超声与钼靶摄片对乳腺癌早期诊断的意义

目的： 评估超声与钼靶摄片检查在乳腺癌早期诊断中的作用，以提高乳腺癌的早期筛查效率。 方法：收集乳腺癌早期诊断的女性患者528例临床资料，其中经B超查出隐匿性乳腺癌132例，经钼靶摄片查出乳癌病灶396例。比较两种检查方式获得初步诊断的乳腺癌患者的临床与影像学特征、手术方式与组织病理学特征、分子生物学标志物与分型的差异。 结果：两者比较显示，绝经前、年青、汉族（相对维吾尔族）女性及致密乳房组织和影像学BI-RADS 4级的乳腺癌超声检查较钼靶摄片更易检出（均P<0.05）；超声检查较钼靶摄片检出的患者更多实行保乳手术，且淋巴结转移阳性率较低，更易发现单发、直径≤1 cm、分化较好的乳腺癌及早期阶段的浸润性乳腺癌（均P<0.05）；超声检查对ER（+）、luminal A乳腺癌检出率高，而钼靶摄片对Her-2（+）、Her-2型乳腺癌检出率高（均P<0.05）。 结论：超声检查较钼钯摄片更容易发现致密乳房组织中的侵袭性与恶性程度较低的早期癌灶，对于检出不同分子分型的早期乳腺癌两者各有优势。故联合应用更利于乳腺癌患者早期筛查。

Ultrasound and molybdenum target X-ray mammography for early diagnosis of breast cancer

Objective: To evaluate the value of ultrasonic examination and molybdenum target X-ray mammography for early diagnosis of breast cancer, so as to improve the efficiency of early breast cancer detection. Methods: The clinical data of 528 female patients with early-diagnosed breast cancer were collected. Of the patients, the lesions in 132 cases, which were both mammographically and clinically occult, were diagnosed by B-ultrasonic examination, and in 396 cases were identified by molybdenum target X-ray mammography. The clinical and imaging characteristics, surgical procedure and histopathological profiles, as well as molecular biological markers and types between the patients diagnosed by the two examination methods were compared. Results: Comparison between the two groups of patients demonstrated that ultrasonic examination was more likely to detect the lesions than molybdenum target X-ray mammography in young, premenopausal, and Han nationality (vs. Uyghur nationality) women, in dense breast tissues, and of BI-RADS category 4 in breast imaging (all P<0.05); compared with molybdenum target X-ray mammography, patients preliminarily diagnosed by ultrasonic examination were more likely to undergo breast-conserving surgery and had a low positive rate of lymph node metastasis, and ultrasonic examination was more likely to find the lesions that were less than 1 cm, solitary and well differentiated, and more likely to find the early-stage invasive breast cancer (all P<0.05); ultrasonic examination had high detection rate for ER-positive or luminal A breast cancer, while molybdenum target X-ray mammography had high detection rate for Her-2-positive or Her-2 subtype breast cancer (all P<0.05). Conclusion: Ultrasonic examination has higher detection rate than molybdenum target X-ray mammography for the early-stage breast cancer with low degree of invasiveness and malignancy in dense breast tissue, but both have their advantages in detection of early breast cancer of molecular subtypes. So, combined application of the two methods can increase the early detection rate of breast cancer.