X线联合彩超对未扪及肿块乳腺癌的诊断价值

X-ray Photography Combined with Ultrasound in the Diagnosis of Non Palpable Breast Cancer

目的比较乳腺X线联合彩超和单独影像检查对乳腺癌的诊断准确率。方法 87例乳腺癌患者均经过乳房X光造影(M)和(或)超声(US)检查。以病理结果和12个月的随访结果作为参考标准,比较M+US和单独使用M诊断的阳性率,敏感性,特异性和诊断准确率(AUC);比较M+US与单独使用M的活检阳性值(PPV)。结果 41例被诊断患有癌症:M+US诊断8例,单独US诊断12例,单独M诊断12例,非影像诊断8例(9例乳房间隔癌症)。单独使用M的诊断率为7.6/1000,而M+US的诊断率提高到11.8/1000,补充率为4.2/1000(95%CI 1.1~7.2;P=0.003)。单独使用M的诊断准确率(AUC)为0.78%(95%CI 0.67~0.87),US+M的诊断准确率为0.91%(95%CI 0.84~0.96,P=0.003),超声补充检测到12例,11例(92%)为浸润性,直径中位大小为10 mm。结论乳腺X线联合彩超可明显提高未扪及肿块乳腺癌的诊断准确率。

Objective To compare the diagnostic accuracy of breast X-ray photography combined with ultrasound and ultrasound imaging alone for breast cancer. Methods 87 cases of breast cancer received breast X-ray mammography( M) and( or) ultrasound( US) examination. Pathology and 12-month follow-up results were the reference standard,positive rate,sensitivity,specificity and diagnostic accuracy( AUC) by M + US and M were compared; positive value( PPV) by M + US and M alone biopsy were compared. Results 41 cases were diagnosed with cancer: 8 suspicious by US and M,12 by US alone,12 by M alone,and 8 participants( 9 breasts,interval cancers) by neither. The diagnostic rate yield for M was 7. 6 /1000,and that of US + M was11. 8 /1000; the supplemental yield was 4. 2 /1000( 95% CI 1. 1 to 7. 2 per 1000; P = 0. 003). The diagnostic accuracy( AUC) by M was 0. 78( 95% CI 0. 67 to 0. 87) and that of US + M was 0. 91( 95% CI 0. 84 to 0. 96)( P = 0. 003). Conclusion X-ray photography combined with ultrasound can significantly improve the diagnostic accuracy of breast cancer.