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目的探讨乳腺血供不对称性增加在诊断同侧乳腺癌中的价值。方法对169例乳腺疾病患者行乳腺动态增强MR检查,在最大密度投影(3D-MIP)图像上进行血管计数,当血管长度≥3 cm且最大直径≥2 mm时,列入筛选合格范围,两侧乳腺合格血管差值≥2个时认为乳腺血供不对称性增加。分析乳腺血供不对称性增加诊断同侧乳腺癌的灵敏性、特异性,以及与浸润性癌病灶最大径及组织学分级的关联。结果病理结果证实恶性病变83例和良性病变43例,其中浸润癌72例和导管内原位癌(ductal carcinoma in situ,DCIS)11例,其余的43例经随访均为阴性。以乳腺不对称性血供增加作为同侧乳腺癌的诊断标准的灵敏性为65%,特异性为84%,准确性为75%,阳性预测值为79%,阴性预测值为71%。在浸润性癌组中的灵敏性与DCIS组相仿(P<0.001)。在浸润性癌组中,病灶最大径越大的组,灵敏性越高(P<0.001)。在组织学Ⅲ级病灶组中的灵敏性高于在组织学Ⅰ级、Ⅱ级病灶组(P=0.013)。结论乳腺血供不对称性增加与同侧乳腺癌相关,尤其在浸润性癌最大径≥20 mm或组织学分级高的情况下。
Objective To investigate the value of asymmetric breast blood supply in the diagnosis of ipsilateral breast cancer. Methods 169 cases of breast disease patients underwent dynamic breast enhancement MR examination, the maximum density projection (3D-MIP) images on the blood count, when the vascular length ≥ 3 cm and maximum diameter ≥ 2 mm, included in the screening eligibility range, two Lateral breast qualified blood vessels difference of 2 or more that the blood supply to the breast asymmetry increased. To analyze the sensitivity and specificity of the diagnosis of ipsilateral breast cancer with the increase of blood supply asymmetry in breast and the correlation with the maximum path of invasive cancer and histological grade. Results Pathological findings confirmed that 83 cases of malignant lesions and 43 cases of benign lesions, including invasive carcinoma in 72 cases and ductal carcinoma in situ (DCIS) in 11 cases, the remaining 43 cases were followed up were negative. The sensitivity for a diagnosis of ipsilateral breast cancer with an increase in breast asymmetry blood supply was 65%, specificity 84%, accuracy 75%, positive predictive value 79%, and negative predictive value 71%. The sensitivity in invasive cancer was similar to DCIS (P <0.001). In the invasive cancer group, the greater the maximum lesion size, the higher the sensitivity (P <0.001). The sensitivity in histological grade Ⅲ lesions was higher than that in histological grade Ⅰ and Ⅱ lesions (P = 0.013). Conclusion The increase of breast blood supply asymmetry is associated with ipsilateral breast cancer, especially when the maximum diameter of invasive carcinoma is ≥20 mm or the histological grade is high.