Appleton D C, Hackney L, Narayanan S
University Hospital of North Staffordshire NHS Trust, UK.
Ann R Coll Surg Engl. 2014 Apr;96(3):202-6. doi: 10.1308/003588414X13824511649896.
Recent guidelines suggest that ultrasonography should be used as the primary imaging modality in women under 40 years of age with mammography being offered if further imaging is required. The aim of this study was to assess the adequacy of ultrasonography and the utility of mammography in this patient group by reviewing the role these imaging techniques had in the diagnosis of breast cancer in our unit.
All breast cancers diagnosed in patients 39 years or younger from June 2009 to June 2011 were reviewed. This was a retrospective review of presentation, clinical findings, imaging modality (ultrasonography, mammography, magnetic resonance imaging [MRI]) and histology. Mammography was the primary imaging modality until May 2011 in women between 35 and 39 years of age. Both invasive and intraductal carcinoma were included in the study but lobular carcinoma in situ was excluded.
A total of 2,495 patients were referred to the symptomatic breast clinic in this age group during the study period. Thirty women were identified with either invasive cancer (n=27) or ductal carcinoma in situ (n=3). Twenty-eight patients underwent mammography, graded as uncertain, suspicious or malignant in the majority. Malignancy was missed in one patient. All 30 patients underwent ultrasonography, reported as uncertain, suspicious or malignant, an indication for diagnostic core biopsy. Ultrasonography alone did not miss any cancers but did fail to detect multifocal disease in one patient.
In this study group, ultrasonography was reliable as the primary imaging modality for women under 40, identifying all cancers in this cohort. Mammography and/or MRI remain essential adjuncts to accurately determine multifocality and/or the extent of disease.
近期指南建议，40岁以下女性应将超声检查作为主要的成像方式，如需进一步成像则进行乳房X线摄影检查。本研究的目的是通过回顾这些成像技术在我们科室乳腺癌诊断中的作用，评估超声检查的充分性以及乳房X线摄影检查在该患者群体中的效用。
回顾了2009年6月至2011年6月期间诊断为乳腺癌的所有39岁及以下患者。这是一项对临床表现、临床检查结果、成像方式（超声检查、乳房X线摄影检查、磁共振成像[MRI]）和组织学的回顾性研究。2011年5月之前，35至39岁女性的主要成像方式为乳房X线摄影检查。研究纳入了浸润性癌和导管内癌，但排除了原位小叶癌。
在研究期间，共有2495名该年龄组的患者被转诊至有症状的乳腺门诊。30名女性被诊断为浸润性癌（n = 27）或导管原位癌（n = 3）。28名患者接受了乳房X线摄影检查，大多数分级为不确定、可疑或恶性。有1名患者漏诊为恶性肿瘤。所有30名患者均接受了超声检查，报告为不确定、可疑或恶性，提示进行诊断性核心活检。单独的超声检查未漏诊任何癌症，但有1名患者未能检测出多灶性疾病。
在本研究组中，超声检查作为40岁以下女性的主要成像方式是可靠的，能够识别该队列中的所有癌症。乳房X线摄影检查和/或MRI仍然是准确确定多灶性和/或疾病范围的重要辅助手段。
