超声与钼靶对原发性乳腺癌临床诊断价值的比较研究  

Comparative study of ultrasound and mammography in the clinicaldiagnosis of primary breast cancer

作　　者：高艺丹 王媛媛[1,2] 孟垒[3] 李钊 张欢 李峻锋 肖琪 冉柏林 谭金祥 GAO Yidan;WANG Yuanyuan;MENG Lei;LI Zhao;ZHANG Huan;LI Junfeng;XIAO Qi;RAN Bolin;TAN Jinxiang(Department of Breast and Thyroid Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Thyroid and Breast Oncology,Yiwu City Central Hospital,Yiwu,Zhejiang 322000,China;Department of Breast and Thyroid Surgery,Yubei District People’s Hospital of Chongqing,Chongqing 401120,China;Department of Urological and Neurosurgical Surgery,Traditional Chinese Medicine Hospital of Shizhu County,Chongqing 409100,China;Department of Laboratory,Traditional Chinese Medicine Hospital of Shizhu County,Chongqing 409100,China)

机构地区：[1]重庆医科大学附属第一医院乳腺甲状腺外科,重庆400016 [2]义乌市中心医院甲状腺乳腺肿瘤科,浙江义乌322000 [3]重庆市渝北区人民医院乳腺甲状腺外科,重庆401120 [4]石柱县中医院泌尿神经外科,重庆409100 [5]石柱县中医院检验科,重庆409100

出　　处：《重庆医学》2023年第18期2795-2800,共6页Chongqing medicine

基　　金：重庆市自然科学基金项目(CSTB2022NSCQ-MSX0866);重庆市人力资源和社会保障局留学回国人员基金项项目(2013218)。

摘　　要：目的 探讨超声与钼靶对女性原发性乳腺癌的临床诊断价值及影响因素。方法 回顾性分析2017年1月至2019年12月重庆医科大学附属第一医院经组织病理学诊断为乳腺癌的3 924例女性患者病历资料,进行单因素及多因素logistic分析。结果 共993例纳入分析。超声诊断符合率高于钼靶[93.45%(928/993)vs. 86.81%(862/993),P<0.05],联合诊断总符合率[97.48%(968/993)]高于单一超声[10.67%(106/993)]和钼靶[4.03%(40/993)]诊断。单因素分析结果显示,年龄、BMI等均不是诊断符合率的影响因素(P>0.05)。分层分析结果显示,年龄<60岁、BMI 18.5~<30.0 kg/m~2、已/未绝经、已生育、乳腺密度a和c类、非Luminal A型及组织学类型为非浸润性癌和非特殊浸润性导管癌女性的超声诊断准符合率更高(P<0.05)。多因素回归分析结果显示,年龄≥60岁、已生育、分子亚型为Her2过表达型和三阴型,以及非特殊浸润性导管癌和小叶癌、特殊浸润性癌是影响钼靶诊断符合率的独立危险因素(P<0.05);年龄>45岁、乳腺密度b和c类,以及非特殊浸润性导管癌和小叶癌是影响超声诊断符合率的独立危险因素(P<0.05)。结论 超声对早期乳腺癌筛查具有重要诊断价值。Objective To analyze the clinical diagnostic value by ultrasound and mammography in primary breast cancer patients and the influencing factors.Methods The medical records of 3924 female patients diagnosed with breast cancer by histopathology in The First Affiliated Hospital of Chongqing Medical University from January 2017 to December 2019 were retrospectively analyzed,univariate and multivariate logistic analysis were performed.Results A total of 993 cases were included in the analysis.The diagnosis coincidence rate of ultrasound was higher than that of mammography[93.45%(928/993)vs.86.81%(862/993),P<0.05].The total coincidence rate of combined diagnosis[97.48%(968/993)]was higher than that of single ultrasound diagnosis[10.67%(106/993)]and mammography diagnosis[4.03%(40/993)].Univariate analysis showed that age and body mass index(BMI)were not factors influencing the diagnosis coincidence rate(P>0.05).Stratified analysis showed that women<60 ye ars old,BMI 18.5-<30.0 kg/m 2,menstruation/reproductive,breast density a and c,non-Luminal A type,and histological type of non-invasive and non-specific invasive ductal carcinoma had a higher rate of accurate diagnosis of ultrasound(P<0.05).Multivariate regression analysis showed that age≥60 years old,reproductive age,Her2 overexpression type and triple negative type of molecular subtype,non-specific invasive ductal carcinoma,lobular carcinoma and specific invasive carcinoma were independent risk factors for mammography diagnosis coincidence rate(P<0.05).Age>45 years old,breast density category b and c,and non-specific invasive ductal carcinoma and lobular carcinoma were independent risk factors for ultrasound diagnosis coincidence rate(P<0.05).Conclusion Ultrasound has important diagnostic value for early breast cancer screening.

关 键 词：乳腺癌 超声 乳腺X射线摄影 分子亚型 诊断符合率 

分 类 号：R737.9[医药卫生—肿瘤]