乳腺超声和钼靶X线摄片对触诊阴性乳腺病灶的诊断价值分析(附87例报告)

The diagnostic significance of sonography and mammography in nonpalpable breast lesions: a report of 87 cases

目的探讨和比较乳腺钼靶X线摄片和超声对临床触诊阴性乳腺病灶的诊断价值。方法回顾性分析77例触诊阴性乳腺病例(87个病灶)的临床资料,所有病例均行乳腺超声和钼靶X线摄片检查,并经穿刺活检或手术切除标本获得病理诊断。分析良恶性乳腺病变患者的年龄和月经状态;总结乳腺癌病灶在钼靶X线摄片和超声诊断中的影像学特点,并比较两种方法的诊断效能。结果全组87个触诊阴性的乳腺病灶中,乳腺癌20个(20例患者),占23%(20/87),其中95%(19/20)为0-Ⅰ期的早期乳腺癌;良性病灶67个(57例患者),占77%(67/87)。乳腺癌患者的年龄明显高于良性乳腺病变患者(P<0.01),但月经状态无明显差异。钼靶X线摄片、超声诊断乳腺癌病灶的阳性率分别为75%(15/20)和55%(11/20);其主要影像学特点分别是恶性钙化和边界不清的低回声占位,分别占诊断阳性病灶的67%(10/15)和55%(6/11)。钼靶X线摄片诊断触诊阴性的乳腺病灶的敏感性、特异性和准确性(分别为75%、64%、67%)均优于乳腺超声(分别为55%、21%、29%)。20例乳腺癌患者经超声或钼靶引导下采用金属丝定位,行切除手术。11例患者行保乳手术,保乳率达55%(11/20)。结论钼靶X线摄片和超声检查在触诊阴性的乳腺癌的早发现、早诊断、早治疗中发挥着重要作用。其中,钼靶X线摄片检查更为重要。

Objective To explore and compare the diagnostic significance of mamrnography and sonography in non-palpation breast lesions （NPBLs）. Methods The clinical data of 87 non-palpable breast lesions in 77 patients were analyzed retrospectively. All patients were examined both by mammography and sonography. Pathologic diagnosis was made with the tissues obtained by core needle biopsy or operative resection. The age and menstrual state of benign and malignant cases were analyzed. The imaging features of mammgraphy and sonography in non-palpable breast cancer （NPBC） were summed up, and diagnostic potency of the two measures were evaluated. Results Among the 87 non-palpable breast lesions, 20 （23%） of 20 patients were pathologically diagnosed as breast cancer, of which 19 （95%） lesions were in 0-Ⅰ early stage. 67 （77%） breast lesions from 57 patients were diagnosed as benign lesions. The patients with non-palpable breast cancer were significantly older than those with benign NPBLs （P〈0. 01）, but no significant difference in menstrual state existed between the two groups. The diagnostic accuracy of rnammography and sonography were 75% （15/20） and 55% （11/20）, respectively. The imaging features of non-palbable breast cancer were malignant calcification and ill-defined low echo-level areas, and 10 out of 15 （67%） positive lesions in mammography and 6 out of 11 （55%） positive lesions in sonography were diagnosed as breast cancer. The sensitivity, specificity and accuracy of marnmography （75%, 64% and 67%, respectively） were statistically higher than that of sonogmphy （55%, 21% and 29% respectively） in the diagnosis of non-palpable breast lesions. Twenty patients with breast cancer underwent tumor resection with wire localization led by mammography or sonography. Eleven patients underwent the operation with preservation of breast. Conclusion Mammography and sonography, especially mammography, play an important role in early detection, early diagnosis and early treatment of non-palpable breast cancer.