Tan K P, Mohamad Azlan Z, Rumaisa M P, Siti Aisyah Murni M R, Radhika S, Nurismah M I, Norlia A, Zulfiqar M A
Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Radiology, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine,Department of Radiology, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
Med J Malaysia. 2014 Apr;69(2):79-85.
This study was performed to determine the accuracy of ultrasound (USG) as compared to mammography (MMG) in detecting breast cancer.
This was a review of patients who had breast imaging and biopsy during an 18-month period. Details of patients who underwent breast biopsy were obtained from the department biopsy record books and imaging request forms. Details of breast imaging findings and histology of lesions biopsied were obtained from the hospital Integrated Radiology Information System (IRIS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of USG and MMG were calculated with histology as the gold standard.
A total of 326 breast lesions were biopsied. Histology results revealed the presence of 74 breast cancers and 252 benign lesions. USG had a sensitivity of 82%, specificity of 84%, PPV = 60%, NPV = 94% and an accuracy of 84%. MMG had a sensitivity of 49%, specificity of 89%, PPV = 53%, NPV = 88% and an accuracy of 81%. A total of 161 lesions which were imaged with both modalities were analyzed to determine the significance in the differences in sensitivity and specificity between USG and MMG. Sensitivity of USG (75%) was significantly higher than sensitivity of MMG (44%) (X(2)1=6.905, p=0.014). Specificity of MMG (91%) was significantly higher than specificity of USG (79%) (X(2)1=27.114, p<0.001). Compared with MMG, the sensitivity of USG was 50% (95% CI 10%-90%) higher in women aged less than 50 years (X(2)1=0.000, p=1.000) and 27% (95% CI 19%-36%) higher in women aged 50 years and above (X(2)1=5.866, p=0.015). Compared with MMG, the sensitivity of USG was 40% (95% CI 10%-70%) higher in women with dense breasts (X(2)1=0.234, p=0.628) and 27% (95% CI 9%-46%) higher in women with non-dense breasts (X(2)1=4.585, p=0.032).
Accuracy of USG was higher compared with MMG. USG was more sensitive than MMG regardless of age group. However, MMG was more specific in those aged 50 years and older. USG was more sensitive and MMG was more specific regardless of breast density. In this study, 20% of breast cancers detected were occult on MMG and seen only on USG.
本研究旨在确定超声（USG）与乳腺X线摄影（MMG）相比在检测乳腺癌方面的准确性。
这是一项对在18个月期间进行乳腺成像和活检的患者的回顾性研究。接受乳腺活检患者的详细信息来自科室活检记录簿和成像申请表。乳腺成像结果和活检病变组织学的详细信息来自医院综合放射信息系统（IRIS）。以组织学为金标准计算USG和MMG的敏感性、特异性、阳性预测值（PPV））、阴性预测值（NPV）和准确性。
共对326个乳腺病变进行了活检。组织学结果显示有74例乳腺癌和252例良性病变。USG的敏感性为82%，特异性为84%，PPV = 60%，NPV = 94%，准确性为84%。MMG的敏感性为49%，特异性为89%，PPV = 53%，NPV = 88%，准确性为81%。对总共161个同时采用两种检查方式成像的病变进行分析，以确定USG和MMG在敏感性和特异性方面差异的显著性。USG的敏感性（75%）显著高于MMG的敏感性（44%）（X(2)1=6.905，p=0.014）。MMG的特异性（91%）显著高于USG的特异性（79%）（X(2)1=27.114，p<0.001）。与MMG相比，USG在年龄小于50岁的女性中敏感性高50%（95%CI 10%-90%）（X(2)1=0.000，p=1.000），在年龄50岁及以上的女性中敏感性高27%（95%CI 19%-36%）（X(2)1=5.866，p=0.015）。与MMG相比，USG在乳腺致密的女性中敏感性高40%（95%CI 10%-70%）（X(2)1=0.234，p=0.628），在乳腺不致密的女性中敏感性高27%（95%CI 9%-46%）（X(2)1=4.585，p=0.032）。
与MMG相比，USG的准确性更高。无论年龄组如何，USG都比MMG更敏感。然而，MMG在50岁及以上人群中更具特异性。无论乳腺密度如何，USG更敏感，MMG更具特异性。在本研究中，检测到的乳腺癌中有20%在MMG上隐匿，仅在USG上可见。
