乳腺微小肿块的影像学诊断对比研究

Comparative study of small breast masses diagnosed by multiple imaging techniques

目的探讨常规超声联合弹性成像及钼靶X线在乳腺微小肿块诊断中的应用价值。方法回顾性分析39例经手术及病理确诊的乳腺微小肿块患者的常规超声、弹性成像及钼靶X线检查图像资料,以病理结果为金标准,比较常规超声联合弹性成像、钼靶X线及三者联合诊断乳腺微小肿块的敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及一致性。结果常规超声联合弹性成像诊断乳腺微小肿块的敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及准确率分别为72.2%、85.7%、81.3%、78.3%、14.3%、27.8%及79.5%;钼靶X线诊断的敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及准确率分别为55.6%、76.2%、66.7%、66.7%、23.8%、44.4%及66.7%;三者联合诊断的敏感性、特异性、阳性预测值、误诊率、漏诊率及准确率分别为94.4%、90.5%、89.5%、95.0%、9.5%、5.6%及92.3%。超声与钼靶X线联合检查准确率较单纯应用超声或钼靶X线高,差异均有统计学意义(均P<0.05)。结论超声联合弹性成像对乳腺微小肿块的诊断价值高于钼靶X线,三者联合检查可以进一步提高准确率,值得推广普及。

Objective To investigate the value of ultrasound combined with elastography and mammography for small breast masses diagnosis. Methods A retrospective analysis on data of 39 cases which confirmed by surgery and pathology. The sensitivity,specificity,positive predictive value,negative predictive value,the rate of misdiagnosis and missed diagnosis rate and consistency were calculated and compared among ultrasound,elastography,ultrasound combined with elastography and mamography.Results Compared with pathological results,the sensitivity,specificity,positive predictive value,negative predictive value,the rate of misdiagnosis and missed diagnosis rate and accuracy were 72.2%,85.7%,81.3%,78.3%,14.3%,27.8% and79. 5 % using ultrasound combined with elastography,55. 6 %,76. 2 %,66. 7 %,66. 7 %,23. 8 %,44. 4 % and 66. 7 % using mammography,94.4%,90.5%,89.5%,95.0%,9.5%,5.6% and 92.3% using combined above three imaging techniques. The accuracy to the pathology was significantly higher using ultrasound combined with mammography than using ultrasonography or mammography only（P〈0.05）. Conclusion The diagnostic value of using ultrasonography combined with elastography for small breast masses is higher than using mammography only,combined three techniques is potentially to improve the accuracy of breast small masses.