别为50.0%、64.5%、95.5%、47.5%)。结论 对于乳腺簇状钙化病变，MRI的诊断价值较MG高。

簇状钙化，乳腺  /  磁共振成像  /  乳房X线摄影

Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) and mammography (MG)in clustered calcification of breast lesions. Methods The imaging and pathological data of 62 patients with clustered calcification breast lesions in the Chinese PLA General Hospital was retrospectively analyzed to compare the diagnostic efficacy of MRI and MG. Results Of 62 clustered calcification lesions, 20 were benign according to pathologic result, and 42 were malignant. In MRI examination, 14 cases (22.6%) were classified as 1-3, 11 cases (17.7%) as 4, and 37 cases (59.7%) as 5. In MG examination, 10 cases (16.1%) were classified as 1-3, 30 cases (48.4%) as 4, and 22 cases (35.5%) as 5. The consistency between MRI and MG was poor (Kappa=0.346). The diagnostic efficacy of MRI (AUC=0.940, 95%CI 0.850-1.000) was higher than that of MG (AUC=0.800,95%CI 0.686-0.914), and the sensitivity, accuracy, positive predictive value, negative predictive value of MRI (85.7%, 88.7%, 97.3%,76.0%) were higher than those of MG (50.0%, 64.5%, 95.5%, 47.5%). Conclusion For clustered calcification of breast lesions, the diagnostic value of MRI is higher than that of MG.

clustered calcification, breast  /  magnetic resonance imaging  /  mammography
马金平, 朱荔, 刘紫朦, 杨丽, 刘丰源, 鲍宝石, 邢宁, 王建东. 磁共振成像与乳房X线摄影对乳腺簇状钙化病变的诊断价值比较. 解放军医学杂志, 2022 , 47 (1) : 53 -57 . DOI: 10.11855/j.issn.0577-7402.2022.01.0053
Jin-Ping Ma, Li Zhu, Zi-Meng Liu, Li Yang, Feng-Yuan Liu, Bao-Shi Bao, Ning Xing, Jian-Dong Wang. Comparison of magnetic resonance imaging and mammography for the diagnosis of cluster calcification of breast lesions[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (1) : 53 -57 . DOI: 10.11855/j.issn.0577-7402.2022.01.0053
正文
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早期诊断对提高乳腺癌患者的生存率至关重要[1]，微钙化可能是早期乳腺癌最有价值的诊断标志物[2]，乳房X线摄影(MG)是目前临床上针对乳腺微钙化病变的主要检查方法。微钙化在乳腺良恶性病变中均可出现，MG检出难以定性的微钙化时，常常建议进一步行组织活检，但创伤性检查会加重患者的生理和心理压力，因此寻求无创性的检查方法判断病灶性质是临床亟待解决的问题。乳腺磁共振成像(MRI)虽然难以显示乳腺的微小钙化，但可检测出恶性病灶的新生血管，并能观察到2~3 mm的病变，可很好地显示病灶的形态及血流动力学参数，对乳腺良、恶性病变的定性具有重要意义。但MRI检查价格昂贵且检查时间较长，其全面推广受到一定限制。MRI动态增强结合MG检查将乳腺可疑微钙化病变的形态学与血流动力学参数综合起来，可对乳腺微钙化病变的定性提供帮助。本研究比较了MRI与MG对乳腺簇状钙化病变的诊断价值，以明确MRI检查是否可提高诊断的准确性。
1 资料与方法
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1.1 研究对象
收集2009年1月－2018年5月就诊于解放军总医院第一医学中心的62例乳腺簇状钙化病变患者的临床资料。纳入标准：(1)术前或穿刺前MG检查发现含簇状钙化病灶，同时行MRI检查；(2)女性患者；(3)术前未行乳房相关治疗；(4)于本院进行手术治疗，对于非肿块型钙化灶，术前行MG下导丝定位，术中切除病灶后行MG检查明确钙化灶完整切除；(5)临床病理资料完整。排除标准：(1)簇状钙化<5粒/cm2；(2)妊娠或哺乳期患者；(3)术前行新辅助治疗或有乳房手术史；(4)未行乳房全切者；(5)术后病理为特殊类型癌。
1.2 MG检查
采用全数字化乳腺摄影机(美国GE公司)，所有患者行轴位(CC位)及侧斜位(MLO位)摄影，增加病变切线以及斜位和局部放大相，观察病灶位置、大小、形态、边缘、密度及钙化情况。簇状钙化计数标准：在钙化范围>1 cm2位置选择最密集处计数，钙化颗粒>5粒/cm2；在钙化范围<1 cm2位置钙化颗粒>5粒。
1.3 MRI检查
采用GE 1.5T和3.0T MRI扫描仪(美国金利公司)，4通道或8通道相控阵乳腺专用线圈，扫描序列包括MR扩散加权成像(DWI)、T2加权成像(T2WI)、T1加权成像(T1WI)、动态增强4个序列。详细参数参照程流泉等[3]的研究。
1.4 图像评估
采用美国放射学院乳腺影像报告与数据系统(breast imaging reporting and data system，BI-RADS)对病灶进行分类，评估报告均由有经验的主治医师或(副)主任医师审核签署。
1.5 统计学处理
使用SPSS 22.0软件进行统计分析。MG与MRI检查的诊断一致性比较采用Kappa检验，采用ROC曲线分析比较两种检查的诊断效能。P<0.05为差异有统计学意义。
2 结果
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2.1 一般资料
共纳入62例乳腺簇状钙化病变患者，年龄49(29~65)岁，术前行MG和MRI检查。术后病理结果显示，良性20例，恶性42例[包括浸润性癌(IDC) 35例、导管原位癌(DCIS) 7例]，病变性质及BI-RADS分类如表1所示。
20例良性患者中，MG检查BI-RADS分类为1－3类8例，其中1例为肿块样病变，7例为非肿块样病变；对应MRI检查BI-RADS分类为1－3类6例，4类2例，其中4例为肿块样病变，4例为非肿块样病变。MG检查BI-RADS分类为4－5类12例，其中3例为肿块样病变，9例为非肿块样病变；对应MRI检查BI-RADS分类为1－3类7例，4－5类5例，其中5例为肿块样病变，7例为非肿块样病变。
42例恶性患者中，MG检查BI-RADS分类为1－3类2例，均为非肿块样病变；对应MRI检查BI-RADS分类为4－5类2例，其中1例为肿块样病变，1例为非肿块样病变。MG检查BI-RADS分类为4－5类40例，其中15例为肿块样病变，余25例为非肿块样病变；对应MRI检查BI-RADS分类为1－3类1例，4－5类39例，其中25例为肿块样病变，15例为非肿块样病变。
2.2 MG与MRI检查诊断乳腺簇状钙化病变的一致性
62例乳腺簇状钙化病变患者中，MG检查诊断为1－3类10例(16.1%，10/62)，4类30例(48.4%，30/62)，5类22例(35.5%，22/62)；MRI检查诊断为1－3类14例(22.6%，14/62)，4类11例(17.7%，11/62)，5类37例(59.7%，37/62)。MG与MRI检查的诊断一致性较差，Kappa值为0.346(表2)。
2.3 MG与MRI检查对乳腺簇状钙化病变的诊断效能比较
MG检查鉴别乳腺良、恶性病变的截断值为4.5(AUC=0.800，95%CI 0.686~0.914)，诊断乳腺簇状钙化恶性疾病的敏感度、特异度和约登指数分别为50.0%、95.0%和45.0%；MRI检查鉴别乳腺良、恶性病变的截断值为4.5(AUC=0.940，95%CI 0.850~1.000)，诊断乳腺簇状钙化恶性疾病的敏感度、特异度和约登指数分别为85.7%、95.0%和80.7%。MRI检查诊断的准确率高于MG检查(88.7% vs. 64.5%，图1、表3)。
3 讨论
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乳腺微钙化是由各种原因引起的矿物质沉积，在乳腺良恶性肿瘤中均可出现。良性钙化一般是钙质沉积造成的，恶性钙化一般是肿瘤坏死残留形成的。根据钙化的大小、形状、分布及密度判断乳腺疾病的良恶性具有重要意义。乳腺微钙化是诊断早期乳腺癌的重要特征，也可能是乳腺恶性肿瘤早期的唯一指征[4]。有研究发现，微钙化是乳腺恶性肿瘤的独立预测因素[5]。最近Clauser等[6]使用微钙化形态、异型性和伴发癌症的标准，通过更广泛频谱的分层算法寻找潜在的恶性病变。但在实际临床工作中，良恶性钙化的形态存在重叠，常出现一些不易或不能定性的可疑钙化，尤以微钙化为著。研究发现，簇状微钙化是无法触及的乳腺癌的主要标志之一，有时甚至是唯一的阳性标志，因此准确判读簇状微钙化、筛选发现乳腺癌是临床亟待解决的问题。根据钙化灶的大小和形态差异，团簇状钙化可分为粗糙不均质钙化、粗大或爆米花样钙化和营养不良性钙化等[7]。研究发现，呈单发团簇状分布的粗糙不均质钙化灶的潜在恶性可能性为7%~15%[8-9]。MG检查操作简单、费用低、诊断较可靠，是目前乳腺筛查常用的影像学方法，特别是其可发现直径0.1~0.2 mm的钙化点，显著提高了含钙化乳腺病灶的检出率。有研究报道，约1/3的MG检查及多达40%的乳腺癌MG检查发现了钙化灶[10]。虽然MG检查在钙化灶的检出方面是其他检查无法替代的，但因其技术特点限制了MG检查的准确性，钙化点大小不一、形态多变、分布随机，与周围乳腺组织对比度低，且放射科医师个体经验存在差异，导致早期诊断的准确率较低[11]。MG检查的阳性预测值为27.4%~60.4%[12]，具有相对较低的敏感度(67.8%)和特异度(75%)[13]，因此单纯依靠MG检查判断簇状微钙化的性质存在一定缺陷。乳腺微钙化的过度活检率高达72.1%~75.0%[14-16]，由于其假阳性率较高，导致许多良性疾病进行了不必要的活检，增加了患者的心理压力及经济负担。
目前，MRI技术得到了很好的推广，由于磁共振对比剂和快速成像序列的开发运用，乳腺MRI诊断水平逐渐增高。MRI可通过注射顺磁对比剂强化肿瘤细胞而对病变进行功能评估，提高诊断乳腺恶性疾病的敏感度和特异度。Pinker等[17]发现，动态增强MRI诊断乳腺癌的准确率为90.6%，但难以显示乳腺的微小钙化，所以在MG发现的钙化病灶中，MRI的评估作用仍存在争议。微小钙化灶虽较难发现，但肿瘤细胞生长较为迅速，致使周围血管增生，肿瘤组织早期血管生成所导致的血流变化，能够通过MRI增强扫描信号反映出来。时间-信号强度曲线为病灶血流灌注及流出等多种因素的综合反映，能够体现病灶情况[18-19]。研究发现，对于MG发现的BI-RADS 3类和5类含钙化病灶，不建议进一步使用乳腺MRI辅助诊断[20]。对于MG检查发现的BI-RADS 4类钙化病灶，可考虑行乳腺MRI检查进一步协助判断病灶性质。Bennani-Baiti等[21]分析了248例微钙化乳腺癌患者，发现MRI对MG分类为BI-RADS 4a和4b类的钙化灶诊断更为精准，有可能避免不必要的活检；而对于4c类钙化灶，不论MRI结果如何，均应进行活检以避免恶性肿瘤漏诊。在Strobel等[22]的研究中，58%(45/78)的簇状微钙化患者通过进一步MRI检查避免了行病灶穿刺活检，且22例MG检查为BI-RADS 4类的簇状微钙化患者经MRI进一步评估后，考虑为恶性，术后病理证实均为导管原位癌。由此可见，MRI可指导后续治疗，且可协助确定手术切除范围。
本研究结果显示，MG对伴有微钙化的乳腺肿瘤诊断准确率为64.5%，MRI为88.7%，MRI对良、恶性肿瘤的诊断准确率均高于MG。由于微钙化可伴随乳腺肿块出现，也可单独存在，在非肿块样病变乳腺癌中，钙化常常是唯一的阳性征象。因此本研究进一步分析了肿块样病变和非肿块样病变中MG和MRI检查的诊断效能，发现在诊断良性微钙化肿块样和非肿块样病变时，二者的准确率均较高，MRI的诊断效能较MG检查无明显提高。但一些特殊病理漏诊情况应结合病史和临床体检，以提高准确性；而对于恶性微钙化非肿块样病变，其诊断难度增加，尤其是MG，此类患者应加做MRI进一步评估病变性质。此外，本研究发现，对于部分MG发现的非肿块样钙化，MRI能够发现肿块样强化，分析原因可能是致密型腺体遮挡了肿物边缘，而MRI断层扫描能很好地弥补这方面的不足。
综上所述，本研究结果表明，MG检查发现乳腺簇状钙化时，建议进一步行MRI检查，以提高诊断准确性。但本研究为回顾性研究，纳入样本数量相对较少，可能存在选择偏倚，且缺乏病灶的病理大小，未对病理结果进行细化分析，其结果有待进一步研究验证。
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2022年第47卷第1期
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doi: 10.11855/j.issn.0577-7402.2022.01.0053
  • 接收时间：2021-05-05
  • 首发时间：2025-12-18
  • 出版时间：2022-01-28
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  • 收稿日期：2021-05-05
  • 录用日期：2021-08-24
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    1解放军总医院第一医学中心普通外科医学部，北京 100853
    2烟台市蓬莱人民医院普外一科，山东烟台 265600
    3北京市顺义区医院普通外科，北京 101300

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