乳腺癌钼靶X射线检查漏诊、误诊原因分析

摘要

Objective The aim of this study is to analysis the factors hindering breast cancer detection and to outline the major guidelines to overcome these factors,we can reduce the missed and misdiagnosis breast carcinoma.Methods We included histopathological y proven breast carcinomas that were initial y missed on mammography and histopathological y proven benign lesions that were initially highly be thought breast carcinomas on mammography.The main factors are responsible for missing and misdiagnosing a carcinoma:disease factors,technical factors,provider factors,patients factors.Summarize these factors,and propose some advices.Results 416 histopathological y proven breast carcinomas,including 72 missed cases,the missed rate is 17.3%.In analyzing the causes responsible for missing of these carcinomas we classified them into 4 causative factors;31 tumor factors,9 technical factors,20 provider factors,12 patient factors.The misdiagnosis cases is 27 cases in the 1617 cases,the misdiagnosis rate is 1.7%,include 15 tumor factors,4 technical,provider 8 factors.Conclusion The main factors are responsible for missing and misdiagnosing a carcinoma:Tumor factors (subtle carcinoma,atypical carcinoma);Technical factors (inadequate exposure factors,malpositioned breasts and bad processing quality,pollution of IP board);Provider factors(read the piece inexperience,bad perception);Patients factors(dense breasts,smal breast).%目的分析乳腺癌钼靶X射线检查漏诊和误诊的原因，并寻求克服这些原因的方法，减少乳腺癌漏诊和误诊，提高其诊断符合率。方法对2008年1月~2013年6月经病理证实的乳腺癌钼靶X线图像进行回顾性分析，将漏诊和误诊病例的漏诊和误诊原因归纳为院病变因素、技术因素、阅片者因素和患者因素，对漏诊和误诊原因进行总结和数据统计，并提出预防措施。结果416例经病理证实的乳腺癌患者同时进行了钼靶X线检查，漏诊72例，漏诊率17.3%，漏诊原因分四类院病变因素31例；技术因素9例；阅片者因素20例、患者因素12例。在1617例乳腺钼靶X线检查中误诊为乳腺癌者27例，误诊率1.7%，误诊病例中病变因素15例，技术因素4例，阅片者因素8例。结论乳腺钼靶X射线检查漏诊和误诊的主要原因有院病变因素（病变隐匿或者是恶性特征不明显）、技术因素（曝光条件不合适、乳腺摆位置不规范、图像后处理质量欠佳、IP板污染）、阅片者因素（阅片经验不足、对病变的认知能力较差）、患者因素（致密性腺体，腺体较小）。