微小乳腺病变的影像学诊断及超声引导下定位活检的临床应用-_0.docVIP

微小乳腺病变的影像学诊断及超声引导下定位活检的临床应用* 　　　　　　张胜花，王光珍△，高 云△△，李志欣 【摘要】 目的 评价和比较乳腺X线摄影、超声成像以及二者联合在微小乳腺病变中的诊断准确率；探讨超声引导下定位活检对微小乳腺病变的临床 应用 。 方法 46个微小乳腺病变同时行乳腺X线和超声成像检查，及超声引导下定位活检。根据怀疑乳腺病变的恶性程度，将术前X线检查、超声成像、二者联合将病变分为四级：级良性；级不能定性；级可能恶性；级恶性。前瞻性记录三种方式的分级，并与病理诊断对照。结果 超声引导下定位切除的46个微小乳腺病变，良性35个，恶性11个。二者联合对乳腺微小病变诊断的敏感性为100％，特异性为94.3％，诊断准确率为95.7％。乳腺X线检查和超声成像的敏感性分别为90.9％和63.6％，特异性分别为91.4％和94.3％，诊断准确率分别为91.3％和87％。二者联合的各项指标均优于单纯采用乳腺X线检查和超声成像。结论 联合应用乳腺X线摄影检查和超声成像可提高对乳腺微小病变诊断准确率。超声引导下定位，对微小乳腺病变的切除准确可靠，具有较大的临床应用价值。 【关键词】 乳腺X线摄影；超声检查；微小乳腺病变；活组织检查，穿刺 【Abstract】 Objective To evaluate the accuracy of mammography，ultrasonography and combination of the two methods in nonpapable breast lesions；and to assess the clinical usefulness of USguided biopsy for nonpapable breast lesions.Methods A total of 46 patients with nonpapable breast lesions was enrolled in this study.According to the grade of suspicion of malignancy by imaging manifestations，every lesion was prospectively classified according to mammographic and ultrasonographic findings into four categories as follows：category Ⅰ：benign；category ：equivocal；category ：probably malignant；and category ：malignant. The imaging classifications were compared with pathologic diagnosis.Results Of the 46 breast lesions diagnosed pathologically，35 lesions were proved benign and 11 malignant.The sensitivity，specificity，and accuracy of combination of the two modalities were 100%，94.3%，95.7%.The sensitivity，specificity，and accuracy of mammography and ultrasonography were 90.9% and 63.6%，91.4% and 94.3%，91.3% and 87% respectively.Every parameter of the two modalities had significant increase than that of each single modality.Conclusion A higher diagnostic value can be achieved by using the combination of the two modalities.US-guided biopsy plays an important role of localization and qualitative determination in diagnosis of nonpapable breast lesions. 【Key words】 mammography；ultrasonogrphy；breast diseases；biopsy，needle 乳腺癌的发病率逐年上升，现已跃居女性恶性肿瘤的首位。因此，乳腺癌的诊治