Department of Breast Surgery, Shanghai Sixth People's Hospital of Shanghai Jiaotong University, Shanghai, China.
Breast J. 2012 Mar-Apr;18(2):130-8. doi: 10.1111/j.1524-4741.2011.01219.x. Epub 2012 Feb 23.
The purpose of this study was to compare mammography and sonography, as well as their combination, for detecting breast tumors in symptomatic patients. The effects of age and hormonal status were also examined. From 1999 to 2007, 549 patients underwent 665 examination sessions (mammography and ultrasound). Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. On pathology, 246 lesions were malignant and 419 were benign in the 549 patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of mammography and sonography were 81.71% and 95.53%, 85.44% and 80.43%, 76.72% and 74.13%, 88.83% and 96.84%, and 0.886 and 0.948, respectively. The sensitivity and diagnostic accuracy among patients <50 years of age were significantly higher for sonography than for mammography (p < 0.05). The sensitivity and diagnostic accuracy among premenopausal or perimenopausal patients were significantly higher for sonography than for mammography (p < 0.05). The sensitivity among postmenopausal patients was significantly higher for sonography than for mammography (p < 0.05). The results of combined mammography and sonography were classified using American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). There were 244 positive and two negative examinations of malignant lesions, and 106 positive and 313 negative examinations of benign lesions. The diagnostic accuracy of the combination was significantly higher than that of mammography (p < 0.05) and similar to that of sonography (p > 0.05). Sonography had better sensitivity and diagnostic accuracy than mammography for diagnosing breast diseases, while their specificities were similar. The diagnostic accuracy of diagnostic sonography was significantly better than that of mammography among patients <50 years of age and premenopausal or perimenopausal patients. The combination of mammography and sonography increased the sensitivity and diagnostic accuracy.
本研究旨在比较乳腺钼靶摄影和超声检查，以及联合应用这两种方法，用于检测有症状患者的乳腺肿瘤。同时还观察了年龄和激素状态的影响。1999 年至 2007 年间，549 例患者共进行了 665 次检查（乳腺钼靶摄影和超声）。如果活检发现恶性病变，则将异常结果判定为阳性；如果活检或所有筛查检查结果为阴性，则将异常结果判定为阴性。在 549 例患者中，246 个病灶为恶性，419 个病灶为良性。乳腺钼靶摄影和超声的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和受试者工作特征曲线（ROC）下面积（AUC）分别为 81.71%和 95.53%、85.44%和 80.43%、76.72%和 74.13%、88.83%和 96.84%以及 0.886 和 0.948。<50 岁患者中，超声的敏感性和诊断准确性明显高于乳腺钼靶摄影（p<0.05）。绝经前或围绝经期患者中，超声的敏感性和诊断准确性明显高于乳腺钼靶摄影（p<0.05）。绝经后患者中，超声的敏感性明显高于乳腺钼靶摄影（p<0.05）。联合应用乳腺钼靶摄影和超声检查的结果采用美国放射学院（ACR）乳腺影像报告和数据系统（BI-RADS）进行分类。244 例恶性病变中有 2 例为阳性检查，2 例为阴性检查；106 例良性病变中有 313 例为阳性检查，313 例为阴性检查。联合检查的诊断准确性明显高于乳腺钼靶摄影（p<0.05），与超声检查相似（p>0.05）。超声在诊断乳腺疾病方面的敏感性和诊断准确性优于乳腺钼靶摄影，但其特异性相似。<50 岁和绝经前或围绝经期患者中，超声诊断的准确性明显优于乳腺钼靶摄影。乳腺钼靶摄影和超声联合应用可提高敏感性和诊断准确性。
