超声检查在基层医院乳腺疾病普查和诊断中的价值

目的探讨超声检查在基层医院乳腺疾病普查和诊断中的价值。方法根据3175例普查或就诊妇女乳腺超声检查声像图表现有异常者,将超声诊断分为未见占位(乳腺小叶增生或退化不全)、良性或良性可能大占位、性质不确定占位及恶性可能大占位4类。对照临床表现或病理诊断,计算超声检查的准确率、计算各类诊断恶性实际发生率;分析良恶性肿块在超声声像图上的特征性征象。结果 3175例普查或就诊妇女,超声提示未见占位(乳腺小叶增生或退化不全)为89.25%(2834/3175),乳腺良性或良性可能大的占位为9.6%(306/3175),性质不确定性的占位为0.25%(8/3175),恶性可能大占位为0.85%(27/3175)。对照临床诊断或/和病理诊断,超声准确率为98%(3128/3175),每类诊断其恶性实际发生率分别为0.07%(2/2834),0.98%(3/306),25%(2/8),77.8%(21/27)。良恶性肿块的超声征象在形态、边界、内部回声和纵横比有显著差异(P值均0.01),CDFI血流流速曲线上RI在良恶性肿块内有显著差异(P0.01),而PSV则无显著差异(P0.05)。结论良恶性肿块在超声征象上有显著差异。以二维超声为主,结合彩色多普勒超声在妇女乳腺疾病的普查及诊断中有较高的应用价值。

Evaluation of ultrasound in screening and diagnosis of breast diseases in primary hospital

Objective To evaluate the value of ultrasound in screening and diagnosis of breast diseases in the primary hospital.Methods The sonographic appearances of the breasts in 3175 women were reviewed in the census.The sonographic diagnosis were classified into 4 types：no mass（lobular hyperplasia or incomplete degradation）,benign or probably benign mass,mass of uncertain nature and probably malignant mass.According to the clinical and pathlolgical diagnosis,the accuracy of ultrasound and the actual incidence of malignancies in every type were calculated.The ultrasonographic features of benign and malignant massess were analgzed.Results Among 3175 women,89%（2834/3175）cases were diagnosed as no mass（lobular hyperplasia or incomplete degradation）,9.6%（306/3175） were diagnosed as benign or probably benign,0.25%（8/3175）were diagnosed as uncertain and 0.85%（27/3175）were diagnosed as probably malignant mass by ultasound.According to the clinical and pathlolgical diagnosis,the accuracy of ultrasound was 98%（3128/3175）.The actual incidence of malignant breast diseases in every type were 0.07%（2/2834）,0.98%（3/306）,25%（2/8）,and 77.8%（21/27）,respeetindy.The sonographic appearance of benign and malignant mass were significantly different（P0.01） in the shape,border,internal echogenicity,and aspect ratio.In color Doppler,RI was significantly different between benign and malignant masses（P0.01）,while there was no signifieant difference between benign and malignant masses（P 0.05）.Conclusion The sonographic appearances of benign and malignant mass are different.Two-dimensional ultrasound combined with color Doppler ultrasound is valuable in screening and diagnosis of breast diseases.