全数字化乳腺摄影对妇女致密型乳腺病变的诊断价值

目的探讨全数字化乳腺摄影（FFDM）对妇女致密型乳腺病变的诊断价值。方法搜集2003年4月至2004年9月门诊及体检者行FFDM的3500余例中致密型乳腺的66例乳腺癌及6例癌前病变，12例囊性增生症，58例纤维腺瘤，1例结核，4例囊肿，11例乳腺腺病作为研究对象。全部病例采用美国GE公司的平板2000D全数字化乳腺摄影机检查，并经病理证实。检查体位常规采用头足位（CC）、内外斜位（MLO），必要时加摄侧位及局部点片。对临床未触及肿块的乳腺癌，均行术前定位。结果72例乳腺癌及癌前病变中，临床触及肿块者57例，未触及肿块者15例。影像表现为肿块23例；肿块并微小钙化18例；片状弥漫微小钙化伴局部结构紊乱11例；结构紊乱并粗长毛刺12例；簇状微小钙化2例；片簇状微小钙化1例；结构紊乱1例；小星状结构1例；长毛刺星状结构1例；平片无明显影像表现2例，其中1例仅导管造影显示僵硬、中断。共发现假阳性10例，假阴性5例，得出FFDM对乳腺癌诊断的敏感性、特异性、准确性分别为93．06％、88．37％、90．51％。良性病变中，58例纤维腺瘤，表现为肿块38例，肿块伴钙化20例；12例囊性增生症，表现为肿块10例，肿块伴点状钙化2例；11例乳腺腺病，表现为肿块9例，肿块伴点状钙化2例。4例囊肿和1例结核，均表现为肿块。结论FFDM能清晰显示乳腺癌的直接及间接征象，尤其能够显示致密乳腺的结构紊乱、粗长毛刺及微小钙化，对临床未触及肿块的乳腺癌及癌前病变具有重要的诊断价值。

Diagnostic evaluation of full-field digital mammography for breast lesions in dense breast

Objective To evaluate the diagnostic significance of full-field digital mammography(FFDM) for breast lesions in dense breast.Methods From April,2003 to September,2004,3500 cases with breast lesions were examined using FFDM and all cases were proved by pathology.Lesions in the dense breast were selected for the study,including breast cancer in 66 cases,precancerous lesions in 6 cases,cyst hyperplasia in 12 cases,fibroma in 58 cases,adenosis in 11 cases,tuberculosis in 1 case,and cyst in(4 cases).Craniocaudal(CC) view and midiolateral oblique(MLO) view were conducted for every patient.Midiolateral view or spot view was achieved if necessary.Preoperative localization was conducted for every patient with nonpalpable breast cancers.Results There were 57 palpable breast cancers and 15 non-palpable breast cancers.Mammography of the malignant lesions showed the mass in 23 cases,mass with microcalcification in 18 cases,architectual distortion with diffuse microcalcifications in 11 case,architectural distortion with long spicule in 12 cases,cluster microcalcifications in 2 cases,diffuse microcalcifications in(1 case),architectual distortion in 1 case,small stellar mass in 1 case,and stellar mass with long spicule in(1 case).Negative X-ray findings were in 2 cases.The sensitivity,specificity,and accuracy of FFDM were 93.06%,88.37%,and 90.51%,respectively.X-ray findings of the benign lesions were as follows: for(58 cases) of fibroma,there were mass in 38 cases and mass with calcification in 20 cases;for 12 cases of cyst hyperplasia,there were mass in 10 cases and mass with microcalcification in 2 cases;for 11 cases of adenosis,there were mass in 9 cases and mass with microcalcification in 2 cases;and masses were detected in 1 case of tuberculosis and 4 cases of cyst.Conclusion FFDM has very important value for the detection of breast lesions in dense breast,especially for nonpalpable breast cancers and precancerous lesions.