临床查体、乳腺超声及X线检查诊断中国人乳腺癌的评价

目的 评价临床查体、乳腺超声及X线检查在诊断中国人乳腺癌中的价值,并比较3种检查的灵敏度、特异度和准确度,分析其联合诊断的意义.方法 对同期乳腺普查和门诊发现的112例可疑乳腺癌的病例(普查组38例,门诊组74例)均进行乳腺查体、超声及X线检查,并作穿刺或手术取活检明确病理诊断.3种检查的结果与病理诊断对照,分别计算出各自的灵敏度、特异度、准确度、阳性预测值及κ值.结果 112例可疑乳腺癌病例中有61例乳腺癌,1例良性病变.乳腺临床查体、超声、X线检查的灵敏度分别为68.85%、88.52%、72.13%;特异度分别为88.23%、21.57%、56.86%;准确度分别为77.68%、58.04%、65.18%.三者两两联合后,乳腺超声与X线检查的灵敏度最高,为98.36%(P＜0.05),但特异度差,仅为3.92%(P＜0.05),准确度为55.36%,而临床查体与X线联合检查的灵敏度虽然较低,为85.25%,但特异度和准确度均较高,分别为56.86%和70.27%.结论 临床查体、乳腺超声、X线检查诊断乳腺癌各有特点.其中乳腺超声的灵敏度最高(P＜0.05),临床查体的特异度最好(P＜0.05),线检查对癌前病变及0期乳腺癌的检出率最高(P＜0.05).若三者联合使用,可以互相补充,减少漏诊,提高早期乳腺癌的检出率,满足大规模乳腺癌普查的需要.

Evaluation of clinical physical examination,ultrasonography and mammography in the diagnosis of breast cancer in Chinese

Objective To evaluate the significance of clinical physical examination, breast ultrasonography, and mammography in the diagnosis of breast cancer in Chinese, to compare their sensitivity, specificity and accuracy, and to elucidate the significance of combined application of the 3 methods. Methods A total of 112 patients suspected to have breast cancer as a result of mass screening (38 cases) and OPD examination (74 cases), were subjected to clinical physical examination, breast ultrasonography and mammography, and biopsy specimens were obtained from all the cases by puncture or surgery, then the final diagnosis was confirmed by pathological examination. The diagnosis made from clinical physical examination, breast ultrasonography or mammography was compared with pathological findings, and the sensitivity, specificity, accuracy, positive predictive value, and Kappa index of the 3 methods were then calculated. Results 61 cases of breast cancer and 51 cases of benign breast disease were identified. The diagnostic sensitivity of clinical physical examination, ultrasonography and mammography was respectively 68.85%, 88.52% and 72.13%, the specificity was respectively 88.23%, 21.57% and 56.86%, while the accuracy was respectively 77.68%, 58.04% and 65.18%. The combined use of ultrasonography and mammography yielded the highest sensitivity of 98.36% (P<0.05), but its specificity was lowest (3.92%, P<0.05), and the accuracy was 55.36%. Although the sensitivity of the combined application of clinical physical examination and mammography was relatively lower (85.25%), the specificity (56.86%) and accuracy (70.27%) were relatively high. Conclusions Each of these methods, namely clinical physical examination, ultrasonography and mammography, has its individual advantages: ultrasonography has the highest sensitivity (P<0.05), clinical physical examination has the highest specificity (P<0.05), and mammography has the best detection rate for precancerous changes and 0 stage of breast cancer (P<0.05). A combined application of the 3 methods can reduce the rate of misdiagnosis, raise diagnosis rate, meet the needs for large scale screening of breast cancer in Chinese.