68例超声检查假阴性乳腺癌的特征分析

Characteristic analysis of 68 cases of false negative breast cancer in ultrasound examination

目的分析超声检查为假阴性的乳腺癌患者临床病理特征,探讨降低该类乳腺癌漏诊率的措施。方法依据纳入、排除标准,选取2011年1月至2016年6月甘肃省肿瘤医院诊治的68例超声检查为假阴性的乳腺癌患者进行回顾性研究。分析其临床病理学因素(超声血流类型、超声血流Adler分级等)与超声BI-RADS分类的关系,以及乳腺钼靶X线BI-RADS分类与超声BI-RADS分类间的关系。单向有序或双向有序等级资料的比较均采用Kruskal-Wallis H法,组间两两比较采用Bonferroni-Dunn法。结果在超声血流为周边型、穿入型、内部型及无血流型的患者中,其BI-RADS分级为1、2、3级者分别2、5、14例,0、1、7例,1、2、13例以及4、12、7例,并且,在超声血流Adler 0、1、2级患者中,其BI-RADS分级1、2、3级者分别为2、12、7例,3、7、26例以及2、1、8例。不同超声血流类型、不同超声血流Adler分级患者间相比,超声漏诊的乳腺癌BI-RADS分类的差异均有统计学意义(χ^(2)=14.756、6.829,P=0.002、0.033)。不同钼靶X线BI-RADS分类的患者相比,超声BI-RADS分类的差异具有统计学意义(χ^(2)=9.574,P=0.023)。增加钼靶X线检查,提高了BI-RADS 4类患者17例,有效减少漏诊机会近四分之一;超声漏诊的乳腺癌绝大多数为早期患者(Tis期、T1mic期分别为22例和14例);其次是T1c和T2期患者,分别为17例和6例。结论病期早、病灶小、病理类型特殊、血流特征不典型是此类乳腺癌超声漏诊的主要因素,增加钼靶X线检查可以提高其诊断准确性,但仍有一定局限性。

Objective To analyze the clinicopathological characteristics of patients with false negative breast cancer diagnosed by ultrasound examination,and explore measures to reduce the missed diagnosis rate of breast cancer.Methods According to the inclusion and exclusion criteria,the data of 68 cases of false-negative breast cancer diagnosed by ultrasound in the Tumor Hospital of Gansu Province from January 2011 to June 2016 were analyzed retrospectively.The relationship between clinicopathological factors(ultrasound blood flow type,Adler classification,etc)and BI-RADS ultrasound classification and the relationship between BI-RADS mammography classification and BI-RADS ultrasound classification were analyzed.The one-way ordered data and the two-way ordered rank data were analyzed by the Kruskal-wallis H test.The pairwise comparison between groups was performed by the Bonferroni-Dunn’s method.Results The number of patients with BI-RADS category 1,2 and 3 lesions was 2,5 and 14;0,1 and 7;1,2 and 13;4,12 and 7 among the patients with peripheral,penetrating,internal and lacking blood flow types,respectively.The number of patients with BI-RADS category 1,2 and 3 lesions was 2,12 and 7;3,7 and 26;2,1 and 8 among the patients with Adler classification 0,1,2 lesions.There were significant differences in BI-RADS category of breast cancer missed by ultrasound among patients with different ultrasound blood flow types and different Adler classification(χ^(2)=14.756,6.829;P=0.002,0.033).The patients with different BI-RADS mammography category showed significant difference in BI-RADS ultrasound category(χ^(2)=9.574,P=0.023).After mammography,17 patients were newly diagnosed with BI-RADS category 4 lesions and the cases of missed diagnosis declined by about 25%.The large majority of breast cancer missed by ultrasound was at early stage(Tis:22 cases;T1mic:14;T1c:17;T2:6).Conclusions Early stage,small lesions,special pathological types and atypical blood flow features are main factors for misseddiagnosis of breast cancer by ultrasound.Additional mammography can improve the diagnostic accuracy of ultrasound to diagnose breast cancer,but it still has certain limitations.