摘要
目的:比较乳腺X线摄影与超声在早期老年乳腺癌诊断中区别与应用价值。方法:选择2014年8月至2016年6月在我院就诊的老年早期乳腺癌患者为研究对象,回顾性分析比较乳腺X线摄影检查结果与乳腺超声在乳腺癌及腋窝淋巴结的辅助诊断中的诊断确诊率,分析其区别与价值。结果:(1)乳腺X线摄影比超声对钙化更敏感,而超声比乳腺X线摄影对肿物检出率更高。(2)对于直径在0.5-2.0 cm之间的小肿瘤,超声检出率比乳腺X线摄影高;而对于肉眼及查体可扪及的乳腺大肿物(直径>2.0 cm),二者的检出率无明显差异。(3)乳腺X线摄影与超声对乳腺癌诊断率无明显差异,乳腺X线摄影+超声对乳腺癌的准确率高于乳腺X线摄影。结论:两种方法在老年早期乳腺癌的辅助检查中各有优缺点,二者联合应用可达到增加诊断准确率之目的。
Objective: To compare the difference and value of mammography and ultrasound examination in the diagnosis of early stage breast cancer in elderly. Methods: Elderly patients with early breast cancer in our hospital from August 2014 to June 2016 were selected. Retrospectively analysed the diagnosis of difference and value of breast cancer by breast X-ray(mammography) results and breast ultrasound examination in the breast cancer. Results:(1) The molybdenum target is more sensitive to calcification than the ultrasound, and the detection rate of the ultrasound is higher than that of the molybdenum target.(2) For small tumors(diameter were between 0.5-2.0 cm), the ultrasound detection rate was higher than that of molybdenum target. And for the naked eye visibility and the can be palpable breast mass(diameter >2.0 cm), the detection rate of the two methods had no significant difference.(3) There was no significant difference in the diagnostic rate of breast cancer between the molybdenum target and ultrasound. But the accuracy rate of the molybdenum target combined ultrasound in the breast cancer was higher than that of the molybdenum target. Conclusions: The two methods have their advantages and disadvantages in the assistant examination of early breast cancer in elderly. The combined application of the two methods can achieve the goal of increasing the accuracy of diagnosis.
引文
[1]令狐锐霞,司文,李莹,等.3846例乳腺癌流行病学及临床病理学分析[J].解放军医学院学报,2015,36(10):1017-1021Linghu Rui-xia,Si Wen,Li Ying,et al.Epidemiological and clinicopathological characteristics of patients with breast cancer:A retrospective analysis of 3 846 case[J].Acad J Chin PLA Med Sch,2015,36(10):1017-1021
[2]谢泽明,唐军,杨名添.老年乳腺癌的特点与治疗策略[J].中华乳腺病杂志(电子版),2013,7(4):288-293Xie Ze-ming,Tang Jun,Yang Ming-tian.Characteristics and treatment strategies of breast cancer in elderly patients[J].Chin J Breast Dis(Electronic Edition),2013,7(4):288-293
[3]黄雅娟,杜峰,魏玲丽.老年乳腺癌的流行病学研究及其对行根治性手术治疗患者生存期的影响[J].中国老年学杂志,2015,35(13):3653-3655Huang Ya-juan,Du Feng,Wei Ling-li.Epidemiologic study of elderly patients with breast cancer and its impact on survival of patients undergoing radical surgery[J].Chinese Journal of Gerontology,2015,35(13):3653-3655
[4]韩颖,李青,徐兵河,等.老年乳腺癌患者应用非蒽环类辅助化疗方案的安全性及耐受性临床研究[J].中国癌症杂志,2014,24(5):367-373Han Ying,Li Qing,Xu Bing-he,et al.Safety and tolerance of non-anthracyclin regimen adjuvant chemotherapy in elderly breast cancer patients[J].China Oncology,2014,24(5):367-373
[5]Li DL,Wei L,Wen XM,et al.The effects of X-ray irradiation on the proliferation and apoptosis of MCF-7 breast cancer cells[J].Ultra-struct Pathol,2014,38(3):211-216
[6]周纯武,李静.推进乳腺影像诊断的规范化建设,提高我国乳腺影像诊断水平[J].中华放射学杂志,2014,48(9):705-706Zhou Chun-wu,Li Jing.To promote the standardization of breast imaging diagnosis,Improve the diagnostic level of breast imaging in China[J].Chin J Radiol,2014,48(9):705-706
[7]Auweter SD,Herzen J,Willner M,et al.X-ray phase-contrast imaging of the breast--advances towards clinical implementation[J].Br J Radiol,2014,87(1034):20130606
[8]周宝民,全数字化X线摄影与彩色多普勒超声诊断乳腺癌的对比研究[J].现代肿瘤医学,2016,24(10):1639-1642Zhou Bao-min.Comparison of fully digital X-ray photography of the and color doppler ultrasound for breast cancer diagnosis[J].Modern Oncology,2016,24(10):1639-1642
[9]Feng SS,D'Orsi CJ,Newell MS,et al.X-ray scatter correction in breast tomosynthesis with a precomputed scatter maplibrary[J].Med Phys,2014,41(3):031912
[10]刘明霞,张蕾,刘琳,等.全数字化乳腺X线摄影诊断临床隐匿型乳腺癌的价值[J].现代生物医学进展,2011,11(21):4156-4158Liu Ming-xia,Zhang Lei,Liu Lin,et al.Full-field Digital Mammography Diagnosis of the Clinical Value of Occult Breast Cancer[J].Progress in Modern Biomedicine,2011,11(21):4156-4158
[11]严稳开,周静.超声自动乳腺全容积扫描与乳腺X线摄影鉴别诊断乳腺癌研究[J].河北医学,2015,21(7):1116-1119Yan Wen-kai,Zhou Jing.Comparative Study of Ultrasonography Automated Breast Volume Scanner and Mammography in Differential[J].Hebei Medicine,2015,21(7):1116-1119
[12]王占秋,李京龙,黄松涛,等.乳腺MRI与乳腺X线在导管原位癌临床诊断中应用的比较研究[J].现代生物医学进展,2016,16(6):1089-1091+1200Wang Zhan-qiu,Li Jing-long,Huang Song-tao,et al.Application Comparison of Mammography MRI and Breast X-ray in Clinical Diagnosis for Ductal Carcinoma in Situ[J].Progress in Modern Biomedicine,2016,16(6):1089-1091+1200
[13]李晶,赵武,回影,等.乳腺癌钼靶X线检查的漏诊及误诊分析[J].现代生物医学进展,2016,16(15):2899-2901Li Jing,Zhao Wu,Hui Ying,et al.Analysis of Misdiagnosis of X-ray Mammography Inspection on Breast Cancer[J].Progress in Modern Biomedicine,2016,16(15):2899-2901
[14]Schleede S,Bech M,Grandl S,et al.X-ray phasecontrasttomosynthesis for improved breast tissue discrimination[J].Eur J Radiol,2014,83(3):531-536
[15]刘桂林,方明.高频超声及彩色多普勒诊断乳腺癌80例临床分析[J].医学影像学杂志,2010,20(11):1739-1740Liu Gui-lin,Fang Ming.Clinical analysis of high-frequency ultrasound and color Doppler flow imaging for 80 breast cancers[J].J Med Imaging,2010,20(11):1739-1740
[16]陈元元,李有怀,马蓉,等.超声测量最大经线在乳腺癌新辅助化疗疗效评价中的价值[J].中国现代普通外科进展,2016,19(3):197-201Chen Yuan-yuan,Li You-huai,Ma Rong,et al.Value of ultrasonic maximum diameter line measurement in evaluating effect of neoadjuvant chemotherapy for breast cancer[J].Chin J Curr Adv Gen Surg,2016,19(3):197-201
[17]韩龙才,李玉柱,张华,等.超声、钼靶、M砒及肿瘤标志物联合检测在乳腺癌诊断中的价值研究[J].标记免疫分析与临床,2016,23(11):1314-1316Han Long-cai,Li Yu-zhu,Zhang Hua,et al.Combined Detection Value of Ultrasound,Mammography,MRI and Tumor Markers in Diagnosis of Breast Cancer[J].Labeled Immunoassays and Clinical Medicine,2016,23(11):1314-1316
[18]常振宇,白玲,唐英,等.早期乳腺癌无创腋窝淋巴结分期的临床初步观察[J].军事医学,2016,40(9):759-776+763Chang Zhen-yu,Bai Ling,Tang Ying,et al.Noninvasive axillary lymph node staging for early-stage breast cancer by ultrasound examination:a preliminary clinical study[J].Military Medical Sciences,2016,40(9):759-776+763
[19]孟淑萍,张正平,王霈,等.CT、超声、X线钼靶在乳腺癌诊断中的应用价值研究[J].中国CT和MRI杂志,2014,12(7):33-35Meng Shu-ping,Zhang Zheng-ping,Wang Pei,et al.Research on Appl icat ion Value of CT,Ultrasound and X-ray Mammography in The Diagnosis of Breast Carcinoma[J].Chinese Journal of CT and MRI,2014,12(7):33-35
[20]Watanabe T,Yamaguchi T,Tsunoda H,et al.Ultrasound Image Classification of Ductal Carcinoma in Situ(DCIS)of the Breast:Analysis of 705 DCIS Lesions[J].Ultrasound Med Biol,2017[Epub ahead of print]
[21]田园,韩东笼,吴迪,等.高频彩色多普勒超声、超声弹性成像在乳腺癌诊断中应用效果比较[J].山东医药,2016,56(26):40-42Tain Yuan,Han Dong-long,Wu Di,et al.Application of high frequency color Doppler ultrasound and ultrasonic elastography in the diagnosis of breast cancer[J].Shandong medical Journal,2016,56(26):40-42