乳腺影像报告与数据系统评估联合乳腺微钙化导丝定位活组织检查对触诊阴性乳腺癌的诊断价值

Diagnostic value of breast imaging reporting and data system combined with wire-guided localization biopsy for breast microcalcifications in impalpable breast cancer

目的探讨X线摄影中乳腺影像报告与数据系统（BI-RADS）联合乳腺微钙化的定位活组织检查技术对触诊阴性乳腺癌的诊断价值。方法收集临床触诊阴性、仅X线发现乳腺微钙化的患者192例，共205处微钙化病灶，回顾其X线表现特征并进行BI-RADS评估分类，对BI-RADS分类4a级及以上患者行X线引导下导丝定位活组织检查及病理诊断。结果205处微钙化病灶中，恶性病灶74处（36.1%），良性病灶131处（63.9%）；成簇、段样、区域样分布的线状分支状钙化对乳腺恶性病灶的阳性预测值较高[分别为83.3%（5/6）、100.0%（11/11）、100.0%（1/1）]，其次为成簇、线样、段样及区域样分布的多形性钙化[分别为55.9%（38/68）、50.0%（1/2）、40.0%（8/20）、33.3%（4/12）]；线状分支状钙化、多形性钙化对恶性病灶的阳性预测值明显高于粗糙不均质钙化、不定形/模糊钙化（χ2值分别为34.44、51.87、16.71、29.86，均P〈0.05）；线状分支状钙化恶性可能性最高；恶性病灶在4种不同的腺体类型中所占的比例分别为极度致密型40.5%（30/74）、不均匀致密型39.2%（29/74）、散在纤维腺体型10.8%（8/74）、脂肪型9.5%（7/74）。结论应用BI-RADS对乳腺微钙化进行术前评估可提高触诊阴性乳腺癌的检出率；线状分支状钙化对恶性病灶具有更高的预测价值；致密型乳腺是乳腺癌发病的危险因素，临床工作中应高度重视。

ObjectiveTo explore the diagnosis value of X-ray breast imaging reporting and data system （BI-RADS） combined with wire-guided localization biopsy for breast microcalcifications in impalpable breast cancer.Methods192 palpation negative patients with 205 microcalcification lesions were detected by mammography. All lesions were classified according to BI-RADS descriptors for calcification and were categorized by the BI-RADS. The patients with BI-RADS category 4a and above underwent X-ray positioning guide wire-guided biopsy and pathological diagnosis.ResultsIn 205 microcalcification lesions, 74 （36.1%） were malignant lesions, 131 （63.9%） were less than benign lesions. The positive predictive value of malignant breast lesions in clustered, segmental, regional linear branching calcifications were higher [83.3% （5/6）, 100.0% （11/11）, 100.0% （1/1）], followed by clustered, linear, segmental, regional pleomorphic calcifications [55.9% （38/68）, 50.0% （1/2）, 40.0% （8/20） and 33.3% （4/12）, respectively]. The positive predictive values of malignant in linear branching calcifications and pleomorphic calcifications were significantly higher than those of coarse heterogeneous calcifications, amorphous or indistinct calcifications （χ2 values were 34.44, 51.87, 16.71, 29.86, all P 〈 0.05）. The linear branching calcification had the highest possibility. The proportions of malignant lesions in four different types of glands were extremely dense 40.5% （30/74）, heterogeneously dense39.2% （29/74）, scattered areas of fibroglandular density 10.8% （8/74） and fat 9.5% （7/74）, respectively.ConclusionsBI-RADS categorization for breast microcalcification lesions can improve the detection rate of impalpable breast cancer. Linear branching calcification has higher predictive value for malignant lesions. Dense breast is the risk factors of breast cancer, which should be attached great importance.