钼靶X线假阴性乳腺癌患者临床病理学特点的回顾性分析

Retrospective analysis of the clinicopathologic features of breast cancer patients with false-negative mammograms

目的回顾性分析钼靶X线诊断假阴性病例的临床及病理学特点。方法2007年1月至2010年12月上海市中西医结合医院乳腺外科经手术治疗及病理证实的女性原发乳腺癌患者共233例，患者术前乳腺钼靶X线片、高频彩色多普勒超声及病理资料完整。根据其术前钼靶X线表现，分为假阴性组和真阳性组，对比分析两组患者的发病年龄、肿块直径、淋巴结受累情况、组织学类型、性激素受体表达等方面的特点，并结合假阴性患者术前超声检查结果分析。结果233例乳腺癌患者中钼靶X线假阴性的比例为10．7％（25／233）。假阴性组比真阳性组发病年龄偏低[（44．23±9．62）岁比（53．41±11．63）岁，t=3．061，P=0．004]，肿块直径小[（2．93±0．78）cm比（3．48±1．12）cm，t=3．536，P=0．007），浸润性癌比例高[92％比64．4％，χ^2=7．72，P=0．005）]，ER表达率低[36％比63．5％，χ^2=7．04，P=0．008]；25例假阴性患者术前超声均显示明确的肿物，恶性诊断符合率为68％（17／25）。结论乳腺癌钼靶X线假阴性与患者年龄、乳腺致密程度、肿瘤直径相关，多为浸润性，ER表达率低，加行超声检查可提高检出率及诊断率。

Objective To retrospectively analyze the clinieopathologic features of breast cancer patients with false-negative mammograms. Methods Two hundred thirty-three female patients with primary breast cancer diagnosed by pathology or confirmed by operation in our hospital between January 2007 and December 2010 were involved in this study, with complete data on preoperative mammogram, high-frequency color Doppler ultrasound and pathological examination. They were divided into false-negative group and truepositive group according to the preoperative mammography. Patients＇ age, tumor size, lymph node involvement, histological type and hormone receptor expression were compared between 2 groups. The results of preoperative uhrasonography in the false-negative group were also analyzed. Results Of the 233 patients, 10. 7% （25/233） were negative in mammogram. The onset age in false-negative group was （44. 23±9. 62 ） years, lower than （53.41 ±11.63 ） years in true-positive group （ t = 3.061, P = 0. 004） ; the tumor diameter in false-negative group was （2. 93±0. 78） cm, smaller than （3.48±1.12） cm in true-positive group （t=3. 536, P= 0. 007 ）. The false-negative group had a higher proportion of infiltrating carcinoma than true-positive group （92% vs 64. 4% , χ^2 =7.72,P=0. 005） and a lower rate of estrogen receptor expression （36% vs 63.5% , χ^2 = 7.04 ,P=0. 008）. The preoperative ultrasound images in all 25 false-negative patients indicated clear tumor and the diagnosis accordance rate of malignancy was 68%. Conclusions Breast cancer patients with false-negative mammograms have younger onset age, dense gland tissue, small tumor size, and a lower rate of estrogen receptor expression, mostly invasive. The mammogram combined with ultrasound examination can increase the detection rate and improve diagnostic accuracy.