自动乳腺全容积成像在致密乳腺中对早期乳腺癌的诊断价值

目的探讨自动乳腺全容积成像（ABVS）在致密乳腺中对早期乳腺癌的诊断价值。方法选取2015年4月至2016年12月就诊的52例乳腺疾病患者，共76个乳腺肿块（直径≤2cm）合并致密乳腺（乳腺密度〉50％）。所有病例术前均经常规手持超声、乳腺X线摄影（以下简称钼靶）及ABVS检查，再行活检或手术治疗，以病理结果为金标准。检查结果与病理结果相对照，对比分析常规手持超声、钼靶及ABVS检查在致密乳腺中对早期乳腺癌的诊断价值。结果76个病灶中ABVS诊断早期乳腺癌的敏感性89．5％、特异性88．4％、准确性89．1％，约登指数为0．779；常规手持超声诊断早期乳腺癌的敏感性76.3％、特异性44．2％、准确性64．7％，约登指数为0．205；钼靶诊断早期乳腺癌的敏感性82．1％、特异性90．3％、准确性85.9％，约登指数为0.724。ABVS的约登指数显著高于常规手持超声（P=0．000）。钼靶和ABVS对致密乳腺中肿块微钙化的检出率分别为92．2％和90.3％，两者差异无统计学意义（P〉0.05）；ABVS和常规手持超声对致密乳腺中肿块微钙化的检出率分别为90.3％和83．2％，两者差异有统计学意义（P〈0．05）。结论ABVS在诊断致密乳腺中的早期乳腺癌敏感性高。尤其在乳腺腺体致密的背景下以微钙化为主要表现的乳腺癌中ABVS能显著提高诊断的准确性，也在一定程度上减少了患者不必要的放射线暴露。

Objective To discuss the diagnostic value of automatic breast full-volume imaging （ ABVS ） in the dense mammary gland for early breast cancer. Methods 52 patients with breast clinic in our hospital from April 2015 and December 2016 were collected, with a total of 76 breast tumors （ diameter of 2 cm or less ） of dense breast （ breast density〉50% ） cases. All cases were treated with conventional hand-held ultrasound, mammography and ABVS, re-biopsy or surgical treatment, and the pathological results were gold standard. The results were compared with pathological results, and the diagnostic value of early breast cancer was analyzed in the dense mammary gland by contrasting analysis of conventional hand-held ultrasound, mammography and ABVS. Results The sensitivity of ABVS diagnosed early breast cancer in 76 cases was 89.5%, specificity 88.4%, accuracy 89.1%, and the youden index was 0.779. The sensitivity of hand-held ultrasound to early breast cancer was 76.3%, specificity 44.2%, accuracy 64.7%, and the youden index was 0.205. The sensitivity of mammography to early breast cancer was 82.1%, specificity 90.3%, accuracy 85.9%, and the youden index was 0.724. The ABVS＇s youden index is significantly higher than the conventional hand-held ultrasound （ P=0.000 ） . The detection rate of microcalcification of the lumps in the dense mammary gland was 92.2% and 90.3% respectively, and the difference was not statistically significant （ P〉0.05 ） . The detection rate of microcalcification was 90.3% and 83.2% in the dense breast lumps with ABVS and conventional hand- held ultrasound, and the difference was statistically significant （ P〈0.05 ） . Conclusion ABVS were sensitive to early breast cancer in the dense breast. Especially under the background of mammary gland density as main feature, the microcalcification ABVS can significantly improve the accuracy of diagnosis of breast cancer, and to a certain extent, reduce the patients unnecessary radiation exposure.