The Value Research Of Dynamic Contrast-enhanced MRI Combined With Mammography On Early Diagnosis Of Breast Cancer Clinical Pathway

Objective With high morbidity and growth rate,breast cancer has become the most common female malignant tumors in China,however,early diagnosis of breast cancer can reduce mortality significantly.Regular mammography is a preferred method to screen breast cancer and MRI can raise the detection rate of breast cancer significantly.In our study,we probe into the value of early diagnosis on clinical pathway of breast cancer,by making comparison between MRI dynamic enhancement technology,regular mammography(digital breast tomosythesis),and their combination.According to health economics and clinical pathway of breast cancer,we compare the diagnostic benefit ratio,by using cost-effectiveness analysis(CEA)provide a reference basis for reasonable choice of clinical examination methods to improve diagnostic accuracy and efficiency.Methods 120 patients with breast masses(tumor tissue maximum diameter less than 2cm)from October 2013 to January 2016 in our hospital scheduled for surgical treatment were chosen as research subjects and underwent regular mammography,MRI and other imaging studies.There was no statistically difference in tumor tissue lesion diameter,age between two groups(P>0.05).To compare the relevant parameters such as sensitivity,specificity,the rate of misdiagnosis,misdiagnosis rate,positive predictive value,negative predictive value,and diagnostic accuracy,Youden index and the positive likelihood ratio test between joint detection and single detection.The cost-effectiveness of different detection methods was converted into a unified evaluation criteria.The analysis was consulted by the government medical services price list.CEA= cost/effectiveness,correct detection rate was effective.Results In this study,MRI was applied to diagnose 58 cases of malignant lesions,48 cases of benign lesions,the sensitivity were 90.6%(58/64),specificity(85.7%,48/56),rate of missed diagnosis(9.4%,6/64),misdiagnosis rate(14.3%,8/56),positive predictive value(87.9%,58/66)and negative predictive value(88.9%,48/54),the diagnostic accuracy rate(88.3%,106/120),Youden index was 0.763,a positive likelihood ratio test was 6.346;Routine mammography was applied to diagnose 52 cases of malignant lesions and 42 cases of benign lesions,the sensitivity(81.3%,52/64)and specificity(75.0%,42/56),rate of missed diagnosis(18.8%,12/64),misdiagnosis rate(25.0%,14/56),the positive predictive value(78.8%,52/66),negative predictive value(77.8%,42/54),the diagnostic accuracy rate(78.3%,94/120),Youden index was 0.562,the positive likelihood ratio test was 3.252;The joint detection was applied to diagnose 62 cases of malignant lesions,52 cases of benign lesions,sensitivity(96.9%,62/64)and specificity(92.9%,52/56),rate of missed diagnosis(3.1%,2/64),misdiagnosis rate(7.1%,4/56),positive predictive value(93.9%,62/66),negative predictive value(96.3%,52/54),the diagnosis accuracy rate(95.0%,114/120),Youden index was 0.898,a positive likelihood ratio test was 13.648.In terms of sensitivity,specificity,positive predictive value,negative predictive value,diagnostic accuracy,Youden index and the positive likelihood ratio test.The joint detection was significantly higher than a single detection(P<0.05).Compare with single test,the benefit ratio of joint detection on diagnosis of breast cancer is significantly higher than single test(P<0.05).Conclusion By using combination of routine mammography and MRI dynamic enhancement technology to diagnose early breast cancer is significantly better than single method,and which is worth for wide clinical application.However,there is no significant difference between two methods on diagnosis of benign breast disease.The joint detection can improve clinical pathway of diagnosis on breast cancer,obviate the unnecessary detection methods,reduce the hospital stays and improve economic benefits.