触诊、B超和钼靶检查判断浸润性乳腺癌原发病灶准确性研究

Study on the accuracy of physical examination,ultrasonography and mammography on diagnosing primary tumor of invasive breast cancer

目的评价临床检查中触诊、B超和钼靶检查判断浸润性乳腺癌原发病灶的准确性。方法回顾性分析2005年3月1日—2008年9月1日新疆医科大学附属肿瘤医院收治的545例经手术证实为浸润性乳腺癌的女性患者的临床检查和病理资料。记录原发肿瘤和腋窝淋巴结触诊、B超、钼靶检查结果,并与病理结果进行对照分析。结果 545例患者触诊和病理资料完整,其中522例接受了B超检查,516例接受了钼靶检查。触诊的准确率为59.1%(322/545),B超的准确率为84.9%(443/522),钼靶的准确率为69.8%(360/516),三者差异有统计学意义(P=0.000)。在评价原发肿瘤大小方面,触诊和B超一致(均为T1、T2、T3或T4)的几率为68.0%(355/522),触诊和钼靶一致的几率为35.1%(181/516),B超和钼靶一致的几率为37.4%(185/495),而三者均一致的几率为32.9%(163/495),4组间差异有统计学意义(P=0.000)。在判断腋窝淋巴结状况方面,触诊、B超和钼靶与病理结果均有统计学差异(P值均为0.000),三者与病理结果的一致性检验Kappa值分别为0.164、0.401和0.171(P值均为0.000),灵敏度分别为25%、63%和31%,特异度分别为93%、78%和87%。结论 B超判断浸润性乳腺癌患者乳腺原发肿瘤的准确性最高。触诊、B超和钼靶判断原发肿瘤大小差异较大,其中B超和触诊结果一致的可能性最大。触诊、B超和钼靶判断腋窝淋巴结状况的准确性均不高。

Objective To evaluate the accuracy of physical examination （PE）, ultrasonography （US） and mammography （MMG） on diagnosing primary tumor of invasive breast cancer. Methods A retrospective review was performed of 545 breast cancer patients received from Affiliated Tumor Hospital of Xinjiang Medical University between 1st, Mar. 2005 and 1st, Sep. 2008. They were all invasive breast cancer patients diagnosed after breast cancer operations. Description of prime tumor was compared between PE, US, MMG and pathologic results. Results Of all the 545 cases whose clinical data of PE and pathological results were complete, 522 cases received US and 516 received MMG.PE could diagnose 59.1% （322/545） of the malignancies,US could diagnose 84.9%（443/522）,and MMG could diagnose 69.8 % （360/516）, the result has statistical significance. The accordance rate of PE and US was 68.0% （355/522） , PE and MMG was 35.1%（181/516）, US and MMG was 37.4%（185/495）, PE,US and MMG was 32.9%（163/495）, which also has statistical difference. PE, US, MMG were all statistically different with pathology on evaluating the status of axillary lymph nodes. The Kappa value of each was 0.164, 0.401 and 0.171, the sensitivity was 25%, 63% and 31%, specificity was 93%, 78% and 87% respectively. Conclusion The accuracy of US among the three modalities was the highest to diagnose prime breast tumor in invasive breast cancer. The accordance rate of PE and US was higher than the other combinations in measuring the tumor size. The accuracy of diagnosing the status of axillary lymph nodes was not high enough of the three modalities.