Jahan A B, Ahmed M U, Begum M, Hossain M M, Rahman M M, Sarwar J M, Hossain M Z, Begum F, Saha P L, Haque S, Muktadira M
Dr Afroza Bilkis Jahan, Radiologist, Department of Radiology & Imaging, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh.
Mymensingh Med J. 2017 Apr;26(2):223-229.
Breast cancer is the most common malignancy in women and the second most common cause of cancer-related mortality. The distinction by physical examination of physiologic nodularity from abnormal masses can be difficult, while the clinical differentiation of a malignant mass from a benign one is difficult; the medical as well as potential legal consequences of missing a palpable carcinoma are high. There are significant number of reported cases of false-negative findings on mammography and the great desire not to miss a malignant lesion in the early stage of disease lead to aggressive biopsy, but the biopsy rate for cancer is only 10.0% to 30.0%. This means that 70.0% to 90.0% of breast biopsies are performed for benign diseases, which induce unnecessary patients discomfort and anxiety in addition to increasing costs to the patient. Clearly, there is a great need for development of additional reliable methods to complement the existing diagnostic procedures to avoid unnecessary biopsy. This cross sectional study was carried out on 43 patients having palpable breast mass, attended in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st January 2012 to 31st December 2013 for the period of two year. These patients were evaluated by USG at the Department of Radiology and Imaging and histopathological examination at the Department of Pathology of the same College to confirm the diagnosis. In diagnosis of malignant mass by USG, 9(20.9%) cases were diagnosed as malignant and 34(79.1%) cases as other than malignant. Eight out of 9 were sonographically diagnosed as malignant lesions also proved as malignant lesion by histopathology and 1 other than malignant. Out of 34 sonographically diagnosed cases of other than malignant lesions 32 were proved histopathologically and 2 did not match with sonographic findings. USG, in diagnosis of malignant lesion, sensitivity was 80.0%, specificity 96.97%, positive predictive value (PPV) (88.89%), negative predictive value 94.12% and accuracy was 93.02% and comparable to other study. In diagnosis of benign lesion by USG, sensitivity was 96.97%, specificity 80.0%, positive predictive value (PPV) (94.12%), negative predictive value 88.89% and accuracy was 93.02%. So, USG is an appropriate imaging method for diagnosis & differential diagnosis of palpable breast mass.
乳腺癌是女性中最常见的恶性肿瘤，也是癌症相关死亡的第二大常见原因。通过体格检查区分生理性结节与异常肿块可能很困难，而临床上区分恶性肿块和良性肿块也很困难；漏诊可触及的癌肿在医学以及潜在法律方面的后果都很严重。有大量关于乳腺钼靶检查假阴性结果的报道病例，且人们非常希望在疾病早期不遗漏恶性病变，这导致了积极的活检，但癌症的活检率仅为10.0%至30.0%。这意味着70.0%至90.0%的乳腺活检是针对良性疾病进行的，这除了增加患者费用外，还会给患者带来不必要的不适和焦虑。显然，迫切需要开发额外可靠的方法来补充现有的诊断程序，以避免不必要的活检。这项横断面研究对43例有可触及乳腺肿块的患者进行，这些患者于2012年1月1日至2013年12月31日期间在迈门辛医学院医院放射科和影像科就诊，为期两年。这些患者在放射科和影像科接受超声检查，并在同一学院的病理科接受组织病理学检查以确诊。在超声诊断恶性肿块时，9例（20.9%）被诊断为恶性，34例（79.1%）被诊断为非恶性。9例超声诊断为恶性病变的患者中，有8例经组织病理学证实为恶性病变，1例为非恶性。在34例超声诊断为非恶性病变的病例中，32例经组织病理学证实，2例与超声检查结果不符。超声在诊断恶性病变时，敏感性为80.0%，特异性为96.97%，阳性预测值（PPV）为88.89%，阴性预测值为94.12%，准确性为93.02%，与其他研究结果相当。超声在诊断良性病变时，敏感性为96.97%，特异性为80.0%，阳性预测值（PPV）为94.12%，阴性预测值为88.89%，准确性为93.02%。因此，超声是诊断及鉴别诊断可触及乳腺肿块的一种合适的影像学方法。
