乳腺钼铑双靶X线摄片误诊病例分析

目的探讨乳腺恶性肿瘤的不典型X线表现,提高乳腺癌的诊断准确率。方法回顾性分析经术后病理证实的乳腺X线摄片误诊的病例82例。其中乳腺恶性肿瘤误诊为乳腺良性病变50例,乳腺良性病变误诊为乳腺恶性肿瘤32例。从临床表现、X线征象分析误诊的原因,并提出解决的方法。结果50例漏诊的乳腺癌病例分别误诊为乳腺纤维腺瘤,乳腺增生症,乳腺慢性炎症,乳腺导管内乳头状瘤,乳腺囊肿等。临床症状主要表现为：边界清楚有一定活动性的肿块,乳房胀痛,乳头溢液等。X线表现为边界清楚的肿块影,片状密度增高阴影,多发性的主、分支导管充盈缺损等。32例良性疾病误诊为乳腺恶性肿瘤的病例中,术后病理诊断分别为乳腺增生性病变,乳腺纤维腺瘤,良性分叶状肿瘤,导管内乳头状瘤病,肉芽肿性乳腺炎,浆细胞性乳腺炎、脂肪坏死、乳腺结核、胸壁结节性筋膜炎等。其中临床表现为边界不清的乳房肿块16例,乳房局限性增厚区7例,乳头溢液5例,边界清楚的分叶状肿块4例。X线表现为片状密度增高阴影14例,边界不清的肿块11例,边界清楚的分叶状肿块4例,多发性分支导管充盈缺损2例,毛刺状肿块1例。结论乳腺良恶性病变在临床表现及X线征象上均有重叠性,这是造成乳腺X线摄片误诊的主要原因。加深对乳腺癌不典型临床及X线表现的认识,结合超声及穿刺活检等其它检查手段,能明显减少乳腺疾病的误诊率。

Analysis of the Misdiagnosis Cases Csused by MO/Rh Mammography

Objective To explore the atypical X-ray features of breast malignant tumors and to improve the accurate rate of the diagnosis in breast tumors. Methods A total of 82 eases were analyzed retrospectively,of which 50 cases of breast malignant tumors were misdiagnosed as benign diseases,and 32 cases of benign diseases were misdiagnosed as malignant tumors. All the cases were confirmed pathologically after operation The clinical manifestations and X-ray features were analyzed to find the causes and solutions of the misdiagnosis. Results Of the 50 cases of breast malignant tumors which were misdiagnosed as fibroadenoma,cyclomastopathy,chronic inflammation,intraductal papilloma and galactoma etc, the clinical manifestations were as follows：smooth and mobile masses, swelling and painful breast and nipple discharge, and the X-ray features included well-defined masses, patchy high density shadow, and irregular filling defect in multifocal main ducts and branch ducts. Of the 32 eases of benign breast diseases which were misdiagnosed as malignant tumors,the pathological diagnosis after operation included cyclomastopathy, benign phyllodes tumor,fibroadenoma,intraductal papilloma, granuloma mastitis, plasma cell mastitis, fat necrosis, breast tuberculosis, and chest wall nodular fasciitis. The clinical manifestations included：ill-defined masses in 16 cases, focal thickening in 7 cases, nipple discharge in 5 cases,welldefined lobulated masses in 4 cases,and the X-rav features included patchy density shadow in 14 cases, indefined masses in 11 cases, well-defined lobulated masses in 4 cases, irregular filling defect in multifocal branch ducts in 2 cases,spiculate masses in 1 case. Conclusion The misdiagnosis by mammography are mainly due to the overlap of clinical manifestations and X ray features between benign and malignant diseases. Deepening the recognition of the atypical manifstations and X-ray features of breast cancers and combining mammography with ultrasound diagnosis and biopsy could decrease the misdiagnosis rate