全数字化乳腺X线成像技术对乳腺癌及有关乳腺疾病诊断价值的临床评估

Clinical evaluation on the values of FFDM and BI-RADS for breast diseases

目的评价全数字化平板乳腺成像技术的外科意义及临床应用价值。方法 2004年1月1日至2005年12月31日间收治的乳腺癌、纤维腺瘤、导管内乳头状瘤及乳腺病等共831例,包括871个病灶。全数字化平板乳腺X线检查的诊断采用美国放射学会推荐的乳腺影像报告和数据系统,并将Ⅳ级及V级初步认定为恶性诊断,将Ⅰ级、Ⅱ级及Ⅲ级初步认定为良性诊断。结果 FFDM对本组乳腺疾病病灶性质诊断的敏感度80.9%,特异度90.0%,阳性预测值88.4%,阴性预测值83.3%及准确度85.5%。影像诊断为V级时乳腺癌占97.7%(260/266),在Ⅳ级的诊断中乳腺癌占67.8%(82/121),在Ⅰ、Ⅱ及Ⅲ级中尚有16.7%(81/484)为乳腺癌。结论乳腺X线诊断为V级时手术活检是唯一的治疗方案,Ⅳ级时应积极建议手术活检。要慎重对待Ⅰ、Ⅱ及Ⅲ级的诊断,应由临床医师根据其他临床证据及有关因素决定治疗方案。

Objective To evaluate the values of full-field digital mammography （FFDM） and Breast imaging reporting and data system （BI-RADS） for breast diseases. Methods In this work, we ana- lyzed 831 patients with 871 focuses who underwent imaging examinations with FFDM before the operation during Jan 1, 2004 to Dec 31, 2005. All the patients received operations, and had identify pathological diagnosis including breast cancer, breast fibroma, intraductal pappiloma and mastosis. The radiologieal diag- nosis followed BI-RADS suggested by American College of Radiology. Results The imaging diagnostic sensitivity of overall focuses was 80.9%, the specificity was 90.0% , positive predictive value was 88.4%, negative predictive value was 83.3%, the diagnose accuracy was 85.5%. If the radiological diagnosis of focuses were BI-RADS Category Ⅴ, 97.7% （260/266） was pathological diagnosed breast cancer. When they were BI-RADS Category Ⅳ, 67.8% （82/121） was breast cancer. In BI-RADS Category Ⅰ , Ⅱ and m focuses, 16.7% （81/484）was breast cancer. ConclusionsWhen the radiological diagnosis is BI-RADS Category Ⅴ, surgery biopsy is the exclusive treatment. To Category IV focuses, surgery biopsy should be suggested. As to Category Ⅰ , Ⅱ and Ⅲ focuses, the management should be prudent, and other factors should be considered, including the social and economic factors, and the follow up is feasible or not.