X射线摄影阴性乳腺癌临床病理因素分析

Clinical and pathological analysis of breast cancer with false-negative mammogram

目的:探讨X线摄影(MG)阴性乳腺癌的临床和病理学特征以及补充诊断方法。方法:对529例首诊并经病理诊断为乳腺癌患者的MG重新阅片,确认MG阴性乳腺癌99例,MG阳性乳腺癌430例,行临床及病理学指标的相关性分析。结果:MG阴性乳腺癌占同期乳腺癌的18.7%(99/529),与MG阳性组相比,MG阴性乳腺癌中以乳头溢液为首发症状〔34.3%(34/99)vs12.3%(53/430),P=0.000 1〕、肿块较小〔(T≤1 cm)和(1 cm<T≤2 cm)16.2%(11/68)vs7.0%(27/385)和51.5%(35/68)vs28.3%(109/385),P=0.001〕、导管内癌(DCIS)〔34.3%(34/99)vs13.0%(56/430),P=0.000 1〕和MG腺体高密度者较多〔53.5%(53/99)vs39.5%(170/430),P=0.008〕,两组年龄差异无统计学意义。MG阴性组中以乳头溢液为首发症状者乳管内视镜检查(FDS)发现率为85.3%(29/34),乳腺肿块者超声检查发现率为94.1%(64/68),乳腺肿块和局限性腺体增厚者行空芯针穿刺活检(CNB)和Mammotome活检确诊率为92.5%(37/40)。结论:乳腺癌患者的首发就诊症状、肿瘤大小、腺体致密程度和病理学类型是造成MG阴性的重要因素。MG联合FDS、乳腺B超和CNB或Mammo-tome活检是MG阴性乳腺癌的补充诊断手段,能减少乳腺癌的漏诊。

OBJECTIVE： To explore the clinical and pathological characteristics and complemental diagnostic methods of breast cancer with false-negative mammogram. METHODS： Five hundred and twenty-nine patients with breast cancer that received operation were identified. Ninety nine patients had false-negative preoperative mammograms and 430 patients had positive preoperative mare rnograms. The clinical presentation and pathological characteristics were analysed. RESULTS： The patients with false-negative mammograms were 99 cases（18.70% ,99/529）. Comparing with positive mammograms group, the patients with false-negative mammograms were more likely to present with nipple discharge （34.3% （34/99） vs 12.3%（53/430）,P= 0.000 1], and had smaller tumors（（T≤ 1 cm） and （1 cm〈T≤2 cm） 16.2%（11/68）vs 7.0%（27/385） and 51.5%（35/68） vs28.3% （109/385）,P= 0.001））. Also these pa tients maybe suffered from DCIS （34. 3% （34/99）vs 13. 0% （56/430） ,P =0. 000 1] and had higher dense breast on mammography （53.5%（53/99） vs 39.5%（170/430）,P=0.008）. There was no difference in the age between the two groups. The detection rates of fiberoptic ductoscopy, ultrasonography and core needle biopsy（CNB） or mammotome minimally invasive biopsy （MMIBS） were 85.3%（29/34）, 94. 1% （64/68）and 92. 5% （37/40）respec tively in the patients with false negative mammograms. CONCLUSIONS： The factors affecting the false-negative rate of mammograms includ the main clinical manifestation, tumor size, density and pathological type of breast. To reduce the missed diagnosis rate, MG combined with FDS, uhrasonography and CNB or MMIBS are complemental diagnostic methods for breast cancer with negative mammogram.