临床乳腺检查筛查乳腺癌中降低病灶漏报率的探讨

目的 探讨临床乳腺检查筛查乳腺癌中降低病灶漏报率的方法 .方法 统计北京协和医院健康医学中心2181例女性乳腺异常病例,分析各种检查方法 的病灶漏报情况.结果 2181例中问诊及望诊降低漏报率0.5%;异常病灶2839个,多种体位联合触诊使漏报率由0.9%减至0.4%;乳腺小结节、乳腺边缘、腋窝、乳晕区病灶及腺休局限性增厚易漏报.手术组乳腺癌与良性病变比较两组之间的差别,问诊望诊异常有非常显著意义(x2=9.770,P=0.002)、触诊结节硬度差异无统计学意义(x2=1.692,P=0.193).乳腺癌病灶漏报率分别为临床检查3.7%;超声检查17.0%;钼靶检查19.4%.结论 临床乳腺检查筛查乳腺癌中降低病灶漏报率的方法 :重视问诊及望诊;依据乳腺形态灵活运用多种触诊方法 ;勿忽视乳腺边缘、腋窝及乳晕区病灶;关注触诊腺体局限性增厚;触诊结节硬度不宜作为判断乳腺癌的独立指征;避免对触诊的盲目自信或过度信赖仪器检查.

Reduction of missing report rate of breast cancer in clinical breast examination

Objective To explore the methods of reducing the missing report rate of breast cancer in clinical breast examination (CBE). Methods The investigators analyzed the data of abnormal breast physical examination in 2181 females and the missing report rate of breast cancer in various kinds of examination methods. Results Interrogation and inspection reduced the missing report rate by 5% in all cases. And the missing report rate was lowered from 0. 9% to 0. 4% by multi-position joint palpation among 2839 breast foci in abnormal physical examination. Small breast nodules, marginal foci of mammary gland,axillary fossa and mammary areola had the tendency to be missed. Focal thickening of mammary gland was also easily missed. Compared with the control group, the abnormity of interrogation and inspection in the breast cancer group were statistically significant in the operation group ( x2 = 9. 770, P = 0. 002 ). The missing report rate of breast cancer was 3.7% in CBE, 17% in ultrasonography and 19.4% in mammography. Conclusions The methods of reducing the missing report rate of breast cancer in clinical breast examination are as follows: valuing the importance of interrogation and inspection; using different palpation methods on the basis of different breast morphologic features; paying more attention to the marginal foci of mammary gland, axillary fossa and mammary areola; examining closely the focal thickening of mammary gland. Scirrhosity is inadvisable as an independent predictor for malignant tumor. A clinician should avoid an excessive dependence on palpation and instruments.