全屏数字化乳腺摄影在不典型乳腺癌中的应用价值

Application Value of Full-field Digital Mammography in Atypical Breast Cancer

目的:探讨全屏数字化乳腺摄影(FFDM)在不典型乳腺癌中的应用价值。方法:收集2014年12月—2020年1月在江苏省南通市中医院就诊的经手术病理证实为乳腺癌但术前FFDM影像表现不典型的31例患者。均行双侧乳腺头尾位、内外斜位双体位投照。结果:31例不典型乳腺癌,致密型乳腺21例,占67.7%(21/31),误诊病例17例,总误诊率54.8%(17/31)。各型乳腺的误诊率,A型乳腺0(0/3),B型乳腺42.9%(3/7),C型乳腺62.5%(5/8),D型乳腺69.2%(9/13),致密型乳腺误诊率66.7%(14/21)。影像表现中,局限性结构紊乱和非对称密度增高多见于致密型乳腺,局限性结构紊乱、非对称密度增高、星芒征误诊率分别为37.5%(3/8)、66.7%(14/21)、0(0/2)。结论:不典型乳腺癌FFDM检查误诊率较高,主要与多见于致密型乳腺及诊断医生认识程度不高有关,DBT是有效的补充检查技术,尤其对致密型乳腺,能明显提高诊断的准确率。

Objective:To explore the application value of full-field digital mammography in atypical breast cancer.Methods:A total of 31 patients with breast cancer confirmed by surgery and pathology and with atypical preoperative FFDM imaging findings who were admitted to the hospital from December 2014 to January 2020 were collected.Results:In 31 cases of atypical breast cancer,21 cases were dense breast,accounting for 67.7%(21/31),17 cases were misdiagnosed,the total misdiagnosis rate was 54.8%(17/31).Among the misdiagnosis rates of various types of breast,type A breast was 0(0/3),type B breast was 42.9%(3/7),type C breast was 62.5%(5/8),and type D breast was 69.2%(9/13),the misdiagnosis rate of dense breast was 66.7%(14/21).In the imaging manifestations,localized structural disorder and asymmetric increase in density are more common in dense breasts.The misdiagnosis rates of localized structural disorder,increased asymmetric density,and astral sign were 37.5%(3/8),66.7%(14/21),and 0(0/2),respectively.Conclusion:The high misdiagnosis rate of FFDM for atypical breast cancer is mainly related to the fact that it is more common in dense breasts and the diagnosis doctor’s low level of recognition.DBT is an effective supplementary examination technique,especially for dense breasts,which can significantly improve the accuracy of diagnosis.