Sener S F, Candela F C, Paige M L, Bernstein J R, Winchester D P
Department of Radiology, Evanston Hospital, Northwestern University Medical School, Illinois 60201.
Surg Gynecol Obstet. 1988 Aug;167(2):135-40.
A retrospective study of 321 patients who underwent localizing mammography and excisional biopsy of the breast from 1984 to 1985 was performed. The study was undertaken to refine selection criteria for biopsy in women with nonpalpable mammographic abnormalities by comparing mammographic features and impression with histologic findings. Twenty-eight of 36 (78 per cent) noninfiltrating carcinomas presented with microcalcifications alone; in contrast, 27 of 39 (69 per cent) infiltrating carcinomas presented with a mass alone. As the number of microcalcifications increased, so did the incidence of carcinoma. The size of the mass was not a guide for predicting carcinoma. Although only 11 of 75 carcinomas presented as a mass with microcalcifications, 11 of 21 calcified masses were carcinoma. There were no significant differences in the mammographic presentation between ductal and lobular carcinoma. The sensitivity of the mammographic impression was 48/75 (0.64), and the specificity was 221/246 (0.898). The false-positive rate was 25/73 (0.34), and the false-negative rate was 10/141 (0.07). From this study, we concluded 1, the incidence of noninfiltrating carcinoma was significantly higher and the incidence of positive nodes was significantly lower in nonpalpable abnormalities than in palpable masses; 2, noninfiltrating carcinomas were generally associated with microcalcifications alone, but infiltrating carcinomas were generally associated with a mass alone, and 3, the diagnostic accuracy of mammography was limited by under-interpretation of the subtler signs of noninfiltrating carcinoma and by over-interpretation of mammographic findings generally accepted as criteria for carcinoma.
对1984年至1985年间接受乳腺定位钼靶检查及切除活检的321例患者进行了一项回顾性研究。该研究旨在通过比较钼靶特征及诊断印象与组织学结果，完善对乳腺钼靶检查有异常但触诊阴性的女性患者进行活检的选择标准。36例（78%）非浸润性癌中有28例仅表现为微钙化；相比之下，39例（69%）浸润性癌中有27例仅表现为肿块。随着微钙化数量的增加，癌的发生率也随之增加。肿块大小并非预测癌的指标。虽然75例癌中只有11例表现为伴有微钙化的肿块，但21例钙化肿块中有11例为癌。导管癌和小叶癌在钼靶表现上无显著差异。钼靶诊断印象的敏感性为48/75（0.64），特异性为221/246（0.898）。假阳性率为25/73（0.34），假阴性率为10/141（0.07）。通过这项研究，我们得出结论：1. 乳腺钼靶检查有异常但触诊阴性的患者中，非浸润性癌的发生率显著更高，阳性淋巴结的发生率显著更低；2. 非浸润性癌通常仅与微钙化相关，而浸润性癌通常仅与肿块相关；3. 钼靶检查的诊断准确性受到对非浸润性癌较细微征象解读不足以及对通常被视为癌诊断标准的钼靶检查结果过度解读的限制。
