摘要
目的 探讨高频超声引导下粗针穿刺活检及肿瘤标志物检测在乳腺肿块良恶性鉴别诊断中的价值。方法 选择140例乳腺肿块患者作为研究对象,经手术术后病理检查确诊乳腺癌72例、乳腺良性病变68例,所有患者术前均接受高频超声检查、高频超声引导下粗针穿刺活检及肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)]检测。比较不同检查方法 (高频超声、高频超声引导下粗针穿刺活检)对乳腺癌的诊断效能,乳腺癌和乳腺良性病变患者的肿瘤标志物(CEA、CA199、CA125)水平,不同高频超声引导下粗针穿刺活检结果患者的超声表现特征及肿瘤标志物水平。结果 高频超声引导下粗针穿刺活检将4例乳腺癌误诊为乳腺良性病变,将1例乳腺纤维瘤和2例纤维样囊肿误诊为乳腺癌。高频超声引导下粗针穿刺活检诊断乳腺癌的灵敏度、特异度及准确率分别为94.44%、95.59%、95.00%,均明显高于高频超声的68.06%、79.41%、73.57%(P<0.05)。乳腺癌患者CEA、CA199、CA125水平分别为(4.55±1.22)ng/ml、(31.86±9.56)U/ml、(26.12±6.18)U/ml,均明显高于乳腺良性病变患者的(1.68±0.52)ng/ml、(12.10±4.33)U/ml、(11.54±4.83)U/ml(P<0.05)。高频超声引导下粗针穿刺活检良性与恶性患者的肿块最大直径、形态、边界、内部回声、淋巴结肿大、钙化、血流信号等超声特征比较差异有统计学意义(P<0.05)。高频超声引导下粗针穿刺活检良性患者的CEA、CA199、CA125水平分别为(1.74±0.55)ng/ml、(12.43±4.40)U/ml、(11.62±4.88)U/ml,均低于恶性患者的(4.53±1.26)ng/ml、(31.88±9.68)U/ml、(26.25±6.20)U/ml(P<0.05)。结论 高频超声引导下粗针穿刺活检能够较好的鉴别诊断乳腺癌与乳腺良性病变,其诊断效能明显优于单纯高频超声,穿刺活检结果与肿瘤标志物、超声表现特征存在明显关系,能够为乳腺肿块治疗提供指导依据。
Objective To explore the value of high-frequency ultrasound-guided coarse needle biopsy and tumor marker detection in differential diagnosis of benign and malignant breast masses.Methods 140 patients with breast mass were selected as the study objects,72 cases of breast cancer and 68 cases of benign breast lesions were confirmed by postoperative pathological examination.All patients underwent high-frequency ultrasound examination,high-frequency ultrasound-guided coarse needle biopsy and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),carbohydrate antigen 125(CA125)]detection before surgery.The diagnostic efficacy of different examination methods(high-frequency ultrasound and high-frequency ultrasound-guided coarse needle biopsy)for breast cancer was compared,as well as the levels of tumor markers(CEA,CA199,CA125)in patients with breast cancer and benign breast lesions,and the ultrasound performance characteristics and tumor marker levels in patients with different high-frequency ultrasound-guided coarse needle biopsy results.Results High-frequency ultrasound-guided coarse needle biopsy misdiagnosed 4 cases of breast cancer as benign breast lesions,1 case of breast fibroma and 2 cases of fibroid cyst as breast cancer.The sensitivity,specificity and accuracy of high-frequency ultrasound-guided coarse needle biopsy in the diagnosis of breast cancer were 94.44%,95.59%and 95.00%,which were significantly higher than 68.06%,79.41%and 73.57%of high-frequency ultrasound(P<0.05).CEA,CA199 and CA125 levels in breast cancer patients were(4.55±1.22)ng/ml,(31.86±9.56)U/ml and(26.12±6.18)U/ml,which were significantly higher than(1.68±0.52)ng/ml,(12.10±4.33)U/ml and(11.54±4.83)U/ml in patients with benign breast lesions(P<0.05).The differences in ultrasound characteristics such as maximum diameter of the mass,morphology,borders,internal echoes,lymph node enlargement,calcification,and blood flow signals were statistically significant when comparing benign and malignant patients undergoing high-frequency ultrasound-guided coarser needle biopsy(P<0.05).The CEA,CA199,and CA125 levels in benign patients undergoing high-frequency ultrasound-guided coarse needle biopsy were(1.74±0.55)ng/ml,(12.43±4.40)U/ml,and(11.62±4.88)U/ml,which were lower than(4.53±1.26)ng/ml,(31.88±9.68)U/ml,and(26.25±6.20)U/ml in malignant patients(P<0.05).Conclusion High-frequency ultrasound-guided coarse needle biopsy can better differentiate breast cancer from benign breast lesions,and its diagnostic efficiency is significantly better than that of high-frequency ultrasound alone,and the results of the aspiration biopsy have a clear correlation with the tumor markers and ultrasound characteristics,which can provide a basis for guiding the treatment of breast mass.
作者
沈勤红
SHEN Qin-hong(Huian County Hospital,Quanzhou 362100,China)
出处
《中国现代药物应用》
2024年第5期68-71,共4页
Chinese Journal of Modern Drug Application
