彩色多普勒超声与全数字化乳腺摄影对乳腺良恶性病变的诊断价值

Diagnostic value of color Doppler ultrasonography and full-field digital mammography for benign and malignant breast lesions

目的探讨彩色多普勒超声(CDU)与全数字化乳腺摄影(FFDM)对乳腺良恶性病变诊断与鉴别诊断的价值。方法回顾性分析经手术和病理证实的107例乳腺良性病变和100例乳腺癌患者的临床资料。将患者术前CDU和FFDM检查结果与最后诊断对比,评价两项检查方法各自的准确性及两项联合的诊断效能。结果所有患者术前均行CDU和FFDM检查,CDU、FFDM及两项联合对乳腺癌诊断的敏感性、特异性分别为88%和82.24%;89%和75.7%;97%和88.78%。经ROC分析,对乳腺良恶性病变诊断的整体准确性依次为两项联合>CDU>FFDM。CDU,FFDM对乳腺癌肿块影显示率分别为95%和70%,两者差异有统计学意义(P<0.01)。对绝经前、后乳腺癌检出率,CDU分别为9 3.5%和8 3.3%(P>0.0 5),FFDM分别为8 0.4%和9 6.3%(P<0.0 5)。绝经前乳腺癌检出率CDU与FFDM无明显差异(P>0.05),绝经后乳腺癌检出率FFDM高于CDU(P<0.05)。结论 CDU检查对肿块敏感性高,FFDM对绝经后乳腺癌的检出率高;两者联用可提高对乳腺良恶性病变诊断的整体准确性,降低误诊率和漏诊率。

Objective To investigate the value of color Doppler ultrasonography （ CDU ） and full-field digital mammography （FFDM） in diagnosis and differential diagnosis of benign and malignant breast lesions. Methods Retrospective analysis was performed on the clinical data of 107 patients with benign breast lesions and 100 patients with breast cancer, which were confirmed by surgical and pathological findings. The results of CDU and FFDM examination of the patients before operation were compared with the final diagnoses to assess the accuracy of the two methods and the diagnostic efficacy of their combination. Results All the patients underwent both CDU and FFDM examinations. The sensitivity and specificity was 88% and 82.84% for CDU, 89% and 75. 7% for FFDM, and 97% and 88. 78% for combination of CDU and FFDM, respectively. Based on a receiver-operating characteristics （ROC） curve analysis, the overall accuracy for breast cancer detection was the combination of CDU and FFDM 〉 CDU 〉 FFDM, successively. The detection rate of CDU and FFDM for breast mass was 95% and 70% , respectively and the difference had statisfical significance （P〈0.01）. The detection rate of breast cancer in pre- and post-menopausal patients by CDU was 93.5% and 83.3% （P 〉 O. 05）, and by FFDM was 80. 4% and 96. 3% （P 〈 O. 05）, respectively. No significant difference was noted in the detection rate of breast cancer in the pre-menopausal patients between CDU and FFDM （ P 〉0. 05 ） , while FFDM had higher detection rate of breast cancer than that of CDU in the post-menopausal patients （ P 〈 0.05 ）. Conclusions CDU has a high sensitivity to breast mass and FFDM has high detection rate of breast cancer in post-menopause patients. The combination of the two examinations can enhance the overall diagnostic accuracy for malignant breast lesions and decrease the missed diagnosis and misdiagnosis rate.