乳腺癌前期导管内增生性病变的临床诊断研究  

Clinical diagnosis of breast precancerous intraductal proliferative lesions

作　　者：张薇[1] 金贻婷[1] 张子敬[1] 储呈玉[1] 王红鹰[1] 邹强[1] 

机构地区：[1]复旦大学附属华山医院外科,上海200040

出　　处：《中华乳腺病杂志（电子版）》2014年第3期27-33,共7页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨常规乳腺疾病检查方法在乳腺癌前期导管内增生性病变中的诊断价值。方法回顾性分析522例经病理证实为乳腺导管上皮内瘤变(DIN)的病例,对其临床乳腺体格检查、乳管镜检查、乳腺超声及钼靶X线摄片BI-RADS分类结果进行分析,对比其诊断价值。检出率比较利用配对χ2检验,单因素分析用Spearman等级相关检验,多因素分析采用二元Logistic回归分析。结果手术切除活组织检查病理诊断为DIN的病灶共533处。乳腺超声对癌前期导管内增生性病变的检查准确率为62.5%(330/528),钼靶X线检出率为75.8%(260/343),总体检出率钼靶X线高于乳腺超声(P=0.004)。乳腺超声对不可扪及癌前期病灶的检出率为37.7%(40/106),钼靶X线对不可扪及的乳腺癌前期病灶检出率为80.7%(71/88),钼靶X线在不可扪及病灶中检出率高于超声(P=0.000)。乳腺超声及钼靶X线对病灶直径较小、病变恶性程度较低的癌前期导管内增生性病变病灶漏诊和误诊率较高。结论在乳腺癌前期导管内增生性病变的诊断中,钼靶X线检出率高于乳腺超声,两者联合临床体征、乳管镜等各种检查方法综合诊断,可降低早期病变的漏诊和误诊率。Objective To investigate the diagnostic value of routine breast examination methods in breast precancerous intraductal proliferative lesions.Methods A total of 522 patients with pathologically confirmed breast ductal intraepithelial neoplasia were collected in this study.The results of different methods,including breast physical examination,fiberoptic ductoscopy,ultrasonography and mammography BI-RADS classification,were retrospectively analyzed.The diagnostic accuracy was compared by paired chi-square test,univariate analysis using the Spearman rank correlation test,multivariate analysis using binary Logistic regression analysis.Results Totally 533 lesions were diagnosed as DIN by biopsy after operation.The detection rate of precancerous intraductal proliferative lesions with ultrasonography and mammography was 62.5％ （330/528） and 75.8％ （260/343） respectively.The detection rate of ultrasonography was significantly higher than that of mammography （P=0.004）.The detection rate of non-palpable precancerous lesions with ultrasonography and mammography was 37.7％ （40/106） and 80.7％ （71/88） respectively.The detection rate of mammography was significantly higher than that of ultrasonography （P=0.000）.Ultrasonography and mammography had a high missed diagnosis and misdiagnosis rate of breast precancerous intraductal proliferative lesions with smaller diameter or lower degree of malignancy.Conclusion Mammography has a higher detection rate than ultrasonography did in the diagnosis of breast precancerous intraductal proliferative lesions.The combination of breast physical examination,fiberoptic ductoscopy,ultrasonography and mammography can reduce the missed diagnosis and misdiagnosis rate of breast precancerous lesions.

关 键 词：乳腺肿瘤 癌 原位 超声检查 乳房 乳房X线摄影术 诊断 

分 类 号：R737.9[医药卫生—肿瘤]