Incidental findings on sonography of the breast:: Clinical significance and diagnostic workup
Incidental findings on sonography of the breast:: Clinical significance and diagnostic workup
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DOI：
10.2214/ajr.173.4.10511149
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发表时间：
1999-10-01
影响因子：
5
通讯作者：
D端nser, M
中科院分区：
文献类型：
--
作者：
Buchberger, W;DeKoekkoek-Doll, P;D端nser, M
目标。本研究的目的是确定医生进行的高分辨率超声检查发现乳房x光检查未发现的不可触及的乳房病变的频率。超声分级方案是测试其准确性预测恶性肿瘤偶然发现乳腺病变。研究对象和方法：6113名乳腺密度分级为2-4级的无症状女性和687名可触及或乳房x光检查发现肿块的患者接受超声检查作为乳房x光检查的辅助检查。所有超声检查、临床和乳房x光检查发现的非单纯性囊肿的隐匿性乳腺病变均被前瞻性地分为良性、不确定或恶性三类。通过超声引导下的细针穿刺或核心穿刺活检确诊。在6113名无症状妇女中，21名患者中有23例恶性肿瘤仅通过超声检查（患病率，0.31%）。在可触及或乳房x线摄影检测到的指数病变中发现恶性（n = 3）或良性（n = 2）另外5个恶性病变。单纯超声检查的浸润性肿瘤平均大小为9.1 mm，与乳房x光检查的浸润性肿瘤平均大小无显著差异（p = 0.07）。超声分级对恶性肿瘤的敏感性为100%，特异性为33.5%。在乳腺致密的女性中，使用高分辨率超声作为乳房x光检查的辅助手段，可能会发现大量隐匿的恶性肿瘤，这些肿瘤的大小与乳房x光检查发现的不可触及的病变没有区别。基于超声特征对这些病变进行前瞻性分类，可显著减少不必要的活检。
OBJECTIVE. The purpose of this study was to determine how often physician-performed high-resolution sonography can detect nonpalpable breast lesions not revealed by mammography. A sonographic classification scheme was tested for its accuracy in predicting malignancy of incidentally detected breast lesions.SUBJECTS AND METHODS, Six thousand one hundred thirteen asymptomatic women with breast density grades 2-4 and 687 patients with palpable or mammographically detected breast masses underwent sonography as an adjunct to mammography. All sonographically detected, clinically and mammographically occult breast lesions that were not simple cysts were prospectively classified into benign, indeterminate, or malignant categories. Diagnoses were confirmed by sonographically guided fine-needle aspiration or core needle biopsy.RESULTS. In 6113 asymptomatic women, 23 malignancies in 21 patients were detected with sonography only (prevalence, 0.31%). Five additional malignant lesions were found in patients with a malignant (n = 3) or a benign (n = 2) palpable or mammographically detected index lesion. The mean size of invasive malignancies detected only by sonography was 9.1 mm, which was not significantly different from the mean size of invasive cancers detected by mammography (p = .07). The sensitivity of the prospective sonographic classification for malignancy was 100%, and the specificity was 33.5%.CONCLUSION. The use of high-resolution sonography as an adjunct to mammography in women, with dense breasts may lead to detection of a significant number of otherwise occult malignancies that are no different in size from nonpalpable mammographically detected lesions. Prospective classification of these lesions based on sonographic characteristics results in a significant reduction in number of unnecessary biopsies performed.