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目的以病理学为基础探讨三维超声成像、乳腺钼靶X线摄影检查、MRI在乳腺肿块鉴别诊断中的价值。方法分析79例患者共81个乳腺肿块的三维超声、钼靶、MRI检查结果,比较三种检查方法及联合应用的诊断效能。结果三维超声对乳腺肿块诊断的敏感性、特异性、阳性预测值、阴性预测值、准确率,分别为95.1%、85.0%、86.7%、94.4%、90.1%;钼靶对乳腺肿块诊断的敏感性、特异性、阳性预测值、阴性预测值、准确率,分别为70.3%、90.0%、87.9%、75.0%、80.2%;MRI对乳腺肿块诊断的敏感性、特异性、阳性预测值、阴性预测值、准确率,分别为83.5%、87.5%、88.4%、92.1%、90.1%;三者联合应用对乳腺肿块诊断的敏感性、特异性、阳性预测值、阴性预测值、准确率,分别为97.6%、92.5%、93.0%、97.4%、95.1%。三者联合应用的ROC曲线下面积为0.963,高于单一检查的曲线下面积0.901(三维超声)、0.804(钼靶)及0.901(MRI)。结论三维超声、钼靶、MRI在乳腺肿块鉴别诊断中各具优势,三者的有机结合为乳腺肿瘤的早期诊断与治疗提供有力支持。
Objective To investigate the value of three-dimensional ultrasonography, mammography and MRI in the differential diagnosis of breast masses based on pathology. Methods A total of 81 breast masses from 79 patients were analyzed by three-dimensional ultrasonography, mammography and MRI. The diagnostic efficacy of the three methods and the combined application were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of three-dimensional ultrasound in the diagnosis of breast masses were 95.1%, 85.0%, 86.7%, 94.4% and 90.1% respectively. The sensitivity of mammography to the diagnosis of breast masses The sensitivity, specificity, positive predictive value and negative predictive value of MRI in the diagnosis of breast masses were 70.3%, 90.0%, 87.9%, 75.0% and 80.2% The predictive value and accuracy were 83.5%, 87.5%, 88.4%, 92.1% and 90.1% respectively. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, 97.6%, 92.5%, 93.0%, 97.4%, 95.1%. The area under the ROC curve was 0.963, which was 0.901 (three dimensional ultrasound), 0.804 (mammography) and 0.901 (MRI) under the single examination. Conclusion Three-dimensional ultrasound, mammography and MRI have their own advantages in the differential diagnosis of breast masses. The organic combination of the three provides strong support for the early diagnosis and treatment of breast tumors.