超声和X线钼靶直接及间接征象对临床触诊阴性乳腺癌诊断价值的探讨  

Direct and indirect signs of ultrasonography and mammagraphy in diagnosis of nonpalpable breast cancer

作　　者：余小琴[1] 万静[1] 张利[1] 于兰[1] 

机构地区：[1]新疆维吾尔自治区人民医院超声科,新疆乌鲁木齐830001

出　　处：《医学影像学杂志》2013年第3期416-419,共4页Journal of Medical Imaging

摘　　要：目的探讨超声和X线钼靶直接及间接征象对临床触诊阴性乳腺癌的诊断价值。方法回顾性分析经手术病理证实的167个临床触诊阴性乳腺肿块中47个乳腺癌超声和X线钼靶的直接及间接征象特征,并与病理结果对照分析,统计超声和X线钼靶及两者联合诊断触诊阴性乳腺癌的灵敏性、特异性、阳性预测值、阴性预测值及准确性,应用受试者工作特征曲线(ROC曲线)评价三者的诊断效果。结果超声能较好提供触诊阴性肿块血流状况及血流动力学信息,47个乳腺癌II～Ⅲ级血流占61.7%(29/47),穿支血管占38.3%(18/47),Vmax≥15cm/s占31.9%(15/22),RI≥0.7占63.83%。X线钼靶对肿块微钙化较敏感,47个乳腺癌微钙化占48.94%(23/47)。超声和X线钼靶及两者联合诊断临床触诊阴性乳腺癌的灵敏性分别为80.85%、85.11%和93.61%,特异性分别为91.67%、89.17%和91.67%,阳性预测值分别为79.17%、75.47%和81.48%,阴性预测值分别为92.44%、93.86%和95.58%,准确性分别为88.62%、88.02%和92.22%。超声和X线钼靶摄片联合检查诊断触诊阴性乳腺癌ROC曲线下面积(0.874±0.036)大于单独超声(0.832±0.041)及X线钼靶(0.831±0.041),且有统计学意义(P分别=0.000、0.000和0.000)。结论超声和X线钼靶直接及间接征象对临床触诊阴性乳腺癌的早期诊断具有重要价值,两者联合应用能提高临床触诊阴性乳腺癌的诊断准确性。Objective To explore the value of direct and indirect ultrasonographic signs of ultrasonography and rnammography in diagnosis of nonpalpable breast cancer. Methods The direct or indirect sonographic and marnrnographie signs of 167 nonpalpable breast lesions （47 malignant, 120 benign） were retrospectively analyzed. The results of ultrasonography were compared with pathology. Sensitivity, specifity, positive predictive rate, negative predictive rate and accurate rate of ultrasonography and rnamrnography were measured. Receiver operating characteristic （ROC） curves were drawn to evaluate their diagnostic results. Results Ultrasonography provided well color and Doppler flow of nonpalpable breast lesions. 61.7% （29/47） lesions of 47 breast cancer were II- Ⅲ grade flow. 38.30% （18/47） lesions appered afferent artiry. Vrnax ≥15 crn/s wre 31.9% （15/22）. RI≥0.7 were 63.83% （30/47）. Mamrnography showed well rnicrocalcifieation of nonpal- pable breast lesions （23/47）. Sensitivity of ultrasonography, rnarnrnography and their combination were 80. 85%, 85. 11% and 93. 61%. Specifity of ultrasonography, rnarnrnography and their combination were 91.67%, 89. 17% and 91.67%. Positive predictive rates of ultrasonography, rnarnrnography and their combination were 79. 17%, 75.47% and 8]. 48%. Negative predictive rates of ultrasonography, marnmography and their combination were 92.44%, 93.86% and 95.58%. Accurate rates of ultrasonography, mamrnography and their combination were 88.62%, 88. 02% and 92.22%. The area under the ROC curve of combination （0. 874±0. 036） was larger than that of ultrasonography （0. 832 ± 0. 041） and marnrnography （0. 831±0.04]）. The increase of the area was significant （ P =0. 000, 0. 000, 0. 000）. Conclusion Direct and indirect signs of ultrasonography or marnrnography were significant in diagnosis of early nonpalpable breast cancer. Combination of ultrasonography could rnamrnography can result in an increase in diagnostic accuracy of nonpalpable breast ca

关 键 词：阴性乳腺癌 触诊 超声检查 X线钼靶检查 

分 类 号：R739.41[医药卫生—肿瘤] R445.1[医药卫生—临床医学]