摘要目的 探讨对比增强乳腺X线摄影(CESM)对致密型乳腺乳腺癌的诊断价值.方法回顾性分析山东省泰安市中心医院2017年4月至2018年4月,经手术病理确诊为乳腺癌,术前行超声(US)、数字乳腺X线摄影(DM)、CESM和动态对比增强MRI(DCE?MRI)检查,且经DM评估为致密型乳腺或不均匀性致密型乳腺的52例女性患者资料.参照乳腺影像报告及数据系统(BI?RADS)标准对乳腺类型及肿块进行评估分类,以手术病理结果为参考,计算US、DM、DM+CESM和DCE?MRI诊断乳腺癌的敏感度和特异度,并采用χ2检验比较DM+CESM及DCE?MRI组诊断乳腺的特异度及检出BI?RADS 5类肿块的差异.结果 乳腺癌病灶87个,良性肿块35个.US、DM、DM+CESM和DCE?MRI这4种方法诊断乳腺癌的敏感度分别为66.67%(58/87)、64.37%(56/87)、100.00%(87/87)和100.00% (87/87),特异度分别为94.28%(33/35)、74.28%(26/35)、85.71%(30/35)和51.43%(18/35).DM+CESM及DCE?MRI间检出乳腺癌特异度的差异有统计学意义(χ2=9.545,P=0.002).DM+CESM及DCE?MRI对BI?RADS 5类肿块的检出率分别为39.08%(34/87)和22.99%(20/87),差异有统计学意义(χ2=5.263, P=0.022).结论 CESM对致密型乳腺乳腺癌的诊断具有较大价值.

abstractsObjective To assess the contribution of contrast?enhanced spectral mammography (CESM) in detecting breast carcinoma of dense breasts. Methods To retrospectively analyze the imaging and clinical data of 52 female patients with breast carcinoma which were confirmed by pathology in Tai′an Central Hospital of Shandong Province from April 2017 to April 2018.All cases classified as dense or uneven dense breasts by DM examination underwent Ultrasound (US), digital mammography (DM), CESM, dynamic contrast enhanced MRI (DCE?MRI).The breast imaging report and data system (BI?RADS) and breast density classification were both evaluated using the 5th edition of BI?RADS. The efficacy of US, DM, DM+CESM, DCE?MRI in detecting breast carcinoma (BI?RADS 5) was evaluated by χ2 test. Results Histopathology confirmed that 87 lesions were malignant and 35 lesions were benign. The sensitivity of US, DM, DM +CESM, DCE?MRI were 66.67%(58/87), 64.37%(56/87), 100.00%(87/87), 100.00%(87/87) and the specificity were 94.28%(33/35), 74.28%(26/35), 85.71%(30/35), 51.43%(18/35), respectively. There was statistically significant difference in specificity (χ2=9.545, P=0.002) and BI?RADS 5 category, detection 39.08%(34/87), 22.99%(20/87), respectively (χ2=5.263, P=0.022) between the DM + CESM group and DCE?MRI group. Conclusion In dense breasts, CESM has a high application value in breast carcinoma diagnosis.