The application of breast ultrasonography in early diagnosis of breast cancer and the influencing factors of missed diagnosis and misdiagnosis
Objective To analyze the diagnostic efficiency of breast ultrasonography in early breast cancer,and explore the influencing factors of missed diagnosis and misdiagnosis,so as to provide evidence for the early screening and diagnosis of breast cancer.Methods The clinical data of 1678 patients with breast mass were retrospectively analyzed.All patients had complete breast ultrasonography and histopathological data.The histopathological results of breast mass were analyzed,and the diagnostic efficiency(sensitivity,specificity,accuracy)of breast ultrasonography for early breast cancer was analyzed with histopathological results as the gold standard.The clinical data of patients were analyzed,including age,maximum diameter of lesions,palpation,number of lesions,whether they were combined with benign lesions,whether they were combined with inflammatory lesions,microcalcification,positive axillary lymph nodes,axillary lymph node enlargement,whether the blood flow signal was obvious,the lesions had peripheral blood supply or no blood flow,and the structure of lesions was complex and diverse,etc.The univariate and multivariate Logistic regression was used to analyze the influencing factors of missed diagnosis and misdiagnosis.Results Among 1678 patients with breast mass,77 cases were confirmed as breast cancer by histopathology,including 29 cases of invasive ductal carcinoma,16 cases of invasive lobular carcinoma,12 cases of mucinous carcinoma,12 cases of ductal carcinoma in situ and 8 cases of ductal papillary carcinoma.Based on the histopathological results,there were 77 cases of breast cancer and 1601 cases of benign breast mass in 1678 patients.The sensitivity of breast ultrasonography was 96.10%(74/77),the specificity was 92.75%(1485/1601),and the accuracy was 92.91%(1559/1678).There were 77 cases of breast cancer,of which 3 cases were missed diagnosis,with a missed diagnosis rate of 3.90%;1601 cases of benign breast mass,of which 116 cases were misdiagnosed,with a misdiagnosis rate of 7.25%;the total incidence of misdiagnosis and misdiagnosis was 7.09%(119/1678).The univariate analysis showed that there were statistically significant differences between misdiagnosed and correctly diagnosed patients in the maximum diameter of lesions,palpation,benign lesions,inflammatory lesions,microcalcification,positive axillary lymph nodes,axillary lymph node enlargement,obvious blood flow signal,the lesions had peripheral blood supply or no blood flow,and the structure of lesions was complex and diverse(P<0.05).Multivariate Logistic regression analysis showed that the maximum diameter of the lesions[OR=1.732;95%CI=(1.104,2.873)],combined with benign lesions[OR=1.689;95%CI=(1.025,2.784)],combined with inflammatory lesions[OR=1.534;95%CI=(1.148,2.050)],microcalcification[OR=1.536;95%CI=(1.111,2.123)],positive axillary lymph nodes[OR=1.868;95%CI=(1.010,3.457)],axillary lymph node enlargement[OR=1.692;95%CI=(1.082,2.645)],unremarkable blood flow signal[OR=1.752;95%CI=(1.136,2.701)],lesions with peripheral blood supply or no blood flow[OR=1.891;95%CI=(1.002,3.569)],complex and diverse structure of the lesion[OR=1.539;95%CI=(1.008,2.350)]were independent factors leading to missed diagnosis and misdiagnosis of breast cancer(P<0.05).Conclusion Breast ultrasonography is an effective method for early diagnosis of breast cancer,but attention should be paid to missed diagnosis and misdiagnosis,especially for lesions with maximum diameter<1 mm,lesions with peripheral blood supply or no blood flow,small calcified lesions,and positive axillary lymph nodes.The possibility of misdiagnosis should be paid attention to when the blood flow signal is not obvious,the structure of complex and diverse lesions,inflammatory lesions,axillary lymph node enlargement.
Breast cancerBreast ultrasonographyMissed diagnosis and misdiagnosisDiagnosis
万方数据
维普
