老年女性乳腺癌的临床特征及超声诊断价值

目的探讨老年女性乳腺癌的临床特征及超声诊断价值。 方法回顾性选取2015年6月至2019年12月就诊于北京协和医院乳腺外科行乳腺病灶手术获得明确病理诊断的≥70岁的老年女性288例，共计298个病灶，获取完整的临床、病理及超声影像资料。分析纳入对象的临床表现、病理特征，应用诊断试验四格表计算超声对老年女性乳腺良、恶性病灶及不同就诊原因患者良、恶性病灶的诊断效能，以及对腋窝淋巴结转移的诊断效能。 结果288例患者中，自行触及肿块189例（65.63%）、乳头溢液23例（7.99%）、体检（临床查体、影像学检查）发现肿块76例（26.39%）。298个病灶中，恶性病灶272个（91.28%），良性病灶26个（8.72%）。263例乳腺癌患者中，160例（60.84%）行乳腺肿块局部扩大切除术，71例（27.00%）行乳腺癌改良根治术，31例（11.79%）行乳腺肿块局部扩大切除术及前哨淋巴结活检或腋窝淋巴结清扫术，1例（0.38%）行全乳切除术。其中237例初诊患者术后病理T分期为T1 127例（53.59%），T2 79例（33.33%）。超声对老年女性乳腺癌的诊断敏感度、特异度和准确性分别为95.59%、50.00%和91.61%，其中超声对以肿块为主诉（包括自行触及和体检筛查发现）患者乳腺癌的诊断准确性（94.53%）高于主诉为乳头溢液患者的诊断准确性（58.33%）。102例乳腺癌患者接受了腋窝淋巴结处理，其中45例病理证实为腋窝淋巴结转移。术前超声对于腋窝转移性淋巴结诊断的敏感度、特异度和准确性分别为93.33%、73.68%、82.35%。 结论老年乳腺癌患者大多数因临床症状就诊，肿瘤分期晚。超声对以肿块为主诉的老年乳腺癌患者的诊断准确性较高，但对乳头溢液患者的诊断准确性仍有待提高。超声术前评估对老年乳腺癌患者腋窝淋巴结临床治疗方式的选择有重要价值。

Clinical characteristics and diagnostic value of ultrasonography in elderly women with breast cancer

ObjectiveTo analyze the clinical characteristics and diagnostic value of ultrasound in women with breast cancer aged 70 years and above. MethodsA total of 288 patients (with 298 breast lesions) aged 70 years and above who were treated at the Breast Surgery Department of Peking Union Medical College Hospital from June 2015 to December 2019 with final histopathological results were enrolled in this study, and their clinicopathological and ultrasonographic data were retrospectively analyzed. The fourfold table was used to calculate the total and separate diagnostic efficacy of ultrasonography in patients with different complaints, as well as axillary lymph node metastasis. ResultsIn the 288 patients, the complains for which medical advice was sought included self-palpable mass (189, 65.63%), nipple discharge (23, 7.99%), and lesions found by physical or imaging examination (76, 26.39%). The 298 breast lesions included 272 (91.28%) malignant and 26 (9.03%) benign lesions. A total of 263 breast cancer patients received surgery including local tumor resection (60.84%, 160 cases), modified radical mastectomy (27.00%, 71 cases), local tumor resection with axillary dissection or sentinel lymphadenectomy (11.79%, 31 cases), and total mastectomy (0.38%, 1 case). According to the TNM staging system, there were 127 (53.59%) cases of T1 and 79 (33.33%) cases of T2. The sensitivity, specificity, and diagnostic accuracy of ultrasound-based diagnosis were 95.59%, 50.00%, and 91.61%, respectively. The diagnostic accuracy of ultrasonography for the self-palpable mass (including self-touch and physical examination screening findings) was higher than that of nipple discharge (94.53% vs 58.33%). The sensitivity, specificity, and accuracy of ultrasound for diagnosing axillary lymph node metastasis were 93.33%, 73.68%, and 82.35%, respectively. ConclusionMost of elderly women with breast cancer visit hospital with clinical symptoms and this may lead to the advanced stage of tumor and delay of care. Ultrasound has an excellent diagnostic accuracy in elderly women with palpable breast mass; however, its accuracy in patients with nipple discharge needs further improvement. Preoperative ultrasound evaluation of axillary lymph nodes has great value in planning treatment strategy.