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100例疑似乳腺癌患 者影像学筛查及确 诊病例的临床特点 分析

作者:肖 敏 陆玲芳 周志英 徐 蓓

所属单位:复旦大学附属中山医院青浦分院超 声科 (上海 201700)

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摘要

目的 比较不同影像学方法对乳 腺癌的筛查价值,并分析乳腺癌患者临床 特点。方法 以本院2014年1月-2015年12 月就诊的100例疑似乳腺癌患者为研究对 象,术前均行X线、超声、CT检查,以手 术病理结果为金标准,比较不同影像学 方法对乳腺癌诊断敏感度、特异度及准 确度。同时分析手术病理证实乳腺癌患 者临床特点。结果 手术病理证实乳腺癌 80例,良性肿块20例。乳腺癌临床病理 特点方面,年龄≤35岁患者淋巴结转移 率、ER阳性率、PR阳性率分别为64.71%、 29.41%、32.35%,较年龄>35岁患者的 32.61%、65.22%、56.52%差异有统计学 意义(P<0.05)。乳腺癌筛查价值方面, X线诊断敏感度、准确度分别为71.25%、 67.00%,较超声的85.00%、83.00%,CT 的87.50%、86.00%差异有统计学意义(P <0.05),且CT诊断特异度明显高于X线(P <0.05)。结论 超声、CT对乳腺癌诊断敏 感度、准确度相比X线有明显优势,CT特 异度最高。确诊乳腺癌患者不同年龄段临 床病理特点存在一定的差异,年轻患者 (年龄≤35岁)具有淋巴结转移率高、ER、 PR阳性率低特点。

Objective To compare the value of different imaging methods in the screening of breast cancer, and to analyze the clinical characteristics of patients with breast cancer. Methods 100 cases of patients with suspected breast cancer who were admitted in our hospital between January 2014 and December 2015 were selected as study objects. Before surgery, all patients underwent X-ray, ultrasound and CT examination. The surgical and pathological results were taken as the golden standard to compare the sensitivity, specificity and accuracy of different imaging methods in the diagnosis of breast cancer. Meanwhile, the clinical characteristics of patients with breast cancer confirmed by surgery and pathology were analyzed. Results 80 cases with breast cancer were confirmed by surgery and pathology, and 20 cases were with benign tumors. For clinical pathological characteristics of breast cancer, the lymph node metastasis rate, positive rates of ER and PR in patients ≤ 35 years old were 64.71%, 29.41% and 32.35%, respectively. Compared with those in patients > 35 years old (32.61%, 65.22%, 56.52%), there were significant differences (P<0.05). For values in screening of breast cancer, the diagnostic sensitivity and accuracy of X-ray were 71.25% and 67.00%, respectively. Compared with those of ultrasound (85.00%, 83.00%) and CT (87.50%, 86.00%), there were significant differences (P<0.05). Besides, the specificity of CT diagnosis was significantly higher than that of X-ray (P<0.05). Conclusion The sensitivity and accuracy of ultrasound and CT in the diagnosis of breast cancer are better than X-ray, and the specificity of CT is the highest. There are differences in clinical pathological characteristics between patients diagnosed with breast cancer in different age groups. The younger patients (age ≤ 35 years old) have such characteristics as high lymph nodemetastasis rate and low positive rates of ER and PR.

【关键词】乳腺癌;X线;CT;临床病理 特点

【中图分类号】R445.3;R734.4

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.09.011

前言

目前临床公认延长乳腺癌患者生存期,改善其预后,降低患者病 死率的关键在于早期诊断及预防[1]。为此采取有效措施提高乳腺癌早 期检出率具有十分重要的意义。国外关于乳腺癌筛查开展较早,近年 来由于我国乳腺癌发病率不断增多,加上现代女性健康意识增强,乳 腺癌筛查工作逐渐推广应用。影像学方法作为乳腺癌早期筛查主要手 段之一,包括X线、超声、CT等,各有优缺点。此外,有研究表明[2]不 同年龄段乳腺癌患者肿瘤病灶大小、分期等临床病理特点存在一定的 差异,预后也不同。基于此,本研究一方面比较X线、超声、CT对疑似 乳腺癌患者筛查价值,另一方面分析手术病理证实乳腺癌患者临床病 理特点,以为临床乳腺癌诊治提供重要依据。报告如下。