微小鈣化分類與乳癌陽性預測值之關係探討

The Relationship between Microcalcification Classification and PPV of Breast Cancer

張振莒(Chen-Chu Chang) ； 趙真(Chen Chao) ； 陳俊文(Chun-Wen Chen) ； 洪佳蓮(Chia-Lien Hung) ； 葉大銘(Da-Ming Yeh)

《臺灣醫事放射期刊》 3卷2期 (2015/09) Pp. 1-8

https://doi.org/10.6717/JTMRT.201509_3(2).0001

摘要

乳癌是婦女最常見且為40歲以上婦女死亡的主要原因之一，乳房Ｘ光攝影檢查為檢測早期乳癌最方便的檢查方法，影像之微小鈣化為判斷早期乳癌的重要指標。本研究回溯100年至101年間接受數位式乳房Ｘ光攝影檢查3,142位個案，並選擇183位在影像判讀報告中具微小鈣化經由組織切片確診之個案影像。由3位通過認證之放射專科醫師依BI-RADS將鈣化依不同形態及分佈情形進行分類及陽性預測值分析。結果顯示：乳房X光攝影影像呈現微小鈣化並接受組織切片有91位，其中32位個案為乳癌。不成形鈣化佔61.5%；PPV 14.3%、粗且形狀各異的鈣化形態佔2.2%；PPV 50.0%、細的多樣性鈣化形態佔25.3%；PPV 60.9 %、細線狀或分枝狀11.0%；PPV 90.0%。以卡方檢定對3位放射專科醫師在影像判讀之差異性進行分析，在91位接受組織切片確定診斷為乳癌之個案影像中，p＜0.001，3位專科醫師在影像判讀上達顯著差異，因此一致性低；但在32位乳癌之個案影像判讀，則p＞0.001，無顯著差異，判讀差異性較低。分析結果中不成型的鈣化是微小鈣化中最常見，但乳癌陽性率低，細線狀或分枝狀型態者，乳癌的陽性率高。

關鍵字

微小鈣化 ； 乳癌 ； BI-RADS ； 乳房Ｘ光攝影

並列摘要

Breast cancer is the most common cause of death of women above 40 year-old. Digital mammography is the most convenient tool in detecting early breast cancer by analyzing microcalcifications. This study is to retrospectively assess cases with microcalicifications who underwent biopsy between January 2011 and December 2012. Digital mammograms obtained before biopsy was analyzed independently by three breast imaging subspecialists according to the BI-RADS microcalcifications descriptors. Total 3142 women were analyzed in this study. 91 women among 183 women with microcalifications received image-guided biopsy. Total 32 cases was pathologicaly proved malignancy. The individual morphologic descriptors & positive predictive value ( PPV ) as follows: amorphous ( 61.5 % ) PPV ( 14.3 % ) ; coarse heterogeneous ( 2.2 % ) PPV ( 50.0 % ) ; fine pleomorphic ( 25.3 %) PPV ( 60.9 % ); fine linear branching ( 11.0 %) PPV ( 90.0 % ). Test for statistical significance were performed using the linear association chi-square test. Among 91women who underwent image-guided biopsy, the reading discordance of interobserver showed statistical significance (p ＜ 0.001). Among 32women who were pathological proved malignancy, the reading discordance of interobserver showed statistical in significance (p ＞ 0.001). Amorphors microcafications is the most commonly seen but low positive predictive value for malignancy. Fine linear branching microcalcifications show high positive predictive value for malignancy.

並列關鍵字

microcalcification ； breast cancer ； BI-RADS ； mammography