乳腺X线摄影中微钙化对乳腺导管内原位癌的诊断价值

Value of micro-calcification in mammography on the diagnosis of breast ductal carcinoma in situ

目的探讨乳腺X线摄影中微钙化对乳腺导管内原位癌(DCIS)的诊断价值。方法回顾性分析住院治疗的163例乳腺肿物患者的临床资料,研究其乳腺X线摄影和病理检查结果,分析乳腺X线摄影诊断良、恶性肿瘤与病理诊断结果的一致性和乳腺X线摄影发现微钙化与病理诊断DCIS的一致性。结果乳腺X线摄影诊断良性肿瘤44例,恶性肿瘤119例。病理检查结果诊断为良性肿瘤37例,恶性肿瘤126例。乳腺X线摄影诊断良、恶性肿瘤与病理诊断结果的一致性为中等(Kappa=0.492,t=6.323,P﹤0.01),诊断乳腺癌的敏感度为84.92%(107/126),特异度为67.57%(25/37),阳性预测值为89.92%(107/119),阴性预测值为56.82%(25/44)。乳腺X线摄影发现微钙化与病理诊断DCIS的一致性较差(Kappa=0.181,t=3.125,P﹤0.01)。乳腺X线摄影发现微钙化对DCIS诊断的敏感度为77.78%(21/27),特异度为55.15%(75/136),阳性预测值为25.61%(21/82),阴性预测值为92.59%(75/81)。结论乳腺X线摄影能够作为临床筛查乳腺癌的有效手段,但是单纯寻找微钙化以诊断DCIS效能较低,不能作为诊断DCIS的标准。

Objective To investigate the value of micro-calcification in mammography in the diagnosis of ductal car- cinoma in situ （DCIS）. Method The clinical profiles of 163 patients with breast lumps who were hospitalized were retro- spectively reviewed to evaluate the mammography and pathological findings, and the consistency of mammography and pathological findings in diagnosing benign and malignant tumors, as well as that of microcalcifications observed in mam- mography and DCIS in pathological examinations were analyzed. Result Mammography findings： 44 cases of benign tu- mors, 119 cases of malignant tumors. Pathological findings： benign tumors were observed in 37 cases, and there were 126 cases of malignant tumors. The consistency of mammography and pathological diagnosis for benign and malignant tu- mors was moderate （Kappa=0.492, t=6.323, P〈0.01）. The sensitivity of breast cancer diagnosis was 84.92% （107/126）, and specificity was 67.57% （25/37）, the positive predictive value was 89.92% （107/119） and the negative predictive value was 56.82% （25/44）. The consistency of micro-calcifications by mammography and pathological findings of DCIS was poor （Kappa=0.181, t=3.125, P〈0.01）. The sensitivity of micro- calcifications in mammography for DCIS diagnosis was 77.18% （21/27）, with specificity being 55.15% （75/136）, and the positive predictive value was 25.61% （21/82）, the nega- tive predictive value was 92.59% （75/81）. Conclusion Mammography can be used as an effective procedure to screen breast cancer clinically. However, looking for micro-calcifications by mammography is with low efficiency, and should not be a standard for DCIS diagnosis.