小乳腺癌X线钼靶及高频超声诊断价值分析

Value of Mo-targeted X-ray and high-frequency ultrasonic waves in diagnosis of small breast cancers

目的比较X线钼靶、高频超声检查对小乳腺癌的诊断优缺点,探讨二者联合诊断的价值。方法选择有X线钼靶与高频超声检查,病灶直径≤1.0cm,并经病理组织学证实的27例小乳腺癌的影像资料进行回顾性分析。结果X线钼靶与高频超声诊断符合率分别为70.4%(19/27)、77.7%(21/27)。X线钼靶对小乳腺癌的检出率略低于高频超声,对乳腺内微细钙化较高频超声更敏感,对合并微细钙化的乳腺小肿瘤及不伴肿瘤单纯钙化的诊断较高频超声更明确;对密度较高、边缘有毛刺征及血管征的肿瘤能够诊断,对发生在致密性乳腺或小叶增生显著的乳腺内的小肿块难以做出性质判断。高频超声对肿块敏感,尤其对致密性乳腺中的病变,可清楚显示边缘是否规则,有无毛刺、分叶征象,对于缺少恶性征象的小肿瘤亦不能确诊;对于乳腺内密集钙化灶能够检出,但对于散在的小钙化诊断不明确。彩色多普勒显像(CDFI)对≤1.0cm的乳腺癌血流观察有重要意义,11例(52.38%)肿块观察到数量不等的血流信号,表现为点状、星状穿入性血流或环绕性血流,血流阻力指数(RI)>0.7或更高。钼靶、高频超声联合诊断与病理诊断符合率为85.2%(23/27)。结论X线钼靶与高频超声检查在小乳腺癌的诊断中可优势互补。

Objective This paper was aimed at comparing the advantages and disadvantages in diagnosis of small breast cancer with ultrasonic images and Mo-targeted X-ray and evaluating the integrated diagnosis of small breast cancer with various imaging. Methods Twenty-seven cases were chosen for analysis, who had been diagnosed with small breast cancer by means of Mo-targeted X-ray, high-frequency ultrasonic waves and demonstrated by pathological histology. Resulls Examining with Mo-targeted X-ray and checking through high-frequency ultrasonic waves had a similar rate of diagnosing. As the former was sensitive to fine calcification than the latter, so it was more evident than the latter in diagnosing finely-calcified breast cancer. Mo-targeted X-ray could be used to produce a clear diagnosis of high density lumps which were purely calcified in the mammary glands and tumors with burrs on the edges and blood vessels, but can not be used to diagnose clearly tumors in the mammary glands with clear lobule proliferation, smooth edges, even density but without burrs and blood vessels. High-frequency ultrasonic waves are sensitive to the lumps, especially pathological changes in compact mammary glands, capable of revealing the irregular burrs and the lobules on the edges of the tumors, but incapable of showing atypical lumps. They could be used to find dense calcifications in the mammary glands but not the scattered small calcifications. Color Doppler flow imaging （CDFI） was significant in observing the blood flow in the breast cancer smaller than 1.0 cm in diameter, characterized by dot-like and starlike penetration of blood flow or circular blood flow. Pulse Doppler could detect the maximum resistance index of blood flow. When the index was 〉0. 7 or higher, with the two methods combined in diagnosis, there would be a higher rate of diagnosing small breast cancer, which had not been detected with Mo targeted X-ray and ultrasonic waves. Conclusion The advantages of Mo-targeted X-ray and high frequency ultrasonic can reinforce each other in diagnosing small breast cancer.