超声辅助乳腺X线摄影在致密型乳腺肿块中的筛查价值  

Diagnostic value of ultrasound-assisted mammography in dense breast screening

作　　者：陈静[1] 吴蓉 刁雪红 何之彦[2] 姚明华 李春晓 邵思惠 CHEN Jing;WU Rong;DIAO Xuehong;HE Zhiyan;YAO Minghua;LI Chunxiao;SHAO Sihui(Department of Ultrasound,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Department of Radiology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院超声医学科,上海200080 [2]上海交通大学医学院附属第一人民医院放射科,上海200080

出　　处：《肿瘤影像学》2024年第1期49-56,共8页Oncoradiology

基　　金：国家自然科学基金(82071931);国家重点研发计划(2022YFC3602400)。

摘　　要：目的:分析超声辅助乳腺X线摄影在致密型乳腺肿块中的筛查价值。方法:回顾并分析2013年1月—2019年8月于上海交通大学医学院附属第一人民医院同时接受常规超声和乳腺X线摄影检查的1096例致密型乳腺肿块患者,按照其年龄、肿块大小及有无钙化进行分组。以病理学检查结果作为金标准,探讨联合检查对乳腺X线摄影乳腺影像报告和数据系统(Breast Imaging Reporting and Data System, BI-RADS)分类的影响。同时绘制受试者工作特征(receiver operating characteristic,ROC)曲线,获得并比较乳腺X线摄影及其联合常规超声诊断致密型乳腺肿块的曲线下面积(areaunder curve,AUC)、灵敏度、特异度和恶性检出率。结果:联合检查对于乳腺X线摄影BI-RADS 0类及1~3类致密型乳腺升级后的恶性检出率分别提高了14.8%和15.1%。乳腺X线摄影及其联合常规超声诊断致密型乳腺肿块的AUC分别为0.774和0.937(Z=13.757,P<0.001)。在不同年龄、不同肿块大小及有无钙化组的致密型乳腺肿块中,乳腺X线摄影联合常规超声的AUC均显著高于乳腺X线摄影,差异均有统计学意义(P<0.05)。乳腺X线摄影及其联合常规超声诊断致密型乳腺肿块的灵敏度分别为65.6%和93.3%(χ^(2)=54.955,P<0.001);特异度分别为89.3%和94.1%(χ^(2)=102.805,P<0.001);恶性检出率分别为24.3%(266/1 096)和34.6%(379/1 096,χ^(2)=293.450,P<0.001)。在不同年龄组、不同肿块大小组及有无钙化组中,乳腺X线摄影联合常规超声诊断致密型乳腺肿块的灵敏度、特异度及恶性检出率均显著高于乳腺X线摄影,差异均有统计学意义(P<0.05)。结论:与单独行乳腺X线摄影相比,超声辅助乳腺X线摄影显著提高了致密型乳腺患者的恶性肿瘤检出率。尤其对于≥55岁及肿块最大径<2 cm的人群,超声联合乳腺X线摄影筛查乳腺癌的意义重大。Objective:To analyze the diagnostic value of ultrasound-assisted mammography in dense breast screening.Methods:A retrospective analysis of 1096 patients with dense breast masses,who underwent both conventional ultrasound and mammography in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine from January 2013 to August 2019.According to age,tumor size and with or without calcification,the patients were divided into several groups.Taking the pathological results as the gold standard,the influence of combined examination on the classification of Breast Imaging Reporting and Data System(BI-RADS)versus mammography was discussed.At the same time,area under curve(AUC),malignant detection rate,sensitivity,and specificity of mammography alone and mammography combined with conventional ultrasound in the diagnosis of dense breast masses were obtained and compared.Results:The increased rate of breast cancer in BI-RADS 0 and 1-3 categories by combined examination were 14.8%and 15.1%,respectively.The AUCs of mammography and mammography combined with conventional ultrasound in the diagnosis of dense breast mass were 0.774 and 0.937(Z=13.757,P<0.001),respectively.Regardless of the dense breast masses with different age groups,different size groups and groups with or without calcification,AUC of mammography combined with conventional ultrasound was significantly higher than that of mammography alone, and the differences were statistically significant(P<0.05). The sensitivity of mammography alone and mammography combined with conventional ultrasound were 65.6% and93.3% (χ^(2)= 54.955, P<0.001);the specificity were 89.3% and 94.1% (χ^(2)=353.013, P<0.001);the detection rate of breast cancerincreased from 24.3% (266/1 096) to 34.6% (379/1 096, χ^(2)= 293.450, P<0.001). In different age groups, different size groupsand groups with or without calcification, the sensitivity and specificity of mammography combined with conventional ultrasoundin the diagnosis of dense breast mass were significantly higher than m

关 键 词：致密型乳腺 超声 乳腺X线摄影 筛查 

分 类 号：R737.9[医药卫生—肿瘤] R445.4[医药卫生—临床医学]