乳腺超声检查在乳腺癌早期诊断中的应用及漏诊误诊的影响因素  

The application of breast ultrasonography in early diagnosis of breast cancer and the influencing factors of missed diagnosis and misdiagnosis

作　　者：陈云贞 CHEN Yun-zhen(Color Ultrasound Room,Huian County Hospital,Quanzhou 362199,China)

机构地区：[1]惠安县医院彩超室,362199

出　　处：《中国现代药物应用》2024年第9期59-63,共5页Chinese Journal of Modern Drug Application

摘　　要：目的分析乳腺超声检查对早期乳腺癌的诊断效能,探讨其漏诊误诊的影响因素,为探索乳腺癌早期筛查和诊断提供依据。方法回顾性分析1678例乳腺肿块患者的临床资料,所有患者具有完整的乳腺超声检查和病理组织学检查资料,分析乳腺肿块的病理组织学检查结果;以病理组织学检查为金标准,分析乳腺超声检查对早期乳腺癌的诊断效能(灵敏度、特异度、准确度);对患者的临床资料进行分析,包括年龄、病灶最大径、触诊情况、病灶数量、是否合并良性病灶、是否合并炎性病变、微钙化、腋窝淋巴结阳性、腋下淋巴结肿大、血流信号是否明显、病灶呈周边型血供或者无血流、病灶结构复杂多样等,并进行乳腺超声在乳腺癌早期诊断中漏诊误诊的单因素及多因素Logistic回归分析。结果1678例乳腺肿块患者经病理组织学证实77例为乳腺癌患者,包括29例浸润性导管癌、16例浸润性小叶癌、12例黏液癌、12例导管原位癌、8例导管乳头状癌。以病理组织学检查结果为金标准,1678例乳腺肿块患者中乳腺癌患者77例,良性乳腺肿块1601例,乳腺超声检查对乳腺癌的诊断灵敏度为96.10%(74/77),特异度为92.75%(1485/1601),准确率为92.91%(1559/1678)。77例乳腺癌患者,漏诊3例,漏诊率为3.90%;1601例良性乳腺肿块,误诊116例,误诊率为7.25%;漏诊误诊总发生率为7.09%(119/1678)。经单因素分析显示,误诊漏诊患者和诊断正确患者的病灶最大径、触诊情况、合并良性病灶、合并炎性病变、微钙化、腋窝淋巴结阳性、腋下淋巴结肿大、血流信号明显、病灶呈周边型血供或者无血流、病灶结构复杂多样情况比较差异有统计学意义(P<0.05)。经多因素Logistic回归分析显示,病灶最大径[OR=1.732,95%CI=(1.104,2.873)]、合并良性病灶[OR=1.689,95%CI=(1.025,2.784)]、合并炎性病变[OR=1.534,95%CI=(1.148,2.050)]、微钙化[OR=1.536,95%CI=(1.111,2.Objective To analyze the diagnostic efficiency of breast ultrasonography in early breast cancer,and explore the influencing factors of missed diagnosis and misdiagnosis,so as to provide evidence for the early screening and diagnosis of breast cancer.Methods The clinical data of 1678 patients with breast mass were retrospectively analyzed.All patients had complete breast ultrasonography and histopathological data.The histopathological results of breast mass were analyzed,and the diagnostic efficiency(sensitivity,specificity,accuracy)of breast ultrasonography for early breast cancer was analyzed with histopathological results as the gold standard.The clinical data of patients were analyzed,including age,maximum diameter of lesions,palpation,number of lesions,whether they were combined with benign lesions,whether they were combined with inflammatory lesions,microcalcification,positive axillary lymph nodes,axillary lymph node enlargement,whether the blood flow signal was obvious,the lesions had peripheral blood supply or no blood flow,and the structure of lesions was complex and diverse,etc.The univariate and multivariate Logistic regression was used to analyze the influencing factors of missed diagnosis and misdiagnosis.Results Among 1678 patients with breast mass,77 cases were confirmed as breast cancer by histopathology,including 29 cases of invasive ductal carcinoma,16 cases of invasive lobular carcinoma,12 cases of mucinous carcinoma,12 cases of ductal carcinoma in situ and 8 cases of ductal papillary carcinoma.Based on the histopathological results,there were 77 cases of breast cancer and 1601 cases of benign breast mass in 1678 patients.The sensitivity of breast ultrasonography was 96.10%(74/77),the specificity was 92.75%(1485/1601),and the accuracy was 92.91%(1559/1678).There were 77 cases of breast cancer,of which 3 cases were missed diagnosis,with a missed diagnosis rate of 3.90%;1601 cases of benign breast mass,of which 116 cases were misdiagnosed,with a misdiagnosis rate of 7.25%;the total incidence of mi

关 键 词：乳腺癌 乳腺超声 漏诊误诊 诊断 

分 类 号：R737.9[医药卫生—肿瘤]