超声联合数字化乳腺X线摄影检查系统对临床触诊阴性乳腺癌诊断价值研究

摘要

目的:分析超声检查联合数字乳腺X线直接及间接征象对临床触诊阴性乳腺癌的诊断价值.方法:选取太和县人民医院2014年9月至2016年9月期间诊治的142例患者166个临床触诊结果为阴性,但超声检查联合数字乳腺X线显示乳腺肿块46个乳腺癌,统计出超声检查、数字乳腺X线及超声检查联合数字乳腺X线诊断触诊阴性乳腺癌的诊断价值.结果:超声46个乳腺癌Ⅱ-Ⅲ 级血流为60.87%(28/46),穿支血管为36.96%(17/46),Vmax≥14 cm/s为66.67%(14/21),RI≥0.7为63.83%.两者联合诊断临床触诊阴性乳腺癌的灵敏度、特异度、阳性预测值、阴性预测值、准确性均更优;超声及乳腺X线摄片应用于诊断触诊阴性乳腺癌患者的曲线下面积(0.873±0.035)超过单独超声(0.831±0.042)或乳腺X线摄片(0.832±0.042),且差异具有显著性.结论:超声和数字乳腺X线摄影联合应用于临床触诊阴性乳腺癌的早期筛查能提高触诊阴性乳腺癌患者的诊断准确度,值得临床借鉴.%Objective: To analyze the clinical application value of ultrasonic inspection combined with direct and indirect signs of digital mammography in the clinical palpation of negative breast carcinoma. Methods: 142 patients treated from September 2014 to September 2016 in our hospital were selected.There were 166 negative breast carcinoma based on the clinical palpation. However,there were just 46 breast carcinoma based on the ultrasonic inspection and digital mammography.Through the pathological examination, the sensitivity, specificity and accuracy based on the ultrasonic inspection, digital mammography and combined examination of ultrasonic inspection and digital mammography was counted; through the ROC curve, the diagnosis value based on three methods was evaluated. Results: Based on the ultrasonic inspection, the blood flow and hemodynamics of negative lumps could be completely confirmed; for 46 breast carcinoma, type Ⅱ-Ⅲ of blood flow accounted for 60.87%(28/46)with perforator vessel (36.96%, 17/46), Vmax≥14cm/s (66.67%,14/21) and RI≥0.7(63.83%).The digital mammography had a higher sensitivity on the micro-calcification. The rate of micro-calcification accounted for 47.83%(22/46).The sensitivity based on ultrasonic inspection, digital mammography and combined examination of ultrasonic inspection and digital mammography was 80.82,85.08 and 93.57; the specificity was 91.66, 89.22% and 91.52%;The positive predictive value was 79.15, 75.26 and 81.37; the negative predictive value was 92.42%,93.74% and 95.42%;The accuracy was 88.58%,87.96% and 92.18%.Based on the combined examination of ultrasonic inspection and digital mammography, the ROC area under the curve (0.873±0.035) was larger than that of ultrasonic inspection (0.831±0.042) and digital mammography (0.832±0.042) (P<0.000). Conclusion: During the early screening of negative breast carcinoma, the combined examination of ultrasonic inspection and digital mammography can improve the diagnosis accuracy of negative breast carcinoma. It shall be recommended in clinical practice.