乳腺X线摄影和超声检查诊断疾病准确性及与女性体质量指数、乳房体积及乳腺密度的相关性研究

Study on diagnostic accuracy of mammography and ultrasonography and its correlation with female body mass index, breast volume, breast density of breast cancer

目的探讨乳腺x线摄影和超声检查诊断疾病准确性及与女性体质量指数（BMI）、乳房体积及乳腺密度的相关性。方法回顾性分析经手术病理证实，且术前同时行乳腺X线摄影和超声检查的1101例女性患者资料。患者BMI为16．23～40．01kg／m^2,平均（24．42＋3．45）kg／m^2。观察乳腺X线摄影和超声检查图像从而进行诊断。以病理结果为金标准，分析影像检查的诊断效能。依据影像结果，将患者分为诊断准确组、假阴性组与假阳性组。采用￡检验比较诊断准确组与假阴性组、假阳性组间BMI、乳房体积及乳腺密度的差异；采用Pearson法评价BMI与乳腺X线摄影测得的乳房体积及乳腺密度的相关性。结果乳腺X线摄影检查诊断准确组、假阴性组与假阳性组病例数分别为1011、40、50例，诊断敏感度、特异度和准确度分别为94．2％（655／695）、87．7％（356／406）和91．8％（1011／1101）；超声检查诊断准确组、假阴性组与假阳性组病例数分别为1006、34、61例，诊断敏感度、特异度和准确度分别为95．1％（661／695）、85．0％（345／406）和91．4％（1006／1101）。BMI与乳腺X线摄影测得的乳房体积呈正相关（r=0．562，P〈0．01），与乳腺密度间相关性差（r=-0．348，P〈0．01），乳房体积与乳腺密度间相关性低（r=-0．270，P〈0．01）。与诊断准确组比较，乳腺X线摄影假阴性组的乳腺密度较大，乳房体积和BMI较小，差异均有统计学意义（P〈0．05）；假阳性组与诊断准确组的乳腺密度、乳房体积和BMI差异均无统计学意义（P〉0．05）。超声检查假阴性组和假阳性组的乳腺密度、乳房体积和BMI差异均无统计学意义（P〉0．05）。结论低BMI、高乳腺密度及小乳房体积易造成乳腺X线上假阴性的诊断；BMI与乳房体积之间具有相关性，提示BMI具有间接反映乳房体积的潜在作用。

Objective To explore the relationship between diagnostic accuracy of mammography, ultrasound and female body mass index （BMI）, breast volume, breast density in breast cancer. Methods We retrospectively analyzed 1101 cases of female patients who were confirmed by operation and pathology. All patients underwent mammography and uhrasonography before operation.BMI were ranged from 16.23 to 40.01 kg/m^2, with an average of （24.42 ± 3.45） kg/m^2. Diagnosis was based on mammography and uhrasonography imaging, and the pathologic diagnosis was as gold standard. The diagnostic efficacy ofdifferent imaging methods was analyzed. The patients were divided into diagnostic accuracy group, false negative group and false positive group according to the imaging results. The differences of BMI, breast volume and breast density between 3 groups were compared by t test. Pearson method was used to evaluate the the correlation between BMI, breast volume and mammary gland density measured by mammography. Results The mammography diagnosis of accuracy group, false negative group and false positive group were 1 011, 40 and 50 cases respectively. The diagnostic sensitivity, specificity and accuracy were 94.2% （655/695）, 87.7% （356/406） and 91.8% （1 011/1 101） respectively. The ultrasound diagnosis of accuracy group, false negative group and false positive group were 1 006, 34 and 61 cases respectively. The diagnostic sensitivity, specificity and accuracy were 95.1% （661/695）, 85.0% （345/406） and 91.4% （1 006/1 101） respectively. The results of Pearson correlation analysis showed that BMI was positively correlated with breast volume （r=0.562, P〈0.01）. Breast density was not correlated with BMI and volume （r=- 0.348, - 0.270; P〈 0.01）. Compared with the diagnostic accuracy group, the breast density of false negative group was much higher, and the breast volume and BMI were smaller with a significant difference （P〈0.05）. There was no significant difference in the breast density, breast volume and the BMI between the false positive group and the diagnosis group（P〉0.05）. There were no significant differences in breast density, breast volume and BMI between false negative group and the false positive group of ultrasonography （P〉0.05）. Conclusions Lower BMI, higher breast density and smaller breast volume may lead to false-negative results. There was a correlation between BMI and breast volume, suggesting that BMI had a potential to indirectly reflect breast