临床病史、X 线和 MRI 三者结合对肉芽肿性乳腺炎的诊断

摘要

Objective:To explore the value of the combination of clinical history,X-ray mammography and breast MRI in the diagnosis of granulomatous mastitis.Methods:635 cases of granulomatous mastitis underwent breast MRI and X-ray mammography in two weeks before surgery,including 14 patients with pathologically confirmed granulomatous mastitis. The sensitivity,specificity,misdiagnosis rate,positive predictive value and negative predictive value of using mammography only,using MRI only and using the combination of three examinations (clinical findings,mammography and MRI)for diag-nosis of granulomatous mastitis were analyzed.Results:The sensitivity of X-ray mammography,MRI and three combined ex-aminations to diagnose granulomatous mastitis was 14.3%,71.4%,85.7% respectively;specificity was 98.6%,99.2%, 99.5%;rate of missed diagnosis was 85.7%,28.6%,14.3%;positive predictive value were 18.2%,66.7%,80%;negative predictive value was 98.1%,99.4%,99.7%.The sensitivity,specificity,positive predictive value and negative predictive value of three combined examinations to diagnose granulomatous mastitis was significantly increased (P values were 0.00, 0.00,0.01,0.01),while misdiagnosis rate was significantly decreased (P =0.00).Conclusion:The combination of clinical history,X-ray mammography and MRI can improve the diagnosis of granulomatous mastitis.%目的：探讨临床病史、X 线和 MRI 三者结合诊断肉芽肿性乳腺炎的价值。方法：搜集术前两周同时行乳腺MRI 及 X 线检查的患者635例，其中14例经病理证实为肉芽肿性乳腺炎。分析单纯 X 线、单纯 MRI 以及三者结合（临床病史、X 线和 MRI）诊断肉芽肿性乳腺炎的灵敏度、特异度、漏诊率、阳性预测值以及阴性预测值。结果：X 线，MRI 及三者结合诊断肉芽肿性乳腺炎的灵敏度分别为14．3％、71．4％、85．7％；特异度分别为98．6％、99．2％、99．5％；漏诊率分别为85．7％、28．6％、14．3％；阳性预测值分别为18．2％、66．7％、80．0％；阴性预测值分别为98．1％、99．4％、99．7％。三者结合诊断肉芽肿性乳腺炎的灵敏度、特异度、阳性预测值及阴性预测值明显提高（P 值分别为0．00、0．00、0．01、0．01），漏诊率显著降低（P ＝0．00）。结论：依据临床病史、X 线及 MRI 三者结合能够提高对肉芽肿性乳腺炎的诊断。