摘要
为降低良性活检的发生,对于经乳腺X线摄像检查发现的可疑病灶(根据乳腺影像-报告和数据系统BI-RADS归为3～5类,无法明确其良性/恶性),进行辅助诊断就显得尤为重要。但是,对于常用的影像诊断方法 (如超声、磁共振、核素成像以及电阻抗扫描成像等),在这一具体临床应用中的诊断性能,目前尚缺乏明确认识。通过全面检索2000～2011年间发表的相关研究文献,采用Meta方法在大量病灶样本基础上明确了各个影像诊断方法的诊断性能。超声、磁共振、核素成像以及电阻抗扫描成像的灵敏度及95%置信区间分别为81.3%(0.794,0.831)、90.0%(0.883,0.916)、84.4%(0.821,0.866)和81.0%(0.778,0.839);特异度及95%置信区间分别为93.0%(0.921,0.938)、82.9%(0.811,0.846)、83.6%(0.816,0.855)和67.9%(0.651,0.707);准确度及95%置信区间分别为94.7%(0.924,0.969)、93.4%(0.894,0.973)、92.8%(0.900,0.955)和76.9%(0.691,0.846)。统计分析结果表明:在乳腺癌影像辅助诊断应用领域,磁共振方法灵敏度最高,超声特异度最好。从准确度角度考虑,超声、磁共振和核素成像3种方法准确度相当,不存在统计学上的显著差异。电阻抗成像方法灵敏度较高,但特异度相对较低。在实际应用中,结合各个方法的诊断性能采取单一的(超声/磁共振/核素成像以及电阻抗成像)或组合的(磁共振再辅以超声)影像方法进行辅助诊断,良性活检率可由80%降低为25.7%/43.0%/43.8%/61.2%,甚至6.4%,但同时存在一定的漏检率(10.0%～27.0%)。实际应用中,应对经辅助诊断判为良性的患者采取进一步的短间隔随诊,以减少漏诊可能带来的不良影响。
To avoid presences of benign biopsies,there is a urgent need to introduce adjunctive diagnostic methods for suspicious lesions classified as BI-RADS 3~5 detected in mammography.However,diagnostic performances of different conventional imaging modalities,such as ultrasound（US）,magnetic resonance imaging（MRI）,scintimammography（SMM） and electrical impedance scanning（EIS）,for this specific clinical application are less known.In this paper,related articles published between 2000 and 2011 were searched,and the diagnostic performances of each imaging modality based on a relative large size of breast lesions were demonstrated by meta-analysis.The sensitivity with 95% confidence interval of US,MRI,SMM and EIS are 81.3%（0.794,0.831）,90.0%（0.883,0.916）,84.4%（0.821,0.866） and 81.0%（0.778,0.839）;the specificity are 93.0%（0.921,0.938）,82.9%（0.811,0.846）,83.6%（0.816,0.855） and 67.9%（0.651,0.707）;the accuracy,as the area under summary receive operation curve,are 94.7%（0.924,0.969）,93.4%（0.894,0.973）,92.8%（0.900,0.955） and 76.9%（0.691,0.846）.Statistic analysis indicated that MRI was the most sensitive one and US was of the most specificity of four conventional imaging modalities.There were no significant differences among US,MRI and SMM in accuracy.EIS had a relative high sensitivity,but its specificity was lower.Adjunctive diagnosis according the characteristic of each imaging modality,adopting single（US/MRI/SMM/EIS） or combing imaging modalities（MRI followed by US）,could reduce benign biopsies rate from 80% to 25.7%/43.0%/43.8%/61.2% and even 6.4%,with a rate of missed diagnosis of 10.0%~27.0%.In application,short-interval follow-up should be taken for benign patients diagnosed by the adjunctive imaging method to decrease the blight of possible missed diagnosis.
出处
《中国生物医学工程学报》
CAS
CSCD
北大核心
2012年第2期276-284,共9页
Chinese Journal of Biomedical Engineering
基金
江苏省研究生创新计划(CX10B-079Z)
关键词
乳腺癌
辅助诊断
性能对比
荟萃分析
breast cancer
adjunctive diagnosis
performance comparison
meta-analysis
