Department of General Surgery, Belfast City Hospital, Belfast, UK.
Int J Clin Pract. 2009 Nov;63(11):1589-94. doi: 10.1111/j.1742-1241.2009.02102.x. Epub 2009 Aug 14.
Ultrasound is the first-line breast imaging modality in younger patients and an adjunct to mammography in older patients. The objectives of this study were to evaluate the complementary value of ultrasound to mammography in breast cancer and to investigate the use of ultrasound in patients above and below the age of 50 years.
Clinical presentation and investigations for consecutive patients undergoing triple assessment at a symptomatic breast clinic were prospectively recorded between January 2000 and August 2003. Clinical data were compared with pathological findings. Patients were divided into two groups, above and below 50 years of age for subgroup analyses.
A total of 999 of 2185 patients had both mammography and ultrasound investigations performed and constituted the study population. Subgroup analysis of the 2185 patients demonstrated that 99 of the 127 patients who were diagnosed with breast cancer had both investigations performed (median age 57.0, range: 34-89 years). Mammography was normal/benign in 14.1%, indeterminate in 29.3% and suspicious of cancer in 56.6% of patients. Adjunctive ultrasound was normal/benign in 13.1%, indeterminate in 6.1% and suspicious of cancer in 80.8% of patients. In these 99 patients, adjunctive ultrasound was more sensitive than mammogram alone (80.8% vs. 56.6%, p < 0.001). Ultrasound upgraded nine of 14 mammographically normal and 16 of 29 mammographically indeterminate X-rays to a cancer. Mammography appeared to be more sensitive in patients over 50 years compared with those patients under 50 years (62.5% vs. 45.7%, p = 0.10). The sensitivity of ultrasound was comparable between patients above and below the age of 50 years (82.8% vs. 77.1%, p = 0.60). Further subgroup analysis demonstrated a higher sensitivity with combined mammography and ultrasound compared with mammography alone in either patient group (below 50: 45.7%-->77.1% and above 50: 62.5%-->82.8%). These results also suggested that the difference in the sensitivities of mammography vs. the combined investigation approach was more marked in patients under 50 years of age (below 50 = 31.4% vs. above 50 = 20.3%).
Adjunctive ultrasound assessment improves breast cancer detection in women of all ages and should be routinely used in symptomatic breast clinics.
超声是年轻患者首选的乳腺影像学检查方法，也是老年患者乳腺 X 线摄影的辅助手段。本研究旨在评估超声在乳腺癌中的补充价值，并研究 50 岁以上和以下患者中超声的应用。
2000 年 1 月至 2003 年 8 月，前瞻性地记录了在有症状的乳腺诊所进行三联评估的连续患者的临床表现和检查结果。将临床数据与病理结果进行比较。患者分为 50 岁以上和 50 岁以下两组进行亚组分析。
共有 2185 例患者中的 999 例同时进行了乳腺 X 线摄影和超声检查，构成了研究人群。对 2185 例患者的亚组分析表明，127 例被诊断为乳腺癌的患者中有 99 例同时进行了这两种检查（中位年龄 57.0 岁，范围：34-89 岁）。乳腺 X 线摄影结果正常/良性占 14.1%，不确定占 29.3%，可疑癌症占 56.6%。附加超声检查正常/良性占 13.1%，不确定占 6.1%，可疑癌症占 80.8%。在这 99 例患者中，附加超声检查比单独的乳腺 X 线摄影检查更敏感（80.8% vs. 56.6%，p<0.001）。超声检查将 14 例乳腺 X 线摄影正常和 29 例乳腺 X 线摄影不确定的 X 射线升级为癌症。与 50 岁以上的患者相比，乳腺 X 线摄影在 50 岁以下的患者中似乎更敏感（62.5% vs. 45.7%，p=0.10）。50 岁以上患者的超声检查敏感性与 50 岁以下患者相似（82.8% vs. 77.1%，p=0.60）。进一步的亚组分析表明，在两个患者组中，与单独进行乳腺 X 线摄影相比，联合使用乳腺 X 线摄影和超声检查具有更高的敏感性（<50 岁：45.7%→77.1%；>50 岁：62.5%→82.8%）。这些结果还表明，乳腺 X 线摄影与联合检查方法的敏感性差异在 50 岁以下的患者中更为明显（<50 岁：31.4%→50 岁以上：20.3%）。
辅助超声评估可提高各年龄段女性乳腺癌的检出率，应常规用于有症状的乳腺诊所。
