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目的:前瞻性评价数字化乳腺X射线摄影和超声对1 432例患者的诊断价值;分析年龄、乳腺密度、触诊及是否钙化对诊断敏感性的影响。方法:2007-12-2008-12我院有临床症状或乳腺癌高危人群随机先后接受数字化乳腺X射线摄影及超声检查,随访截至2009-12,具有病理或临床随诊≥1年者共1 432例患者。按照BI-RADS分类对2种检查结果进行评价,与病理作对照,比较2种方法的诊断效能及相关影响因素。利用χ2检验及ROC曲线进行统计分析。结果:1 432例患者共1 500个病灶,良性737个,恶性763个。数字化乳腺X射线摄影的敏感性、特异性及准确性分别为90.0%、83.0%及86.6%;超声分别为95.4%、84.8%及90.2%,两者差异有统计学意义,P<0.05。X射线及超声检查联合可提高乳腺恶性疾病诊断的敏感性(98.4%)。患者年龄及乳腺密度影响X射线的敏感性,但不影响超声。对于年龄≤50岁或致密性纤维腺体患者,超声敏感性均高于X射线,χ2=17.107,P<0.001;对于>50岁或非致密纤维腺体患者,两者敏感性差异无统计学意义。对于触诊阳性的病灶,超声敏感性(98.0%)优于X射线(91.4%),χ2=13.285,P=0.004。对于表现为钙化的病灶,X射线诊断敏感性(97.0%)显著高于超声(95.1%),χ2=24.223,P=0.001。对于表现为单纯钙化的乳腺癌,X射线敏感性(91.5%)高于超声(85.1%),χ2=8.502,P=0.016。结论:数字化乳腺X射线摄影及超声检查都是乳腺疾病诊断的有效检查方法。对于临床患者超声检查的敏感性、特异性及准确性优于X射线检查。对于年轻或致密性纤维腺体患者,或触诊阳性的病灶,超声敏感性优于X射线检查。但对于钙化性病变,X射线敏感性优于超声。
OBJECTIVE: To prospectively evaluate the diagnostic value of digital mammography and ultrasound in 1 432 patients and analyze the influence of age, density of breast, palpation and whether calcification on diagnostic sensitivity. Methods: 2007-12-2008-12 In our hospital, patients with clinical symptoms or high risk of breast cancer were randomized to undergo digital mammography and ultrasound examination. The patients were followed up up to 2009-12, with a total of 1 432 patients with pathological or clinical follow-up ≥ 1 year Cases of patients. According to BI-RADS classification, two kinds of test results were evaluated and compared with the pathology, and the diagnostic efficacy and related influencing factors of the two methods were compared. Using χ2 test and ROC curve for statistical analysis. Results: A total of 1 432 lesions were found in 1 432 patients, 737 benign and 763 malignant. The sensitivity, specificity and accuracy of digital mammography were 90.0%, 83.0% and 86.6% respectively; the ultrasound was 95.4%, 84.8% and 90.2%, respectively, with significant difference between the two groups (P <0.05). X-ray and ultrasound combined to improve the diagnosis of malignant breast disease sensitivity (98.4%). The patient’s age and breast density affect the X-ray sensitivity but do not affect ultrasound. For age ≤50 years or dense fibrous gland patients, the ultrasonic sensitivity were higher than the X-ray, χ2 = 17.107, P <0.001; for patients> 50 years of age or non-compact fiber glands, the difference was not statistically significant significance. For palpation-positive lesions, ultrasound sensitivity (98.0%) was superior to X-ray (91.4%), χ2 = 13.285, P = 0.004. X-ray diagnostic sensitivity (97.0%) was significantly higher than that of ultrasound (95.1%), χ2 = 24.223, P = 0.001 for lesions that manifested as calcification. X-ray sensitivity (91.5%) was higher than that of ultrasound (85.1%), χ2 = 8.502, P = 0.016 for simple calcified breast cancer. Conclusion: Digital mammography and ultrasonography are all effective methods for the diagnosis of breast disease. The sensitivity, specificity and accuracy of ultrasonography in clinical patients are superior to those of X-rays. For young or dense fibrous gland patients, or palpation of positive lesions, ultrasonic sensitivity than X-ray examination. But for calcified lesions, X-ray sensitivity is superior to ultrasound.