常用乳腺影像诊断方法的比较研究

Comparative Study on Breast Imaging Diagnostic Methods of Commonly Used

目的比较彩色多普勒超声、钼靶和近红外线在乳腺癌及乳腺良性疾病诊断中的作用。方法以术后病理结果为金标准,比较术前3种检查方法的诊断准确性。结果共计565例乳腺疾病患者接受检查,其中乳腺癌274例,良性乳腺疾病291例。对乳腺癌彩超、钼靶和近红外线检查的灵敏度分别为83.7%(200/239)、84.2%(64/76)和76.9%(100/130),特异度分别为88.6%(226/255)、93.2%(69/74)和82.6%(114/138),诊断符合率分别为86.2%(426/494)、88.7%(133/150)和79.9%(214/268),其中彩超和钼靶检查的诊断符合率优于近红外线(P<0.05),尤其对≤2cm的乳腺癌,近红外线对其诊断有较高的假阴性率(48.8%,21/43)。对乳腺炎性病变和导管瘤,彩超的检出率分别为58.8%(10/17)和69.2%(18/26),高于近红外线的检出率分别为0和23.5%(4/17),P<0.05和P<0.01。对乳腺癌在无查体配合诊断情况下行近红外线检查,其灵敏度和诊断符合率明显下降灵敏度从76.9%(100/130)降到56.9%(74/130),P<0.01;诊断符合率从79.9%(214/298)降到61.9%(166/268),P<0.01。结论彩色多普勒超声和钼靶是有价值的常用乳腺影像诊断方法。

Objective To compare the accuracy of color-doppler ultrasonography, mammography and near-infrared light scanning for diagnosing breast diseases. Methods The diagnostic accuracy of the above three imaging methods were analyzed and compared with each other on the basis of the postoperative pathological results. Results Five hundreds and sixty five cases （breast cancer： 274 cases, benign diseases： 291 cases） were examined. The sensitivity of color-doppler ultrasonography, mammography and near infrared light scanning for diagnosing breast cancer were 83.7% （200/239）, 84. 2% （64/76） and 76. 9% （100/130）, respectively. The specificity were 88. 6% （226/255）, 93.2% （69/74） and 82.6% （114/138） , and the accuracy were 86.2% （426/494） , 88.7% （133/150） and 79.9% （214/268）, respectively. Color doppler ultrasonography and mammography were superior to near-infrared light in the item of accuracy （P〈0.05）, especially for lesions of breast cancers that were less than 2 cm. The false negative rate of near-infrared light was higher （48.8% , 21/43）than those of the other methods in detecting breast cancer at early stage. The sensitivity for detecting intraductal papilloma and inflammation of breast using colordoppler ultrasonography were 58. 8%（10/17） and 69. 2% （18/26）, respectively, which were higher than that of near-infrared light scanning [0 and 23.5% （4/17）, P〈0.05 and P〈0.01]. The sensitivity and the accuracy of near infrared light without physical examination reduced significantly, in which the sensitivity reduced from 76. 9% （100/130） to 56.9% （74/130）, P〈0.01, and the accuracy reduced from 79. 9% （214/298） to 61. 9% （166/268）, P〈0.01. Conclusion Color-doppler ultrasonography and mammography are accurate imaging methods for diagnosing breast diseases.