钼靶、多模态MRI对乳腺癌及肿块型浆细胞性乳腺炎的鉴别诊断价值研究

摘要 目的：探讨钼靶、多模态MRI对乳腺癌及肿块型浆细胞性乳腺炎（PCM）的鉴别诊断价值。方法：回顾性分析2017年4月-2021年2月我院经病理证实的98例乳腺癌患者及31例肿块型PCM患者的钼靶和MRI资料，比较乳腺癌和肿块型PCM的钼靶及MRI形态学表现、ADC值、时间-信号强度曲线（TIC）的差异。采用受试者工作特征曲线（ROC）分析钼靶、多模态MRI鉴别诊断乳腺癌及肿块型PCM的效能。结果：钼靶形态学显示：乳腺癌、肿块型PCM在病灶形态及边缘表现上差异有统计学意义（P＜0.05）；乳腺癌、肿块型PCM在密度、伴随征象以及是否有斑点、泥沙样钙化表现上差异无统计学意义（P＞0.05）。多模态MRI形态学显示：乳腺癌、肿块型PCM在形态、边缘、导管扩张、强化方式、TIC曲线类型及ADC信号表现上差异有统计学意义（P＜0.05）；乳腺癌、肿块型PCM在T2WI信号及伴随征象表现上差异无统计学意义（P＞0.05）。ROC曲线分析结果显示：多模态MRI成像检查对乳腺癌及肿块型PCM的鉴别诊断价值明显优于钼靶检查，其曲线下面积（AUC）、准确度、敏感度、特异度及Youden指数分别为0.921、90.63%、100%、89.37%、0.89。结论：钼靶主要通过形态学表现鉴别诊断乳腺癌和肿块型PCM，多模态MRI则可通过病灶形态学表现、ADC值、动态增强表现及TIC客观性判断病灶性质，因此其鉴别诊断价值优于钼靶检查。

Differential Diagnosis of Breast Cancer and Mass Plasma Cell Mastitis by Molybdenum Target and Multimodal MRI

ABSTRACT Objective: To explore the differential diagnosis value of molybdenum target and multimodal MRI in breast cancer and plasma cell mastitis (PCM). Methods: The molybdenum target and MRI data of 98 patients with breast cancer and 31 patients with mass PCM confirmed by pathology in our hospital from April 2017 to February 2021 were retrospectively analyzed, and the differences of molybdenum target and MRI morphological features, ADC value and time-signal intensity curve (TIC) between breast cancer and mass PCM were compared. Receiver operating characteristic curve (ROC) was used to analyze the efficiency of molybdenum target and multimodal MRI in differential diagnosis of breast cancer and mass PCM. Results: Molybdenum target morphology showed that there were statistically significant differences between breast cancer and mass PCM in lesion morphology and marginal appearance (P<0.05). There were no significant differences in density, concompost signs, specks or silt calcification between breast cancer and mass PCM (P>0.05). Morphology of multimodal MRI showed that there were statistically significant differences between breast cancer and mass PCM in morphology, edge, catheter dilation, enhancement mode, TIC curve type and ADC signal performance (P<0.05). There was no significant difference in T2WI signal and accompanying signs between breast cancer and mass PCM (P>0.05). ROC curve analysis results show that the value of multimodal MRI in differential diagnosis of breast cancer and mass TYPE PCM is obviously better than molybdenum target, and its area under curve (AUC), accuracy, sensitivity, specificity and Youden index are 0.921, 90.63%, 100%, 89.37% and 0.89, respectively. Conclusion: Molybdenum target mainly differentiates breast cancer and PCM of mass type through morphological manifestations, while multi-mode MRI can determine the nature of lesions through morphological manifestations, ADC values, dynamic enhancement and TIC objectivity. Therefore, its differential diagnostic value is better than molybdenum target.