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目的对比分析数字乳腺X线摄影(DM)、自动乳腺全容积扫描(ABVS)及高频超声(HUS)3种影像检查方法对乳腺导管内原位癌的诊断价值。方法回顾性分析2014年8月~2015年8月在潍坊市人民医院经手术病理或穿刺活检证实为乳腺导管内原位癌的198例患者的临床资料。所有患者影像资料完整,均通过DM,ABVS及HUS检查,并由两位及两位以上主治医师共同影像诊断,并对其进行乳腺BI-RADS分级。P<0.05为差异有统计学意义。结果 DM,HUS,ABVS 3种影像检查方法对DCIS的检出率分别为80.0%,82.0%,82.5%,两两比较,差异无显著性(P>0.05)。但ABVS和HUS对微小癌的检出率高于DM,DM对钙化型DCIS的敏感性高于HUS和ABVS,但对导管型钙化的敏感度及检出率低于ABVS,ABVS对于直径<10mm的肿块型DCIS的检出率高于HUS、明显高于DM,且ABVS和DM间的差异具有统计学意义;对直径10~20mm,>20mm的肿块型DCIS的检出率无明显差异。结论 DM,HUS及ABVS均可用于乳腺导管内原位癌的检出。DM对单纯钙化型导管内原位癌的检出率及敏感度高于HUS和ABVS,但ABVS的冠状面三维重建对导管型钙化较敏感,HUS及ABVS对单纯肿块型(直径<10mm)及微小癌的检出率要高于DM,且ABVS要高于HUS。在临床工作中ABVS不适于单独用于疾病诊断,最好将ABVS和HUS联合使用。
Objective To compare and analyze the diagnostic value of digital mammography (DM), automatic total breast volume scanning (ABVS) and high frequency ultrasound (HUS) in the diagnosis of ductal carcinoma in situ in breast duct. Methods The clinical data of 198 patients with ductal carcinoma in situ confirmed by pathology or biopsy in Weifang People’s Hospital from August 2014 to August 2015 were retrospectively analyzed. All patients with complete image data were examined by DM, ABVS and HUS, and two or more than two attending physicians diagnosed the disease and screened them for breast BI-RADS. P <0.05 for the difference was statistically significant. Results The detection rates of DCIS by three imaging methods of DM, HUS and ABVS were 80.0%, 82.0% and 82.5%, respectively. There was no significant difference between the two methods (P> 0.05). However, the detection rate of ABVS and HUS on micro-cancer was higher than that of DM. The sensitivity of DM to calcified DCIS was higher than that of HUS and ABVS, but the sensitivity and detection rate to catheter-type calcification was lower than that of ABVS. The detection rate of mass DCIS was higher than that of HUS, significantly higher than that of DM, and the difference between ABVS and DM was statistically significant. There was no significant difference in the detection rate of mass DCIS between 10mm and 20mm in diameter. Conclusion DM, HUS and ABVS can be used for the detection of ductal carcinoma in situ in breast duct. The detection rate and sensitivity of DM in simple calcified ductal carcinoma in situ were higher than those in HUS and ABVS. However, three-dimensional reconstruction of coronal plane of ABVS was more sensitive to ductal calcification. HUS and ABVS were more sensitive to simple tumor type (diameter <10mm) and The detection rate of micro-cancer is higher than DM, and ABVS is higher than HUS. In clinical work, ABVS is not suitable for disease diagnosis alone, it is best to use ABVS and HUS in combination.