全数字化乳腺X线摄影在乳腺癌诊断中的作用

目的分析经手术病理证实的乳腺病变在全数字化乳腺摄影（FFDM）中的影像学表现,提高X线在乳腺癌诊断中的准确性。方法搜集2008年1月-2010年10月313例行FFDM检查、手术和病理证实的乳腺病变患者的临床资料及乳腺X线片,由放射科医师对患者的X线片观察并分析,参照乳腺影像学报告和数据系统（BI-RADS）进行分级,以术后病理结果为金标准,评价FFDM检查诊断乳腺癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值,并分析误诊和漏诊的原因。结果病理结果显示,313例乳腺标本中,乳腺癌194例,乳腺良性病变119例。在乳腺恶性病变中,X线主要表现为单纯肿块型83例,钙化型95例,结构扭曲6例,不对称致密影8例,乳腺内弥漫性腺体结构模糊2例。X线诊断假阳性18例,假阴性20例。FFDM检查对乳腺癌诊断的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别约89.2%、84.9%、87.7%、90.6%、82.8%。误诊的主要原因是肿块的边缘形态、微小钙化等类似于恶性;漏诊的主要原因是乳腺腺体致密、不对称致密影及微小结构扭曲。结论数字化乳腺X线摄影在乳腺癌诊断中具有较高的价值。

Diagnostic Role of Full Field Mammography for Breast Carcinoma

Objective To analyzes the mammographic features of breast lesions confirmed by pathology,in order to improve the diagnostic accuracy of full field mammography（FFDM） in detecting breast carcinoma.Methods The mammographic features of 313 patients with breast lesions between January 2008 to October 2010 confirmed by operation and pathology were analyzed.The radiologists in breast imaging assessment analyzed and classified all the mammograms according to breast imaging reporting and data system（BI-RADS）.The sensitivity,specificity,accuracy,positive predictive value（PPV） and negative predictive value（NPV） were evaluated according to their pathological diagnosis.The reasons resulting in false-positive and false-negative diagnosis were analyzed.Results Of all the 313 breast lesions,194 were malignant,and 119 were benign.Of the malignant lesions,mass simplex type was found in 83;and masses with calcification type were found in 72.Among all the patients,there were 18 false-positive cases and 20 false-negative.The sensitivity, specificity,accuracy,PPV and NPV of FFDM in detecting breast carcinoma were 89.2%,84.9%,87.7%,90.6%,and 82.8%, respectively.The false-positive signs were masses and tiny calcification which were common to malignant lesions.The false-negative signs were dense mammary gland,dissymmetrical density and tiny architectural distortion.Conclusions FFDM has its higher value in the diagnosis of breast carcinoma.Breast carcinoma with different types has its characteristic X-ray results.