影响乳腺X线摄影和超声检出早期乳腺癌的流行病学相关因素分析  

Influencing factors analysis on mammography versus ultrasonography in detecting early stage breast cancer and epidemiological characteristics by logistic regression

作　　者：邵真真[1] 李军楠[1] 赵玉梅[1] 季宇[1] 刘佩芳[1] 

机构地区：[1]天津医科大学肿瘤医院乳腺影像诊断科 国家肿瘤临床医学研究中心天津市“肿瘤防治”重点实验室乳腺癌防治教育部重点实验 室天津市恶性肿瘤临床医学研究中心,300060

出　　处：《中华放射学杂志》2017年第2期127-131,共5页Chinese Journal of Radiology

摘　　要：目的探讨影响乳腺X线摄影和超声检出早期乳腺癌的相关流行病学因素。方法回顾性分析经病理证实为T1期（肿瘤长径≤2cm）和Tis期（原位癌）乳腺癌，且具有完整的乳腺X线摄影、超声检查及流行病学因素资料的959例患者（971个病变）。依据美国放射学会乳腺影像报告及数据系统（BI—RADS）分类标准，进行乳腺X线摄影和超声图像的判读。BI-RADS1、2、3、4A类病变归为阴性，BI-RADS4B、4C、5类病变归为阳性。采用问卷调查的形式获取乳腺癌患者的基本情况，包括：年龄、体质量指数、初潮年龄、初次生育年龄、怀孕史、生育次数、哺乳史、流产史和绝经情况。采用χ^2检验比较不同检查方法间早期乳腺癌检出率的差异；采用单因素二元Logistic回归分析评价各组间检出早期乳腺癌的影响因素。结果乳腺X线摄影和乳腺超声对971个病变的检出率分别为90．1％（875／971）、92．6％（899／971），差异有统计学意义（χ^2=150．34，P=0．000）。乳腺腺体类型、乳腺病变类型、年龄、是否绝经是影响乳腺X线摄影检出早期乳腺癌的相关流行病学因素，优势比分别为0．315、6．669、2．609和2．236，95％可信区间分别为0．136—0．731、2．841—15．658、1．681～4．048和1．453～3．439。乳腺病变类型、年龄是影响乳腺超声检出早期乳腺癌的相关流行病学因素，优势比分别为0．204、1．798，95％可信区间分别为0．103～0．405和1．107—2．920。≤50岁的女性多表现为单纯钙化型乳腺癌（优势比为2．256，95％可信区间为1．348～3．773）；未生育的女性患者多表现为非单纯钙化型乳腺癌（优势比为O．467，95％可信区间0．250～0．872）。结论乳腺腺体类型、是否绝经、年龄、X线上病变类型是影响乳腺X线摄影和超声检出早期乳腺癌的相关因素。Objective To evaluate the influencing factors of mammography versus ultrasonography in detecting early stage breast cancer and epidemiological characteristics. Methods A retrospective analysis was performed on stage T1 （tumor diameter ≤2 cm） and Tis （ductal carcinoma in situ） breast cancer confirmed by histopathology from July 2011 to July 2013, 959 patients （971 lesions） had mammography, ultrasonography, and epidemiological data. According to the BI-RADS, the lesions of BI-RADS categories 1, 2, 3, 4A were negative, the lesions of BI-RADS categories 4B, 4C, 5 were positive. A face to face interview questionnaire collected information regarding epidemiological data, including age, body mass index, age at menarche, age at first live birth, history of pregnancy, number of live births, history of lactation, history of abortion, and menopausal status. The χ^2 test was used to compare the efficacy of mammography and ultrasound in detecting early stage breast cancer. Logistic regression was used to analyze the relative factors influencing the detection rate of two modalities. Results The detection rate of mammography and ultrasound was 90.1% （875/971） and 92.6% （899/971） respectively with statistical significance （χ^=150.34, P=0.000）. Breast density, lesion types, age, and postmenopausal status were risk factors for the detection rate of early stage breast cancer on mammography, the odds ratios （OR） was 0.315, 6.669, 2.609, and 2.236 and the 95%CI was 0.1364.731, 2.841--15.658, 1.681-4.048, and 1.453-3.439, respectively. Lesion types and age were risk factors for the detection rate of early stage breast cancer on ultrasonography, the OR was 0.204, 1.798, and 95%CI was 0.1034-0.405, 1.107-2.920, respectively. More than patients with less than 50 years old showed only-calcification type breast cancer on mammography（OR=2.256, 95%CI：1.348- 3.773）, women with lower number of live birth showed not only-calcification type breast cancer on mammography （0R=0.467, 95% CI：0.250-0.872）. C

关 键 词：乳腺肿瘤 乳房X线摄影术 超声检查 流行病学因素 

分 类 号：R445.1[医药卫生—影像医学与核医学] R730.44[医药卫生—诊断学] R737.9[医药卫生—临床医学]