超声未能诊断乳腺癌的原因回顾分析.docVIP

超声未能诊断乳腺癌的原因回顾分析 【摘要】 目的 回顾分析先前乳腺超声诊断为阴性（假阴性），而在超声随访中诊断为乳腺癌的患者临床资料，分析产生假阴性的原因。 方法 筛选本院PACS系统中病理确诊的乳腺癌病例，选取其中先前超声没有诊断，而在其后随访中检查出乳腺癌的病例，共56例。由二位副教授职称的超声医师在非双盲的情况下回顾分析保存在PACS系统中乳腺超声图像，并结合其钼靶、MRI等其它影像资料，两人取得一致诊断意见，分析未能诊断乳腺癌的可能原因（漏诊、误诊、处理不当），结果 56个乳腺癌病例中，有14例无法获取完整影像学资料，其余42个乳腺癌的BI-RADS分级为3～5级，其中7例为漏诊，初次诊断全部由低年资医生做出。27例为误诊，误诊主要原因为肿块边缘规整（8例），大小稳定（3例），内部回声均匀（2例），多发病灶、良恶性重叠（5例）；妊娠、哺乳时期（3例）；其中先前乳腺病变超声BI-RADS 3级的有27例（64.29%）。另有8例属于处理不当所致，主要来自对钼靶、MRI图像关联及重视不够，2例为超声引导下取样失误。结论 在超声检查罹患乳腺肿瘤的病人中，回顾分析总结认为：低年资医师有待增加超声诊断乳腺癌的经验；误诊的概率要高于漏诊及处理不当，其中BI-RADS 3级病变误诊率最高；超声检查应与MRI、钼靶图像紧密关联，减少漏诊、误诊的发生。 【关键词】 乳腺癌；BI-RADS分级；超声检查 【中图法分类号】 R737.9 【文献标识码】A Undiagnosed breast cancer at ultrasound imaging:analysis of causes 【Abstract】Objective To retrospectively review the causes of false-negative results on prior ultrasound(US) imaging studies in patients who developed breast cancer as revealed on a follow-up US imaging study and to determine the presumptive causes of these false-negative findings. Methods To screened the breast cancer cases which were diagnosis in pathological in our hospital’s Picture Archiving and Communication Systems(PACS). We selected 56 cases diagnosed by follow-up examination with previous ultrasonic negative diagnosis. Two associate professor ultrasound doctors retrospectively analysised breast ultrasound images saved in the PACS system with other date as Mammography, MRI, and the reasons of misdiagnose and misconduct, then they two got together. Results 56 cases of breast cancer in 14 cases, unable to obtain complete imaging data, the remaining 42 breast cancer BI-RADS classification is 3 ～5, In 7 cases of missed diagnosis, initial diagnosed by junior doctors. In 27 cases of misdiagnosed, the main cause of misdiagnosis were masses with regular edges (8 cases ), size stability (3 cases ), internal echo is homogeneous ( 2 cases), multiple lesions, benign and malignant overlap (5 cases ); pregnancy, lactation period (n = 3 ); the prev