54例乳腺恶性肿瘤钼靶X线误诊原因分析及FNA检查的诊断价值

目的:探讨乳腺恶性肿瘤的不典型影像学征象及更经济、简便的检查手段,提高诊断准确率。方法:回顾性分析54例经乳腺钼靶X线误诊的乳腺恶性肿瘤患者的临床、病理资料及钼靶X线检查结果,所有患者均可触及肿块并行数字化钼靶X线检查,其中34例行细针吸取细胞学检查(FNA),1月内行手术切除治疗,术后病理证实为恶性肿瘤。结果:54例误诊病例中误诊纤维腺瘤18例(33.3%),囊性增生或增生结节2例(3.7%)、良性肿瘤可能性大26例(48.1%),乳头状瘤或乳头状瘤病5例(9.3%),低度恶性或交界性肿瘤3例(5.6%)。34例行FNA检查,找到癌细胞28例(敏感度82.4%,漏诊率17.6%)。结论:部分乳腺恶性肿瘤影像表现缺少特征性,诊断具良性征象的恶性肿瘤时应结合各种影像资料及临床资料,必要时行FNA检查,其可操作性强,诊断恶性肿瘤敏感度高,能最大限度地减少患者手术创伤及良性病变的手术概率。

Analysis of 54 cases of breast carcinoma misdiagnosis with mammography and diagnosis value of FNA

Objective：To increase the diagnostic accuracy of breast carcinoma by investigating its atypical signs and a more economic,convenient examination method. Methods： The records of 54 women with pathologically proven breast carcinoma who have undergone imaging from January 2007 to December 2009 were reviewed. The data of 54 cases were analyzed including clin- ic, pathology and mammography, 34 cases of them underwent concurrent FNA. All cases were operated in one month. Results： In 54 misdiagnosed cases with mammography, including fibroadenomas in 18 cases （33.3 % ）, cystic hyperplasia or nodules in 2 cases （3.7%）, benign tumors in 26 cases （48.1%）, papilloma or papillomatosis in 5 cases （9.3% ）, low grade or bordering cancer in 3 cases （5.6 % ）;34 cases of them underwent concurrent FNA, 28 of them were found cancer cells （sensitivity was 82.4% ,omission diagnose rate was 17.6% ）. Conclusion： Part of breast cancer has little of characteristic imaging findings. Combine with a variety of image and clinical data when diagnosis of a small number of atypical malignant tumors, check in line fine needle aspiration cytology（FNA） if necessary, which is operable, complementary, sensitive and can minimize the surgical trauma and risk of benign lesions.