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乳腺癌是女性最常见的恶性肿瘤之一,发病率占全身各种恶性肿瘤的7%~10%,在女性恶性肿瘤发病率中仅次于子宫癌,已成为威胁妇女健康的主要疾病[1]。该病的发病常与遗传有关,年龄在40~60岁,绝经期前后的妇女发病率较高。目前的临床治疗主要依赖于手术及放化疗,治疗效果及预后与病变能否早期检出有直接关系,因此有效的检出手段对于乳腺癌的早期发现和治疗至关重要。如能提前6个月发现病灶,早期手术并辅以放化疗及内分泌治疗,可以获得较好的预后。目前,应用较多的影像学检查有钼靶X线摄影和超声,这些主要依赖于影像征象提供诊断依据[2]。与钼靶X线所提供的直接解剖学影像不同,放射性核素显像作为功能学影像则通过肿瘤细胞代谢水平作出诊断,目前临床开展有限,本研究将钼靶X线与99Tcm-MIBI显像进行比较分析。
99Tcm-MIBI显像与钼靶X线对乳腺癌诊断的比较研究
Diagnostic value of technetium 99Tcm sestamibi and X-ray mammography in breast cancer: a comparison study
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摘要:
目的 比较99Tcm-MIBI SPECT/CT显像和钼靶X线对女性乳腺癌的诊断价值。 方法 女性患者83例, 先行99Tcm-MIBI胸部SPECT/CT早期显像和延迟显像, 并以延迟显像阳性为判定标准, 再行乳腺钼靶X线摄影, 并与最终的病理结果进行对照。 结果 延迟显像的阳性患者为52例(T/NT值>3.33), 阳性与阴性病灶的早期、延迟显像分别比较, 差异均有统计学意义, 且以延时2 h结果更为显著, 最终病理结果证实45例为恶性病灶。99Tcm-MIBI显像结果的灵敏度为93.33%、特异度为73.68%、阳性预测值为80.77%、阴性预测值为90.32%;而钼靶X线对于相同病灶的灵敏度、特异度分别为64.44%、73.68%, 阳性、阴性预测值分别为74.36%、63.63%。99Tcm-MIBI显像对乳腺癌诊断价值优于钼靶X线(χ2=4.11, P < 0.05), 但两种方法的一致性较差(Kappa=0.217, P < 0.05)。 结论 99Tcm-MIBI显像较之钼靶X线的结果判定更为客观, 而两种方法同时运用则能提高乳腺癌的检出率, 显著提高影像学对于乳腺癌的早期诊断。 -
关键词:
- 乳腺肿瘤 /
- 99m锝甲氧基异丁基异腈 /
- 乳房X线摄影术
Abstract:Objective To compare the diagnostic value of 99Tcm-MIBI SPECT/CT chest imaging combined with X-ray mammography and to investigate their complementarity. Methods This study included 83 female patients, including those suspected to have breast nodules and those diagnosed with breast cancer. All patients were examined initially via 99Tcm-MIBI chest SPECT/CT imaging and delayed imaging followed by X-ray mammography, and all data were compared with final pathological results. Results Among the 99Tcm-MIBI imaging results of the 83 female patients, 52 lesions were revealed by delay images(T/NT ratio >3.33). The final criterion for diagnosis was based on positive delay imaging. The T/NT ratio between benign and malignant breast lesions was statistically significant(P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of diagnosis via 99Tcm-MIBI SPECT/CT chest imaging were 93.33%, 73.68%, 80.77%, and 90.32%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of X-ray were 64.44%, 73.68%, 74.36%, 63.63%, respectively. 99Tcm-MIBI imaging superior value to diagnosis X-ray mammogragh for breast cancer(χ2=4.11, P < 0.05), but two methods of consistency spreads(Kappa=0.217, P < 0.05). Conclusions The sensitivity and specificity of 99Tcm-MIBI were higher than those of X-ray mammography in diagnosis of early-stage breast cancer. 99Tcm-MIBI imaging offers advantages in detecting virus infection aslar-pacific nodules. It is speculated that detecting regular breast nodules and occult lesions can be improved if these two methods are combined because they are complementary techniques. -
Key words:
- Breast neoplasms /
- Technetium tc 99m sestamibi /
- Mammography
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