全数字化乳腺X线摄影诊断中青年乳腺癌的价值

目的探讨全数字化乳腺X线摄影（FFDM）诊断中青年乳腺癌的应用价值。方法收集2008年9月至2011年6月进行FFDM检查并经病理证实的中青年乳腺癌与良性乳腺病患者共375例。X线诊断标准采用美国放射学会推荐的乳腺报告和数据系统（BI-RADS）：Ⅰ-Ⅲ级为良性，Ⅳ、Ⅴ级为恶性，并与病理结果对照；同时分析乳腺癌的X线表现。以致密型和多量腺体型为A组，少量腺体型和脂肪型为B组，两组灵敏度和特异度的比较采用χ^2检验。结果乳腺癌的X线征象包括肿块或结节、钙化、片状致密影、结构紊乱等。FFDM诊断的灵敏度为82．0％（91／111），特异度为87．1％（230／264），阳性预测值为72．8％（91／125），阴性预测值为92．0％（230／250），正确率为85．6％（321／375）。A、B两组的FFDM诊断灵敏度、特异度分别为74．5％（35／47）和87．5％（56／64），84．4％（108／128）和89．7％（122／136），其差异无统计学意义（P〉0．05）。结论全数字化乳腺X线摄影能及时发现乳腺病灶，对中青年乳腺癌具有较高的应用价值，X线诊断为BI—RADS—Ⅳ、Ⅴ级时建议行手术活组织检查。

Diagnosis value of full-field digital mammography for breast cancer in young and middle-aged patients

Objective To explore the diagnosis value of full-field digital mammography(FFDM) for breast cancer in young and middle-aged patients.Methods From September 2008 to June 2011,the data of 375 young and middle-aged patients with breast cancer or benign disease,confirmed with FFDM and pathologic diagnosis,were collected.The X-ray diagnosis followed the breast report and data system(BI-RADS) recommended by American College of Radiology:grade Ⅰ to Ⅲ regarded as benign,Ⅳ and Ⅴ as malignant.The grading was compared with the pathological results.The X-ray features of breast cancer were analyzed.All cases were divided into 2 groups:group A including the patients with heterogeneously dense and extremely dense breast and group B including the patients with scattered fibroglandular densities and almost entirely fat breast tissue.The imaging diagnostic sensitivity and specificity of group A and B were analyzed by Chi-square test.Results The X-ray features of breast cancer included mass or nodule,calcification,flake shadow and structural disorder.The diagnostic sensitivity of FFDM was 82.0%(91/111),the specificity was 87.1%(230/264),the positive predictive value was 72.8%(91/125),the negative predictive value was 92.0%(230/250),and the diagnose accuracy was 85.6%(321/375).The imaging diagnostic sensitivity and specificity were 74.5%(35/47)and 87.5%(56/64) in group A,and 84.4%(108/128)and 89.7%(122/136)in group B,respectively.There were no statistically significant differences between the two groups(P>0.05).Conclusion Full-field digital mammography can find breast cancer lesion timely,and has a high diagnosis value for breast cancer in young and middle-aged patients.The grades Ⅳ and Ⅴ are recommended for surgery.