术前超声及钼靶BI-RADS分类对早期乳腺癌的诊断价值

Diagnostic value of preoperative breast ultrasound and mammogram BI-RADS classification in early breast cancer

目的探索术前超声及钼靶BI-RADS分类对早期乳腺癌的诊断价值。方法收集2015-08至2017-08在医院确诊为早期乳腺癌(TNM分期为Ⅰ、Ⅱ期)且术前同时行超声及钼靶检查的43例患者资料,共44个病灶。以BI-RADS分类≤3判为良性,=4a为可疑恶性,≥4b判为恶性,回顾性分析超声、钼靶及两者联合对早期乳腺癌的诊断价值。结果早期乳腺癌术前超声BI-RADS分类判为可疑恶性及恶性的比例为93. 2%(41/44),明显高于钼靶75. 0%(33/44),差异有统计学意义(P <0. 05),两者联合诊断比例为95. 5%(42/44)。其中对于黏液腺癌,超声判读为可疑恶性及恶性的比例明显高于钼靶,而浸润性导管癌、导管内癌及其他类型乳腺癌超声与钼靶BI-RADS分类无差异。其中两者联合仍判为良性的2个病灶分别为导管内癌和髓样癌。结论对于早期乳腺癌尤其是黏液腺癌,术前超声BI-RADS分类判为可疑恶性及恶性的比例较钼靶更高;术前超声和钼靶判为可疑恶性及恶性的比例与乳腺癌病理类型密切相关;而对于特殊类型的早期乳腺癌及导管内癌两者结合仍有可能漏诊。

Objective To explore the diagnostic value and influencing factors of preoperative ultrasound and mammography BI-RADS classification in the early-stage breast cancer. Methods The clinical data on 43 patients with 44 breast lesions diagnosed as early stage( TNM Ⅰ-Ⅱ) breast cancer between August 2015 and August 2017 was retrospectively analyzed. All the patients received breast ultrasound and mammography examination and their BI-RADS classification before surgery was recorded. According to BI-RADS classification,the imaging results were divided into three types: benign( ≤3),suspicious for malignancy( = 4 a),and malignant( ≥4 b). The diagnostic value of ultrasound combined with mammography BI-RADS in a variety of breast cancers was explored and the influencing factors were analyzed. Results The proportion of cases that were suspicious for malignancy or malignant according to preoperative ultrasound BI-RADS classification of early stage breast cancer was 93. 2%( 41/44),which was significantly higher than that of mammography 75%( 33/44)( P < 0. 05). However,no significant difference were found between detection with ultrasound alone and that with the combined method( 95%( 42/44)). For mucous adenocarcinoma,the proportion of cases diagnosed as suspicious for malignancy or malignant with ultrasound was higher than with mammography,but there was no significant difference in BI-RADS classification of infiltrating ductal carcinoma,intra-ductal carcinoma and other types of breast cancer. The two lesions diagnosed as benign with the combined method were intra-ductal carcinoma and medullary carcinoma respectively. Conclusions For early-stage breast cancer and mucous adenocarcinoma in particular,the proportion of cases diagnosed as suspicious for malignancy or malignant with ultrasound was higher than with mammography during preoperative ultrasound BI-RADS classification. The proportion of cases diagnosed as suspicious for malignancy or malignant with ultrasound or mammography is closely related to the pathologic types,but there is still the possibility that the combined method fails to detect some special types of early-stage breast cancer and intra-ductal carcinoma.