高频B超在中国妇女致密型乳腺的乳腺癌筛查中的应用

The application of ultrasonography in breast cancer′s screening of chinese women with dense breast

目的探讨超声检查及定位在中国妇女致密型乳腺发生的早期乳腺癌筛查中的作用。方法对2 0 0 2年2月—2 0 0 6年4月来湘雅医院乳腺科门诊就诊及体检中心健康检查的5万余名女性行乳腺高频超声检查,筛查出乳腺肿块4 0 0 0余例,其中经手术病理证实的致密型乳腺患者乳腺癌1 4 2例(肿块最大横径均≤2 cm),将患者的超声检查与钼靶片结果资料进行分析对比。结果在1 4 2例致密型乳腺的乳腺癌患者中,超声发现微小钙化4 7例(3 3.1 0%),敏感性达7 4.6 0%,准确率为8 8.7 3%;钼靶发现泥沙样钙化3 8例(2 6.7 6%),敏感性6 0.3 2%,准确率为8 2.3 9%。钙化灶的检出率为4 4.3 7%。其中超声发现微小肿块1 1 0例(7 7.4 6%),敏感性8 8.7 1%,准确率为9 0.1 4%;钼靶片发现1 0 0例(7 0.4 2%),敏感性8 0.6 5%,准确率为8 3.1 0%。1 2例临床上未扪及肿块患者均在超声定位下准确地切除病灶。结论(1)高频超声检查在中国妇女致密型乳腺的乳腺癌筛查中检出小肿块及恶性钙化的敏感性以及准确率要高于钼靶片检查。(2)高频超声检查可作为年青妇女、致密型乳腺以及扁平型乳腺早期乳腺癌筛查的有效方法之一,它不仅提高早期乳腺癌的诊断率也提高了保乳率,值得推广使用。

Objective To explore the contribution of ultrasonic examination and localization in early breast cancer screening of chinese women with dense breast. Methods From February, 2002 to April, 2006, the breasts of 5 000 women were examined using ultrasonic examination, and in about 4 000 women a mass was detected, which included 142 cases of breast cancer proved by pathology with diameter ≤ 2cm occurred in patients with dense breast. In these patients, ultrasonic visualization and molybdenum target mammographic were performed. Results In these with breast cancer and dense breast , there were 47 cases （ 33. 1 0 % ） with microcalcification detected by uhrasonography, the sensitivity rate was 74. 60% and the accuracy rate was 88. 73 %. Only 38 （26. 76% ） cases were detected by mammography, the sensitivity rate was 60.32% and the accuracy was 82. 39%. About 44. 37% breast cancer with dense brast display as the microcalcification. There were 110 cases（ 77.46% ） of the small breast cancer detected by uhrasonography , the sensitivity was 88. 71% and the accuracy rate was 90. 14%, There were 100 cases （70. 42% ） detected by mammography, the sensitivity rate was 80.65 % and the accuracy rate was 83. 10% . Also, in 12 patients an unpalpation breast lesion was correctly excised by the use of ultrasonic localization.Conclusions （ 1 ） For the small breast cancer in dense breast the sensitivity and the accuracy of ultrasonography surpassed those of mammography. （ 2 ） The ultrasonic examination is an effective way for early breast cancer screening in young women with dense breast and flat breast. Ultrasonography can improve the rate of dignosis in early breast cancer, and also improve the breast- conserving surgical rate. Ultrasonography is worth of widespread use spreading.