檢體攝影下微小鈣化點呈現對乳癌的診斷價值

Diagnostic Value of Microcalcification Findings on Specimen Radiography for Breast Cancer

湯雅君(Ya-Chun Tang) ； 張美華(Mei-Hua Chang) ； 羅永豐(Yung-Feng Lo) ； 黃培青(Pei-Chin Huang) ； 翁世樺(Shir-Hwa Ueng) ； 張潤忠(Yun-Chung Cheung)

《中華放射線技術學雜誌》 38卷3期 (2014/09) Pp. 157-164

摘要

立體定位導引真空抽吸切片（Stereotactic-guided vacuum-assisted core needle biopsy, SVACNB）為診斷乳癌的可靠工具。研究目的為評估於切片檢體上微小鈣化點呈現於診斷乳癌之關聯性。研究中調查2008年至2012年12月間400位因乳房微小鈣化點而進行SVACNB的病患醫療資料，並將其中86位接受進一步外科手術診斷之病患納入評估。將病患身上取得具有鈣化點的切片檢體，依據檢體數量及微小鈣化點的分佈型態及數目加以定義。並與最終外科診斷，用曼惠特尼氏檢定（Mann-whitney rank Sum test）做檢體數量比較，費雪氏檢定（Fisher exact test）做微小鈣化點的分佈型態及數目比較，以分析檢體特性對最終乳癌診斷結果的影響。研究中分析由86位病患取得597條切片檢體。顯示檢體攝影下所呈現鈣化點分佈型態及數目，診斷結果上皆無統計上的差別（分別為p = 0.264與p = 0.167），唯取得含有鈣化點之切片檢體數量具統計上差異（p = 0.005）。進而經由二元多變數邏輯式分析（Binary multivariate logistic regression）方式，顯示切片的數量與最終的外科診斷有獨立相關性（OR: 1.251, CI 95%: 1.072-1.461; p = 0.005）；在接收者操作特徵曲線（ROC）下的面積為0.855。將切片數量分組後，分析其敏感度分別為91.63%，93.75%，100%，及100%。理想的SVACNB取得的切片檢體應含微小鈣化點，而取得含有微小鈣化點的切片數量多寡對診斷的影響，遠較於切片檢體中鈣化點分佈型態或數目來的重要。

關鍵字

乳癌 ； 乳房攝影 ； 乳房立體定位切片檢查 ； 微小鈣化點

並列摘要

This rerospective study aimed to evaluate the possible role of specimen radiography in cancer diagnosis. From 2008 to December 2012, the medical data of 400 patients with micro-calcified breast lesion who received SVACNB were reviewed. Eighty-six patients who subsequently underwent surgical intervention were enrolled. The characteristics of the specimen with micro-calcification were defined, including specimen number, distribution of micro-calcification, and calcified fleck number. The specimen number was compared to the final surgical diagnosis using the Mann-Whitney Rank Sum Test and the calcified fleck number and morphology by Fisher exact test. A total of 597 specimens from 86 patients were analyzed. Comparing the surgically-proven malignant and non-malignant lesions, there was no significant difference between the distribution of micro-calcifications in the specimens (p = 0.264) and the micro-calcification fleck number (p = 0.167). Only the specimen number showed statistically significant difference (p = 0.005). Binary multivariate logistic regression further demonstrated that the specimen amount independently correlated to surgical diagnosis (OR: 1.251, CI 95%: 1.072-1.461; p=0.005). The area under the receiver operating characteristic curve was 0.855. For the four sub-groups of calcified specimen amount, sensitivity was 91.63%, 93.75%, 100%, and 100% respectively. The appropriate specimens obtained from SVACNB should contain micro-calcifications. The number of calcified specimens obtained from the procedure is statistically informative than the micro-calcification distribution and fleck number.

並列關鍵字

Breast biopsy ； stereotactic biopsy ； microcalcifications