Balu-Maestro C, Chapellier C, Ben Taaritt I, Fournol M
Centre Antoine-Lacassagne, Service de Radiologie, 33 Avenue de Valombrose, 06189 Nice Cedex 01.
J Radiol. 2006 Dec;87(12 Pt 1):1849-58. doi: 10.1016/s0221-0363(06)74165-8.
Determine the value of ultrasound for the diagnosis of isolated breast microcalcifications.
Fifty clusters of microcalcifications, including 25 smaller than 10 mm, were examined by ultrasound (5-13 MHz) prior to stereotactic aspiration macrobiopsy (30 benign lesions, three borderline lesions, and 17 malignant lesions, including ten in situ lesions and seven invasive lesions). Mammography had placed 13 of these cases in BI-RADS 3, 24 in BI-RADS 4, and 13 in BI-RADS 5. The BI-RADS classification was also used for ultrasound assessment.
Six of the 18 microcalcifications that were not seen by ultrasound were malignant (two invasive ductal cancers [IDC] and four ductal carcinomas in situ [DCIS]). Two of the four cases with no sonographically visible tissue mass proved to be malignant (one IDC, one DCIS); these two lesions had been classified BI-RADS 4 and 5 by mammography and were larger than 10 mm. Ultrasound visualized 16 masses classed BI-RADS 3, ten masses classed BI-RADS 4, and two masses classed BI-RADS 5. One of the lesions classified as BI-RADS 3 by mammography was an IDC that was classed BI-RADS3 by ultrasound. Four of the lesions classed BI-RADS 4 by mammography were malignant (three were classified BI-RADS3 by ultrasound while one was classed BI-RADS4). One benign lesion was classified BI-RADS 5 by ultrasound. Four cancers were mammographically classed BI-RADS 5; ultrasound was in agreement in one case but classed three of the cases as BI-RADS 4. In one case, ultrasound gave a diagnosis of benignity (BI-RADS 3 classification).
Ultrasound is unsuited for the diagnosis of microcalcifications because it fails to visualize a mass in one-third of cancers and the existence of a mass is correlated with malignancy in one-third of cases. Furthermore, US does not correct the false-negative errors of mammography, and it underestimates the rate of malignancy by ascribing a benign appearance to 50% of cancers, which mammography correctly classifies BI-RADS 4 or 5.
确定超声在孤立性乳腺微钙化诊断中的价值。
在立体定向穿刺活检前，用超声（5 - 13兆赫）检查50个微钙化灶群，其中25个小于10毫米（30个良性病变、3个交界性病变和17个恶性病变，包括10个原位病变和7个浸润性病变）。乳腺钼靶将其中13例归为BI-RADS 3类，24例归为BI-RADS 4类，13例归为BI-RADS 5类。BI-RADS分类也用于超声评估。
超声未显示的18个微钙化灶中有6个为恶性（2例浸润性导管癌[IDC]和4例导管原位癌[DCIS]）。4例超声未显示组织肿块的病例中有2例为恶性（1例IDC，1例DCIS）；这2个病变在乳腺钼靶检查中被归为BI-RADS 4类和5类，且大于10毫米。超声显示16个BI-RADS 3类肿块、10个BI-RADS 4类肿块和2个BI-RADS 5类肿块。乳腺钼靶检查归为BI-RADS 3类的1个病变为IDC，超声检查也归为BI-RADS 3类。乳腺钼靶检查归为BI-RADS 4类的病变中有4个为恶性（3个超声检查归为BI-RADS 3类，1个归为BI-RADS 4类）。1个良性病变超声检查归为BI-RADS 5类。4例癌症在乳腺钼靶检查中归为BI-RADS 5类；超声检查在1例中诊断一致，但将3例归为BI-RADS 4类。在1例中，超声诊断为良性（BI-RADS 3类）。
超声不适用于微钙化的诊断，因为它在三分之一的癌症中未能显示肿块，且在三分之一的病例中肿块的存在与恶性相关。此外，超声不能纠正乳腺钼靶的假阴性错误，并且将50%乳腺钼靶正确分类为BI-RADS 4或5类的癌症误诊为良性，从而低估了恶性率。
