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目的：探讨乳腺X线摄影、动态对比增强核磁共振成像（DCE-MRI）联合彩色多普勒超声（CDUS）对致密型乳腺良恶性病变鉴别诊断的应用效果。方法：选取2022年5月至2024年6月期间我院收治的86例怀疑乳腺病变的致密型乳腺患者。所有患者均行乳腺X线摄影、DCE-MRI以及CDUS检查。以病理检查结果为金标准，对比致密型乳腺良恶性病变乳腺X线摄影、DCE-MRI、CDUS检查结果。采用受试者工作特征（ROC）曲线分析乳腺X线摄影、DCE-MRI、CDUS对致密型乳腺良恶性病变的诊断效能。结果：86例致密型乳腺患者经病理检查结果发现，按良恶性病变分类，乳腺癌39例（45.35%），良性病变47例（54.65%）；按乳腺纤维腺体组织分类，不均匀致密腺体型31例，其中含乳腺癌11例（35.48%），良性病变20例（64.52%）；极度致密腺体型55例，其中含乳腺癌28例（50.91%），良性病变27例（49.09%）。86例致密型乳腺患者经乳腺X线摄影检查结合病理检查结果诊断为恶性病变30例（34.88%），良性病变44例（51.16%）；经DCE-MRI检查结合病理检查结果诊断为恶性病变35例（40.70%），良性病变45例（52.33%）；经CDUS检查结合病理检查结果诊断为恶性病变33例（38.37%），良性病变46例（53.49%）。乳腺X线摄影、DCE-MRI、CDUS单独应用诊断致密型乳腺良恶性病变的曲线下面积（AUC）分别为0.746、0.782、0.759，而联合应用诊断致密型乳腺良恶性病变的AUC为0.968。联合预测效能更高（P＜0.05）。结论：乳腺X线摄影、DCE-MRI联合CDUS对致密型乳腺良恶性病变鉴别诊断效能较高，值得进行推广和应用。

英文摘要:

Objective: To explore the application effect of mammography, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with color Doppler ultrasound (CDUS) in the differential diagnosis of good and malignant lesions of dense breast. Methods: 86 suspected breast lesions dense breast patients who were admitted in our hospital from May 2022 to June 2024 were selected. All patients underwent mammography, DCE-MRI and CDUS examination. Pathological examination result were used as the gold standard, the results of mammography, DCE-MRI and CDUS were compared. The diagnostic efficacy of mammography, DCE-MRI and CDUS for good and malignant lesions of dense breast were analyzed by receiver operating characteristic (ROC) curve. Results: The pathological examination results of 86 dense breast patients showed that according to the classification of good and malignant lesions, there were 39 cases of breast cancer (45.35%), and 47 cases of good lesions (54.65%). According to the classification of breast fibroglandular tissue, there were 31 cases of inhomogeneous dense glandular type, including 11 cases of breast cancer (35.48%), and 20 cases of good lesions (64.52%). There were 55 cases of extremely dense glandular type, including 28 cases of breast cancer (50.91%), and 27 cases of good lesions (49.09%). Among 86 dense breast patients, 30 cases (34.88%) were diagnosed as malignant lesions by mammography combined with pathological examination result, good lesions 44 cases (51.16%). 35 cases (40.70%) were diagnosed as malignant lesions by DCE-MRI combined with pathological examination result, good lesions 45 cases (52.33%). 33 cases (38.37%) were diagnosed as malignant lesions by CDUS combined with pathological examination result, good lesions 46 cases (53.49%). The area under the curve (AUC) of mammography, DCE-MRI and CDUS alone in the diagnosis of good and malignant lesions of dense breast was 0.746, 0.782 and 0.759, respectively, and the AUC of combined diagnosis of good and malignant lesions of dense breast was 0.968. The combined prediction efficiency is higher (P<0.05). Conclusion: Mammography, DCE-MRI combined with CDUS have high differential diagnostic efficiency for good and malignant lesions of dense breast,which is worthy of promotion and application.

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