不同年龄乳腺癌患者早期诊断的方法学比较
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摘要
目的探讨不同影像学检查方法在青年、中年、老年乳腺癌患者中的诊断价值,为临床诊断提供参考依据。方法选取2013年1月至2018年1月就诊于首都医科大学附属北京朝阳医院且资料完整的乳腺癌患者430例为研究对象,其中青年组(年龄<40岁)130例,中年组(年龄40~59岁)150例,老年组(年龄≥60岁)150例,分别评价彩色多普勒超声、钼靶X线摄影、MRI检查在不同分组中对肿物的检出率、准确率及淋巴结转移准确率,并计算上述3种影像学检查两两联合应用的准确率。结果①在判断肿物良恶性方面,MRI在青年组、中年组、老年组中均具有显著优势;青年组中彩色多普勒超声诊断乳腺癌的准确率显著高于钼靶X线摄影(P <0.05),彩色多普勒超声和钼靶X线摄影联合检查与彩色多普勒超声单一检查准确率比较无明显差异(P> 0.05)。中年组和老年组彩色多普勒超声与钼靶X线摄影诊断乳腺癌的准确率比较均无明显差异(P_均> 0.05)。②在判断淋巴结转移准确率方面,MRI在青年组、中年组、老年组中均优于彩色多普勒超声(P_均<0.05),彩色多普勒超声均优于钼靶X线摄影(P_均<0.05)。彩色多普勒超声联合钼靶X线摄影检查较单一检查均无显著优势(P_均>0.05)。结论不同检查方法在不同年龄段乳腺癌患者中的应用价值存在较大差异,临床上应根据患者年龄选择适合的检查方式,既能提高检查的准确率,又能减少不必要的检查。
Objective To explore the diagnostic value of different imaging methods in young, middle-aged and elderly breast cancer patients, and to provide reference for clinical diagnosis. Method 430 cases of breast cancer patients with complete data in Beijing Chaoyang Hospital, Capital Medical University from January 2013 to January 2018 were selected as subjects of study. Among them, 130 cases were included in youth group( < 40 years old), 150 cases were included in middle-aged group(40 ~ 59 years old) and 150 cases were included in elderly group( ≥ 60 years old). The detection rate, accuracy rate and lymph node examination accuracy of color Doppler ultrasound, molybdenum target X-ray photography and MRI in different groups were evaluated respectively. The accuracy rate of combined application of the above three imaging examinations was calculated. Result ①For the judgment of benign and malignant tumor, whether in the youth group, middle-aged group or elderly group, the MRI had a signi?cant advantage; in youth group, the accuracy of color Doppler ultrasound was signi?cantly higher than that of molybdenum target X-ray photography(P < 0.05), and there was no signi?cant difference between the accuracy of color Doppler ultrasound and molybdenum target X-ray photography combined examination and color Doppler ultrasound single examination(P > 0.05). There were no signi?cant differences in the accuracy of the same color Doppler ultrasound and molybdenum target X-ray photography between middle-aged group and elderly group(P_(all)> 0.05). ②For the determination of lymph node metastasis accuracy, whether in the youth group, middle-aged group or elderly group, MRI was better than that of color Doppler ultrasound(P_(all)< 0.05), color Doppler ultrasound was better than that of molybdenum target X-ray photography(P_(all)< 0.05). Color doppler ultrasound combined with molybdenum target X-ray examination had no signi?cant advantage over single examination(P_(all)> 0.05). Conclusion There are great differences in the application value of different examination methods in different age groups of breast cancer patients. Clinically,appropriate examination methods should be selected according to the age of patients, which can not only improve the accuracy of examination, but also reduce unnecessary examination.
Objective To explore the diagnostic value of different imaging methods in young, middle-aged and elderly breast cancer patients, and to provide reference for clinical diagnosis. Method 430 cases of breast cancer patients with complete data in Beijing Chaoyang Hospital, Capital Medical University from January 2013 to January 2018 were selected as subjects of study. Among them, 130 cases were included in youth group( < 40 years old), 150 cases were included in middle-aged group(40 ~ 59 years old) and 150 cases were included in elderly group( ≥ 60 years old). The detection rate, accuracy rate and lymph node examination accuracy of color Doppler ultrasound, molybdenum target X-ray photography and MRI in different groups were evaluated respectively. The accuracy rate of combined application of the above three imaging examinations was calculated. Result ①For the judgment of benign and malignant tumor, whether in the youth group, middle-aged group or elderly group, the MRI had a signi?cant advantage; in youth group, the accuracy of color Doppler ultrasound was signi?cantly higher than that of molybdenum target X-ray photography(P < 0.05), and there was no signi?cant difference between the accuracy of color Doppler ultrasound and molybdenum target X-ray photography combined examination and color Doppler ultrasound single examination(P > 0.05). There were no signi?cant differences in the accuracy of the same color Doppler ultrasound and molybdenum target X-ray photography between middle-aged group and elderly group(P_(all)> 0.05). ②For the determination of lymph node metastasis accuracy, whether in the youth group, middle-aged group or elderly group, MRI was better than that of color Doppler ultrasound(P_(all)< 0.05), color Doppler ultrasound was better than that of molybdenum target X-ray photography(P_(all)< 0.05). Color doppler ultrasound combined with molybdenum target X-ray examination had no signi?cant advantage over single examination(P_(all)> 0.05). Conclusion There are great differences in the application value of different examination methods in different age groups of breast cancer patients. Clinically,appropriate examination methods should be selected according to the age of patients, which can not only improve the accuracy of examination, but also reduce unnecessary examination.
引文
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[7]李朋,杨满,程苒,等,乳腺X线在198例青年乳腺癌患者中的应用价值探讨[J].岭南现代临床外科,2018,18(3):269-272,276.
[8]王敏红,周运锋,周理想,等.乳腺MRI背景实质分型及强化对乳腺癌的辅助诊断价值[J].临床放射学杂志,2018,37(1):49-53.
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[10]李团结,王洲,任永凤,等.超声造影联合弹性成像对非哺乳期肉芽肿性小叶乳腺炎的表现及与乳腺癌的鉴别诊断价值探究[J].中国医学前沿杂志(电子版),2018,10(7):58-63.
[11]陈玫洁,王蓓.青年乳腺癌患者心理韧性、焦虑及抑郁的影响因素分析[J].中国医学前沿杂志(电子版),2018,10(11):74-77.
[12]周世云,陈霞,洪涛,等.磁共振成像、彩色多普勒超声和全数字化钼靶X线摄影对乳腺疾病的诊断价值[J].山东医药,2015,55(37):82-83.
[13]周平,李国栋,朱西琪,等.MRI动态增强及扩散加权序列与钼靶X线摄影对乳腺疾病诊断的对比研究[J].中国医学影像学杂志,2011,19(10):733-738.
[14]陈静.50例青年女性乳腺癌临床治疗效果和病理分析[J].中国实用医药,2016,11(27):83-84.
[15]覃蕾,刘峥,倪嘉伟,等.MRI检查中“幽闭恐惧症”的预防及处理[J].智慧健康,2018,4(10):138-140.
[16]杨化云,刘英刚,于逍,等.核磁共振联合彩超对乳腺癌淋巴结转移的诊断效果[J].影像研究与医学应用,2018,2(23):171-172.
[17]Zhang Y,Ma AD,Jia HX.Correlation between molybdenum target mammography signs and pathological prognostic factors of breast cancer[J].J Biol Regul Homeost Agents,2016,30(1):219-225.
[18]张俊萍,雷莉,黄凤萍.乳腺钼靶片中簇状钙化对乳腺癌的诊断价值[J].中国现代药物应用,2017,11(13):60-61.
[19]殷艳宇,李毅,杨春霞,等.乳腺X线检查对伴钙化的早期乳腺癌的诊断效果分析[J].中华肿瘤防治杂志,2018,25(S1):49,51.
[20]陈春发,张玉玲,林豪雨,等.乳腺彩超和X线摄影在乳腺癌早期淋巴结的评估作用[J].汕头大学医学院学报,2016,29(2):109-110,115.
[2]Balekouzou A,Yin P,Afewerky HK,et al.Behavioral risk factors of breast cancer in Bangui of Central African Republic:Aretrospective case-control study[J].PLoS One,2017,12(2):e0171154.
[3]张军强,孙智国,王登强,等.青年乳腺癌患者的临床病理特征、分子分型及预后情况分析[J].实用癌症杂志,2015,30(4):527-530.
[4]荣小翠,康一鹤,武中林,等.老年与青年乳腺癌全数字化X线表现和临床病理对比[J].中国老年学杂志,2018,38(7):1664-1665.
[5]伍颖君,李超.青年乳腺癌与老年乳腺癌患者分子分型及临床病理特征的对比分析[J].实用临床医学,2018,19(2):35-37.
[6]侯怡如,张宇虹,于韬.青年乳腺癌与中老年乳腺癌超声影像学对比研究[J].大连医科大学学报,2016,38(6):574-578.
[7]李朋,杨满,程苒,等,乳腺X线在198例青年乳腺癌患者中的应用价值探讨[J].岭南现代临床外科,2018,18(3):269-272,276.
[8]王敏红,周运锋,周理想,等.乳腺MRI背景实质分型及强化对乳腺癌的辅助诊断价值[J].临床放射学杂志,2018,37(1):49-53.
[9]Tardivon AA,Athanasiou A,Thibault F,et al.Breast imaging and reporting data system(BIRADS):magnetic resonance imaging[J].Eur J Radiol,2007,61(2):212-215.
[10]李团结,王洲,任永凤,等.超声造影联合弹性成像对非哺乳期肉芽肿性小叶乳腺炎的表现及与乳腺癌的鉴别诊断价值探究[J].中国医学前沿杂志(电子版),2018,10(7):58-63.
[11]陈玫洁,王蓓.青年乳腺癌患者心理韧性、焦虑及抑郁的影响因素分析[J].中国医学前沿杂志(电子版),2018,10(11):74-77.
[12]周世云,陈霞,洪涛,等.磁共振成像、彩色多普勒超声和全数字化钼靶X线摄影对乳腺疾病的诊断价值[J].山东医药,2015,55(37):82-83.
[13]周平,李国栋,朱西琪,等.MRI动态增强及扩散加权序列与钼靶X线摄影对乳腺疾病诊断的对比研究[J].中国医学影像学杂志,2011,19(10):733-738.
[14]陈静.50例青年女性乳腺癌临床治疗效果和病理分析[J].中国实用医药,2016,11(27):83-84.
[15]覃蕾,刘峥,倪嘉伟,等.MRI检查中“幽闭恐惧症”的预防及处理[J].智慧健康,2018,4(10):138-140.
[16]杨化云,刘英刚,于逍,等.核磁共振联合彩超对乳腺癌淋巴结转移的诊断效果[J].影像研究与医学应用,2018,2(23):171-172.
[17]Zhang Y,Ma AD,Jia HX.Correlation between molybdenum target mammography signs and pathological prognostic factors of breast cancer[J].J Biol Regul Homeost Agents,2016,30(1):219-225.
[18]张俊萍,雷莉,黄凤萍.乳腺钼靶片中簇状钙化对乳腺癌的诊断价值[J].中国现代药物应用,2017,11(13):60-61.
[19]殷艳宇,李毅,杨春霞,等.乳腺X线检查对伴钙化的早期乳腺癌的诊断效果分析[J].中华肿瘤防治杂志,2018,25(S1):49,51.
[20]陈春发,张玉玲,林豪雨,等.乳腺彩超和X线摄影在乳腺癌早期淋巴结的评估作用[J].汕头大学医学院学报,2016,29(2):109-110,115.