乳腺疾病诊断中影像学检查的灵活应用

The flexible application of image examination in diagnosis of breast diseases

目的:探讨乳腺影像学检查的优劣性和确诊率。方法回顾性分析2010年1月至2014年2月手术的389例乳腺疾病患者资料,行彩超检查389例、乳腺X线摄影检查325例、MRI检查188例、多层螺旋CT(MSCT)检查122例。结合文献复习进行分析。结果全组病例均行手术治疗、病理证实,其中176例为乳腺癌(浸润性导管癌117例,黏液腺癌48例,单纯癌11例),213例为乳腺良性病变(纤维腺瘤86例,导管内乳头状瘤35例,脂肪瘤14例,非典型增生26例,囊性增生34例,平滑肌瘤3例,腺病12例,叶状肿瘤2例,炎症1例)。选择健侧的乳腺进行对比分析。彩超检查阳性发现率91.0%(354例/389例),提示恶性病变率75.0%(132例/176例);乳腺X线摄影检查阳性发现率89.5%(291例/325例),提示恶性病变率89.8%(158例/176例);MRI检查阳性发现率92.0%(173例/188例),提示恶性病变率93.8%(165例/176例)、MSCT阳性发现率91.8%(112例/122例),提示恶性病变率92.0%(162例/176例)。结论MRI、MSCT在乳腺良恶性病变鉴别方面都具有较高的诊断价值;彩超、乳腺X线摄影、MRI、MSCT在乳腺病变的阳性检出率差异不明显。

Objective To investigate the advantage and diagnosis rate of different image examination in breast diseases.Methods From January 2010 to February 2014,all image examination data of 389 breast disease pa-tients who received surgical operation were collected and analyzed retrospectively.All patients underwent color Doppler ultrasound examination.Breast X-ray photographic examination was performed in 325 patients,and MRI ex-amination in 188 patients,while 122 patients received MSCT examination.Results All surgical specimens were ex-amined and diagnosed pathologically.Of all the patients,176 patients were diagnosed with breast cancer(including 117 cases of infiltrating ductal carcinoma,48 cases of mucinous carcinoma,and 11 cases of carcinoma simplex),213 patients were confirmed as benign lesions(including 86 cases of adenomas,35 cases of intraductal papilloma,14 cases of lipoma,26 cases of atypical hyperplasia,34 cases of cystic hyperplasia,3 cases of fibroids,12 cases of adenomyosis,2 cases of phyllodes tumor,and 1 cases with inflammation).The diagnosis rate with color Doppler ultrasound was 91.0%(354/389),and the results showed suggestive of malignancy was 75.0%(132/176 cases).The diagnosis rate with breast X-ray photographic examination was 89.5%(291/325 cases),and suggestive of malignancy rate was 89.8%(158/176).The diagnosis rate with MRI was 92.0%(173/188),suggestive of malignancy was 93.8%(165/176).The diagnosis rate with MSCT was 91.8%(112/122),while the suggestive of malignancy was 92.0%(162/176).Conclusions Both MRI and MSCT have a high diagnostic value than other image examination in discriminat-ing benign and malignant breast diseases.However,there is no difference in diagnosis rate in breast diseases whenever color Doppler ultrasound,breast X-ray photographic examination,MRI or MSCT was used.