钼靶X线导丝定位切除触诊阴性乳腺病灶的临床应用价值
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摘要
目的探讨钼靶X线导丝定位切除触诊阴性乳腺病灶手术的临床应用价值。方法对291例299个触诊阴性乳腺病灶在钼靶X线指引下经导丝定位并切除活检,确定病理类型。结果 299个触诊阴性乳腺病灶中乳腺癌病灶42个(14.05%),癌前病变40个(13.38%),良性病变257个(85.95%),其中乳腺癌灶多表现为簇状或弥漫细点状钙化,乳腺癌病灶中原位癌22个(52.38%,22/42),浸润癌Ⅰ期13个(30.95%,13/42),Ⅱ期4个(9.52%,4/42),Ⅲ期3个(7.15%,3/42)。40例乳腺癌患者(2例为双侧癌)均长期随访,最长随访时间为10年,复发转移2例。应用钼靶X线诊断乳腺癌的灵敏度为92.86%(39/42);特异度为95.33%(245/257),诊断比值比(DOR)为265.42。结论钼靶X线导丝定位病灶切除技术可提高触诊阴性乳腺病灶的早期诊断率,指导手术切除病灶,其组织损伤小,可靠性高,促进了乳腺癌二级预防,适合二级医院广泛应用。
引文
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[15]赵玉年,徐向红,崔怀萍,等.乳腺内微钙化在乳腺癌诊断中的价值[J].肿瘤基础与临床,2010,23(4):342-344.
[2]申龙河,金日.乳腺钼靶载线摄影及乳腺微小钙化灶定位活检在触诊阴性乳腺疾病诊治中的临床意义[J].中国医药指南,2008,3(6):12-14.
[3]Esserman LE,Cura MA,DaCosta D.Recognizing pitfalls in earlyand late migration of clip markers after imaging-guided directionalvacuum-assisted biopsy[J].Radiographics,2004,24(1):147-156.
[4]魏冉,张蓓,胡文娟,等.X线导引下乳腺钙化导丝定位活检的应用价值[J].中国癌症杂志,2011,21(6):473-477.
[5]Coleman MP,Quaresma M,Berrino F,et al.Cancer survival in five continents:a worldwide population-based study(CONCORD)[J].Lancet Oncol,2008,9(8):730-756.
[6]Zujewski JA,Harlan LC,Morrell DM,et al.Ductal carcinoma in situ:trends in treatment over time in the US[J].Breast Cancer Res Treat,2011,127(1):251-257.
[7]朱思吉,吴佳毅,陈伟国.乳腺小叶原位癌外科治疗进展[J].中国实用外科杂志,2013,33(3):230-233.
[8]王颀,连臻强.乳腺癌早期诊断的临床思路[J].中华乳腺病杂志:电子版,2010,4(4):357-360.
[9]李春艳,侯国芳,张晟,等.乳腺导管内癌治疗方式研究进展[J].中国老年学杂志,2013,33(4):963-966.
[10]王仲照,张保宁.触诊阴性乳腺病灶活检在乳腺癌早诊早治中的价值[J].中国普外基础与临床杂志,2005,12(3):223-225.
[11]许艳春,姚晓虹,祝明洁.乳腺非典型性导管增生的研究进展[J].上海交通大学学报:医学版,2014,33(4):516-520.
[12]Otterbach F,Bankfalvi A,Bergner S,et al.Cytokeratin 5/6 immunohistochemistry assists the differential diagnosis of atypical proliferations of the breast[J].Histopathology,2000,37(3):232-240.
[13]Fitzgibbons PL,Henson DE,Hutter RV.Benign breast changes and the risk for subsequent breast cancer:an update of the 1985consensus statement.Cancer Committee of the College of American Pathologists[J].Arch Pathol Lab Med,1998,122(12):1053-1055.
[14]赵红,郑穗生,金晶,等.钼靶X线影像对乳腺疾病的诊断价值[J].中国医学影像学杂志,2012,20(7):511-514.
[15]赵玉年,徐向红,崔怀萍,等.乳腺内微钙化在乳腺癌诊断中的价值[J].肿瘤基础与临床,2010,23(4):342-344.