全数字化乳腺摄影对乳腺癌的诊断价值  

Diagnostic value of full-field digital mammography for breast carcinoma

作　　者：丁建辉[1] 彭卫军[1] 蒋朝霞[1] 许玲辉[1] 胡丹婷[1] 郑晓静[1] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华肿瘤杂志》2009年第11期854-857,共4页Chinese Journal of Oncology

基　　金：上海市科委优秀学科带头人项目（07XD14007）

摘　　要：目的评价全数字化乳腺摄影（FFDM）对乳腺癌的诊断价值。方法搜集2008年1月至7月间230例女性乳腺疾病患者的临床资料以及乳腺X线片（其中有8例患者为双侧乳腺病变）。术前所有患者均行FFDM检查，常规拍摄双侧乳腺头尾位（CC）和内外斜位（MLO）。3位擅长乳腺影像诊断的放射科医师对乳腺X线片分析，并进行乳腺影像学报告数据系统（BI-RADS）分级。以术后病理结果为金标准，评价FFDM检查诊断乳腺癌的敏感度、特异度和准确率，并分析漏诊和误诊的原因。结果术后病理结果显示，238例手术乳腺标本中，130例为恶性肿瘤，其中最常见为浸润性导管癌（109例）；108例为乳腺良性病变，其中最常见为乳腺病（57例）。乳腺恶性肿瘤最常见的X线表现为肿块（40．8％），其次为肿块伴钙化（20．8％）。共发现假阴性12例，假阳性14例。FFDM检查对乳腺癌诊断的敏感度、特异度和准确率分别为90．8％、87．0％和89．1％。漏诊最主要的原因是某些乳腺癌的X线表现正常（5例）或X线表现为局灶性非对称性致密（4例）。误诊最主要的原因是将边缘模糊、毛刺、分叶的肿块误诊为恶性肿瘤（7例）。结论FFDM检查诊断乳腺癌的敏感度、特异度和准确率均较高，具有重要的临床应用价值。Objective To evaluate the diagnostic value of full-field digital mammography for breast cancer. Methods The clinical data and mammograms of 230 patients with breast diseases between January 2008 and July 2008 were collected and reviewed. Craniocaudal （CC） and mediolateral oblique （MLO） view mammograms were performed in all patients before surgery. Three experienced radiologists in breast imaging assessment analyzed and classified all the mammograms according to breast imaging reporting and data system （BI-RADS）. The sensitivity, specificity and accuracy were evaluated according to their pathological diagnosis. The reasons resulting in false-negative and false-positive diagnosis were also analyzed. Results Of the 238 samples, 130 had a malignant breast tumors and 108 cases of benign breast lesions. One hundred and nine of the 130 malignant breast tumors were invasive ductal carcinoma. Fifty-seven of the 108 benign breast lesions were breast adenosis. Masses or masses with microcalcifieation were the most frequently seen signs of the malignant tumors, accounting for 40.8% and 20.8%, respectively. The sensitivity, specificity and accuracy of FFDM in detecting breast carcinoma were 90.8%, 87.0% and 89.1%, respectively. The false-negative signs including negative X-ray finding （5 cases） and focal asymmetric densities （4 cases）. The false-positive signs were masses with spiculate, indistinctive or lobulated margin leading to misdiagnosing the lesions as malignant tumors. Conclusion Full-field digital mammography （FFDM） is helpful in detection of breast cancers in women, with a higher sensitivity, specificity and accuracy, and has an important clinical application value.

关 键 词：乳腺肿瘤 乳房X线摄影术 图像处理 计算机辅助 

分 类 号：R686[医药卫生—骨科学]