千例乳腺不可触及病变的临床及病理分析  

The Clinical and Pathological Analysis of 1012 Cases of Nonpalpable Breast Lesions

作　　者：何俊玲[1] 高建莉[2] 徐海滨[1] 杨欧欧[1] 罗华[1] 蓝天[1] 

机构地区：[1]浙江中医药大学附属广兴医院乳腺外科,杭州310006 [2]浙江中医药大学药物研究所

出　　处：《浙江中医药大学学报》2016年第6期439-444,共6页Journal of Zhejiang Chinese Medical University

基　　金：国家自然科学基金项目(81473575)~~

摘　　要：[目的]回顾1012例采用不同定位方式下手术的乳腺不可触及病变(nonpalpable breast lesion,NPBL)的病例,概括其临床病理特点,并分析患者多参数之间的相关性,为NPBL的正确诊断及治疗提供依据。[方法]回顾性分析1012例患者1278个病灶的临床病理特征,根据定位方式不同分3组:X线组、超声组、乳头溢液组(染色定位)。比较各组的乳腺影像报告及数据系统(Breast Imaging Reporting and Data System,BI-RADS)评分及具体表现、病理类型、阳性预测值、临床病理特点,并采用SPSS软件对部分病例的年龄、BI-RADS评分及表现、病理类型等参数进行相关性分析。[结果]1012例不同定位方式下手术NPBL,X线组、超声组、乳头溢液组恶性NPBL病例分别为38、36、23个,X线组及乳头溢液组以原位癌为主,超声组以浸润性癌居多,原位癌分别占各组恶性NPBL的65.8%(25/38)、38.9%(14/36)、73.9%(17/23)。X线组中BI-RADS评分≥4的阳性预测值(positive predictive value,PPV)为24.0%(37/154),超声组中BI-RADS≥4的PPV为8.2%(30/368),溢液组中血性溢液的PPV为25.0%(18/72)。良性NPBL中,X线组以钙化灶为主,多数诊断为乳腺腺病;超声组以结节为主,多数为纤维腺瘤;乳头溢液组则以导管内乳头状瘤为主。相关性分析结果发现,除超声具体表现类型及溢液表现与乳腺病理呈显著正相关外(P<0.01),X线BI-RADS分级与患者年龄呈正相关(P<0.01)。[结论]超声是检出NPBL最敏感的方式,而X线摄片及溢液特征在恶性NPBL的诊断中体现更重要的价值。[Objective] To analyse the clinical and pathological feature of breast nonpalpable breast lesion located by different methods. [Method] Total 1278 lesions in 1012 patients were collected and divided into 3 groups： mammography group, ultrasound group, nipple discharge group（located by staining）, their positive predictive value, clinical and pathological feature were analyzed, the correlation analysis based on muhi-parameters was also analyzed by SPSS. [Result] 38, 36, and 23 malignant NPBLs are found in mammography group, ultrasound group, nipple discharge group respectively. Breast carcinoma in situ was detected in the malignant lesions of these groups, mammugraphy group 65.8%（25/38）, ultrasound group 38.9%（14/36）, nipple discharge group 73.9%（17/ 23）. PPV of mammography group（BI-RADS score ≥4） is 24.0% （37/154）; PPV of ultrasound group（BI-RADS score 94） is 8.2% （30/368）; PPV of nipple discharge group（blood discharge） is 25.0%（18/72）. In the mammography group, benign NPBL is mostly characteristic of calcification; its pathology is breast adenosis. In ultrasound group, benign NPBL is mostly characteristic of nodule, its pathology is adenoma. In discharge group, pathology of most lesions is intraductal papilloma. Besides the strong positive relationship between the performance of ultrasound/nipple discharge and pathological feature, correlation analysis indicate that BI-RADS score of mammography has a positive relationship associated with the patient age. [Conclusion] Ultrasound is the most sensitive method to detect NPBL, but mammography and nipple blood discharge are more valuable in the diagnosis of malignant NPBL.

关 键 词：NPBL PPV 原位癌 定位 X线 超声 乳头溢液 

分 类 号：R271[医药卫生—中医妇科学]