乳腺癌术前早期诊断方法比较与筛选

Comparing and Filtrating the Methods to Improve the Preoperative Earlier Diagnostic Accordance Rate of the Breast Cancer

目的比较乳腺癌术前早期诊断的方法,探讨筛选的指征,以提高乳腺癌术前早期诊断准确率和患者生存率。方法回顾性分析10余年我院358例乳癌术前诊断方法及结果情况。结果358例运用现有的诊断方式进行术前诊断的仅176例,不到50%;运用穿刺细胞学检查及钼钯等准确性较高的检查方式的79例,占总病例数的25%左右;真正得到术前确诊的32例,不到10%;约90%的病例均采取了肿块切取活检的方式。结论目前临床上惯用的肿块切取活检方式使很大的一部分病人失去了术前治疗的机会,也阻碍了新的治疗方法在临床上的应用。红外线及B超检查虽在临床上使用较多,但准确率较低,只能作为常规筛选病例而用,应辅以更为可靠的检查方法。穿刺细胞学检查及钼钯检查准确率较高,简便易行,应作为常规检查方法在临床上广泛开展,并应结合其他诊断方法如乳腺彩超等综合使用以提高确诊率。并提出了在穿刺方式及标本固定技术上的一点小小改进。

Objective To explore the preoperative misdiagnosis in the breast cancer and the methods to improve the diagnostic accordance rate. Methods The preoperative diagnosis and results of 358 cases with breast cancer has been analysized retrospectively in the recent ten years. Results Total Cases with present diagnostic technique diagnosed befor operation was 176 only; the accordance rate was less than 50%. With aspiration biopsy and molybdenum palladium roentgenograph, the rate was 25 % （79 cases） . The actual preoperative accordance rate was less than 10% （32 cases） .It is said approximately 90% cases were postoperatively diagnosed. Conclusion The present excision biopsy not only has made many patients lost the chance of chemotherapy preoperation, but also interfereneed the application of new therapic methods in the clinical practice.Infrared spectroscopy and ultrasonography have been commonly used in the clinical practice.With the low diagnostic accordance rate, they were applied only for screening. With simplity and high diagnostic accor dance rate, aspiration biopsy and molybdenum pall adium roentgenograph should be enrolled extensively in the clinical practice. The puncture and specimen fixing technique also should be improved.