乳腺自动全容积成像技术对乳腺癌诊断价值研究

【作者】 李娜；

【导师】 姜玉新；

【作者基本信息】 北京协和医学院 ， 影像医学与核医学， 2014， 博士

【摘要】 目的：首次前瞻性研究自动全乳容积成像技术(ABVS)对多灶性及多中心性乳腺癌(MMBC)的诊断价值,并以全乳连续切片病理检查作为金标准,与常规超声(HHUS)进行前瞻性平行对照,探讨此项新技术的临床应用价值。资料与方法：254例纳入者共取得94个全乳病理学标本,其中2例为同期双侧乳腺癌。所有研究对象术前均完成ABVS及常规超声检查,采用全乳病理检查作为金标准,分析ABVS诊断MMBC的敏感性、阳性预测值、准确性、真阳性、假阳性及假阴性,进一步确定ABVS的诊断效能与影响因素(病理类型、超声图像模式及病灶大小)之间的相互关系。比较常规超声及ABVS在上述诊断指标之间的差异性,以及两者的诊断差异与病理类型、超声图像模式及病灶大小之间的相关性。另一方面,分析ABVS假阴性病灶中浸润灶/非浸润灶比值及病灶大小与病灶特征,并进一步总结两种诊断方法在不同病理类型(浸润性癌或导管内原位癌)中的敏感性及阳性预测值差异。根据病灶数量及位置是否与病理一致,将结果分为低估诊断,准确诊断及高估诊断,明确ABVS诊断的准确率。全部资料进行相应统计学分析。结果：94个送检乳腺中,经病理证实单灶乳腺癌32个,多灶性乳腺癌46个以及多中心性乳腺癌16个,总计196个恶性病灶(171个浸润癌,25个原位癌)。常规超声总计发现155(90.6%)个浸润灶及11(44.0%)个非浸润灶,ABVS总计发现154(90.1%)个浸润灶及19(76.0%)个非浸润灶。全部病灶中,ABVS及常规超声诊断一致病灶172个(87.8%)。浸润灶中两者的一致性明显高于非浸润灶(91.8%vs.60.0%)。ABVS和常规超声诊断MMBC的总敏感性分别为84.7%及87.8%(p>0.05)。浸润癌中的敏感性分别为89.5%及90.6%(p>0.05)。原位癌中的敏感性分别为76.0%及44.0%(p<0.05)。常规超声及ABVS分别漏诊30个和24个癌灶。漏诊病灶直径中位数分别为7.5mm和8.0mm(p=0.923)；漏诊病灶浸润/非浸润为1.1：1及3.0:1(p=0.101)。ABVS及常规超声诊断的PPV分别为86.0%和75.1%(p<0.05)。肿块型病灶中,ABVS和常规超声诊断的敏感性分别为92.5%和93.7%(p>0.05);PPV分别为86.6%和86.5%(p>0.05)。非肿块型病变中,敏感性分别为77.8%、60.4%(p<0.05);PPV分别为84.5%、48.5%(p<0.001)。ABVS对69例(73.4%)患者术前做出正确诊断,其中包括78.3%(36/46)的多灶性乳癌及56.3%(9/16)的多中心性乳癌。评估的准确率均高于常规超声(59.6%、52.2%及43.8%)。结论：ABVS对诊断MMBC具有较高敏感性及PPV,有助于检出常规超声隐匿的癌灶,可提高术前诊断MMBC的准确性。尤其针对DCIS癌灶、非肿物型病变及小病灶具有明显优势。ABVS在术前评价多发乳腺癌方面具有较好的临床应用前景,其对患者预后的影响尚需大规模研究进一步证实。目的：比较乳腺自动全容积成像技术(ABVS)与常规超声在术前检测和评估单纯性导管内原位癌(DCIS)病灶范围的诊断价值,并与组织病理学结果相对照。探讨此项新技术在制定手术方案中的应用价值。资料与方法：采用前瞻性研究。254例纳入者中,最终,经病理证实为单纯性DCIS的33例序贯女性患者(平均年龄：52岁；年龄中位数：49岁)进入统计学分析。所有研究对象均完成ABVS及常规超声检查,对两者所测肿瘤大小的准确性进行评价。对照组织病理学结果,根据常规超声及ABVS与病理结果之间的差异,将诊断结果分类。比较常规超声及ABVS所测DCIS病灶大小差异的显著性。此外,分析比较两种成像模式与病理之间的相关性。结果：ABVS所测定的DCIS病灶大小与术后病理未出现显著差异性(p=0.358)。ABVS准确诊断(±5mm)DCIS病灶的63.64%(N=21),低估病灶18.18%(N=6),高估病灶18.18%(N=6)。并对59%(13/22)的高级别病灶及73%(8/11)的非高级别病灶做出准确评价。ABVS与病理结果之间的差异较常规超声显著减低(p=0.006).ABVS与病理的相关系数明显高于常规超声(0.720,p<0.001vs.0.371,p<0.05)。结论：本研究显示,ABVS可以作为术前评估单纯性DCIS病灶范围的有效手段,其诊断准确性优于常规超声,尤其对于广泛分布的弥漫性原位癌病灶具有明显优势。ABVS的全容积成像特点有可能在保乳术前提供更加精确的诊断信息。此技术在不增加手术切缘阳性的同时,有助于确定适当的手术切缘,从而提高保乳手术的成功率。更多还原

【Abstract】 Objective:This prospective study aims to evaluate the efficacy of preoperative automated breast volume scanner (ABVS) in the detection of multifocal multicentric breast carcinoma (MMBC), defined by pathology on surgical specimens, and the effect of ABVS information on therapeutic decisions.Materials and methods:Two hundred and fifty-four patients who were suspected of having breast cancer underwent ABVS examination prior to surgery and133women with breast carcinoma pathologically diagnosed on surgical specimens. The gold standard was pathologic examination of the whole excised breast (slice thickness,5mm). The radiologists were evaluated all neoplastic foci, and blinded to the original mammograms and conventional hand-held ultrasonography (HHUS) reports. With regards to ABVS, our considered size of the lesions, BI-RADS classification and imaging pattern and lesion characteristics. According to the histological size, the lesions were classified as:1st cancer,2nd lesion,3rd lesion,4th lesion, and5th lesion. Any pathologically identified malignant foci not previously described in the original imaging reports, were defined as undetected or missed lesions. Sensitivity and positive predictive values were calculated for ABVS and HHUS for detecting the presence of the index cancer as well as additional satellite lesions.Results:Of94breasts, pathologic findings revealed32unifocal,46multifocal, and16multicentric cancers for a total of196malignant foci (171invasive and25in situ). Overall sensitivity was84.7%(166/196) for HHUS and87.8%(172/196) for ABVS (not significant);90.6%(155/171) and89.5%(153/171) for invasive foci (not significant); and44.0%(11/25) and76.0%(19/25) for in situ foci (p<0.05), respectively. HHUS and ABVS missed30and24malignant foci, respectively, with median diameters of7.5mm and8.0mm (not significant) and an invasive-noninvasive ratio of1.1:1(16/14) and3.0:1(18/6)(not significant), respectively. The overall positive predictive value (PPV) was75.1%(166/221) for HHUS and86.0%(172/200) for ABVS (p<0.05). In malignant foci with a mass-like imaging pattern, sensitivity was93.7%for HHUS and92.5%for ABVS (not significant), and the PPV was86.5%and86.6%(not significant), respectively. In malignant foci with non-mass-like pattern, the sensitivity was60.4%and77.8%(p=0.01), and the PPV was48.5%and84.5%(p<0.001), respectively. ABVS imaging identified15HHUS occult malignant lesions. On the basis of these US findings, therapy was correctly changed in12patients (13.0%). The diagnostic performance in terms of understaging, correct staging, and overstaging on a breast-by-breast basis are13.8%,73.4%,12.8%for ABVS and17.0%,59.6%,23.4%for HHUS.Conclusions:In patients with MMBC, preoperative ABVS imaging is useful for detecting additional synchronous malignancies that are not detected on conventional HHUS. ABVS was more sensitive than conventional HHUS for the detection of multiple malignant foci in non-mass-like imaging pattern and non-invasive cancer foci. The use of preoperative ABVS imaging as an adjunct to conventional HHUS in women with MMBC is especially beneficial. Objective:The goal of the study described here was to compare the accuracy of an automated breast volume scanner (ABVS) with that of hand-held ultrasound (HHUS) in assessing the pre-operative extent of pure ductal carcinoma in situ (DCIS).Materials and methods:This prospective study consisted of33patients with histopathologically proven pure DCIS who received conventional HHUS and ABVS examinations. The discrepancy and correlation coefficients were calculated to assess differences in sizes determined by imaging and histopathologic examination.Results:Mean age was51.8y. Mean lesion size as assessed with the ABVS did not differ significantly from that determined by histopathology. Lesion size was adequately estimated, under-estimated or over-estimated with the ABVS in64%,15%and21%of patients, and with HHUS in42%,15%and42%, respectively (p<0.05). The coefficient of correlation between histopathologic and ABVS measurements was higher than that between histopathologic and HHUS measurements.Conclusions:The ABVS appears to assess the extent of the lesion better than HHUS and can provide more accurate information pre-operatively.更多还原