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目的探讨全数字化乳腺摄影(FFDM)对妇女致密型乳腺病变的诊断价值。方法搜集2003年4月至2004年9月门诊及体检者行FFDM的3500余例中致密型乳腺的66例乳腺癌及6例癌前病变,12例囊性增生症,58例纤维腺瘤,1例结核,4例囊肿,11例乳腺腺病作为研究对象。全部病例采用美国GE公司的平板2000D全数字化乳腺摄影机检查,并经病理证实。检查体位常规采用头足位(CC)、内外斜位(MLO),必要时加摄侧位及局部点片。对临床未触及肿块的乳腺癌,均行术前定位。结果72例乳腺癌及癌前病变中,临床触及肿块者57例,未触及肿块者15例。影像表现为肿块23例;肿块并微小钙化18例;片状弥漫微小钙化伴局部结构紊乱11例;结构紊乱并粗长毛刺12例;簇状微小钙化2例;片簇状微小钙化1例;结构紊乱1例;小星状结构1例;长毛刺星状结构1例;平片无明显影像表现2例,其中1例仅导管造影显示僵硬、中断。共发现假阳性10例,假阴性5例,得出FFDM对乳腺癌诊断的敏感性、特异性、准确性分别为93.06%、88.37%、90.51%。良性病变中,58例纤维腺瘤,表现为肿块38例,肿块伴钙化20例;12例囊性增生症,表现为肿块10例,肿块伴点状钙化2例;11例乳腺腺病,表现为肿块9例,肿块伴点状钙化2例。4例囊肿和1例结核,均表现为肿块。结论FFDM能清晰显示乳腺癌的直接及间接征象,尤其能够显示致密乳腺的结构紊乱、粗长毛刺及微小钙化,对临床未触及肿块的乳腺癌及癌前病变具有重要的诊断价值。
Objective To investigate the value of full digital mammography (FFDM) in the diagnosis of dense breast lesions in women. Methods A total of 66 cases of breast cancer, 6 cases of precancerous lesions, 12 cases of cystic hyperplasia and 58 cases of fibroadenoma were collected from over 3,500 dense medium breast cancer clinics in FFDM from April 2003 to September 2004. 1 case of tuberculosis, 4 cases of cyst, 11 cases of breast adenosis as the research object. All cases using the United States GE’s flat 2000D digital camera examination, and confirmed by pathology. Check the body position using conventional head and foot (CC), internal and external oblique position (MLO), if necessary, plus lateral and local filming. On the clinical non-palpable breast cancer, preoperative positioning. Results Among the 72 cases of breast cancer and precancerous lesions, 57 cases were clinically involved with mass and 15 cases were not touched with mass. Imaging showed mass in 23 cases; lumps and microcalcification in 18 cases; lamellar diffuse microcalcifications with localized structural disorders in 11 cases; structural disorder and coarse-lengthy burr in 12 cases; cluster-like microcalcification in 2 cases; 1 case of structural disorder; 1 case of small stellate structure; 1 case of long-burr stellate structure; 2 cases showed no obvious radiographs, of which 1 case showed rigid and interrupted only ductal angiography. A total of 10 false positives and 5 false negatives were obtained. The sensitivity, specificity and accuracy of FFDM for the diagnosis of breast cancer were 93.06%, 88.37% and 90.51% respectively. Benign lesions, 58 cases of fibroadenoma, manifested as lumps in 38 cases, mass with calcification in 20 cases; 12 cases of cystic hyperplasia, manifested as mass in 10 cases, mass with dot-like calcification in 2 cases; 11 cases of breast adenosis, the performance 9 cases of lumps, mass with dotted calcification in 2 cases. 4 cases of cyst and 1 case of tuberculosis, were manifested as lumps. Conclusion FFDM can clearly show the direct and indirect signs of breast cancer. In particular, FFDM can show the structural disorder, coarse burrs and microcalcifications of dense breasts, and is of great diagnostic value for breast cancer and precancerous lesions not touched by the tumor.