- 期刊
乳房超音波及超音波引導細針抽取細胞學檢查在乳癌診斷的效益分析
Combined Sonography and Fine-Needle Aspiration Cytology Improved Diagnostic Accuracy and Efficacy on Breast Tumors
摘要
目的：本研究之目的是探討乳房超音波檢查以及超音波引導細針抽吸細胞學檢查在乳癌診斷中所扮演的重要角色，暸解超音波檢查與超音波引導細針抽吸細胞學檢查單獨或合併使用在乳癌診斷中的特性。方法：收集來自南部某區域教學醫院乳房門診，接受乳房超音波檢查及超音波引導細針抽吸細胞學檢查的個案共計2776人次，比較臨床醫師以乳房超音波檢查為主之疾病診斷的良性或惡性比例，超音波引導細針抽吸細胞學診斷的良性或惡性比例，開刀個案組織學診斷的良性或惡性比例。結果：研究結果發現2776人次中，在本院開刀的總數555人次，占所有研究個案的20%。開刀結果為惡性腫瘤的個案數205（36.9%）；開刀結果為良性腫瘤的個案數350（63.1%）。乳房開刀結果惡性、良性及乳房未開刀的個案平均年齡分別為52.8歲、39.4歲、42.1歲，達顯著差異（p＜0.001）；平均腫瘤大小分別為2.6 cm、1.8 cm、1.3 cm，達顯著差異（p＜0.001）。乳房開刀結果與超音波診斷分組呈現顯著性相關（p＜0.001）；與細胞學診斷分組呈現顯著性相關（p＜0.001）。細胞學檢查在診斷乳癌時，其診斷特定度（specificity）為100%，偽陽性率（False positive ratio）為0，陽性預測值（positive predictive value）為100%。罹患乳癌的勝算比（Odds ratios）在超音波診斷分層、年齡分層、腫瘤大小分層分別為4.132(95% C.I:1.5~11.6）、31.957（95% C.I:3.7~272.4）、0.457（95% C.I:0.1~1.5）。超音波及細胞學檢查合併以平行檢查（parallel tests）方式使用，其診斷準確度（accuracy）為89.2%，敏感度（sensitivity）為90.2%，特定度（specificity）為88.6%，陽性預測值（positive predictive value）為82.2%，陰性預測值（negative predictive value）為93.9%；以系列檢查（serial testing）方式使用，其診斷準確度為88.1%，特定度為100%，敏感度下降為67.8%，陽性預測值為100%。陰性預測值為84.1%。結論：乳房超音波檢查及超音波引導細針抽吸細胞學檢查合併使用，可以提高乳癌診斷之準確度，降低偽陽性、偽陰性比率。這兩種檢查在門診部門就可施行，是簡單、迅速、正確、具成本效益的診斷乳癌之工具。做為乳癌篩檢的工具，可以早期診斷年輕女性的乳癌，早期介入治療，提高乳癌存活率
並列摘要
Objective: The breast sonography and fine needle aspiration cytology (FNAC) are common screening methods for breast cancer diagnosis. Nevertheless, little study has focused on the benefits of combing these two methods in clinical application. This study aims to fill such research gap. Methods: This study conducted medical chart reviews and collected 2,776 observations that were under breast sonography and FNAC examination from a regional hospital locates in southern Taiwan. The diagnosis categories for sonography include: malignant, benign, and probably benign tumor. The diagnosis categories for FNAC include: malignant, benign, and suspicious for malignant. Results: Among 2,776 observations, there were 555 observations (20%) had operation in the studied hospital. The operation results indicated that 205 (36.9%) observations were with malignant status, and 350 (63.1%) observations were with benign status. The diagnosis categories of both sonography and FNAC were significantly associated with the operation results (p＜0.001). The FNAC had specificity in 100%, false positive ratio in zero, and positive predictive value in 100%. The Odds ratios for sonography diagnosis categories, age groups, and tumor sizes were OR=4.132 (95%CI: 1.5-11.6), OR=31.957 (95% CI: 3.7-272.4), OR=0.457 (95% CI: 0.1-1.5), respectively. When combining sonography and FNAC in parallel tests, the diagnosis accuracy was 89.2%, sensitivity was 90.2%, specificity was 88.6%, positive predictive value was 82.2%, and negative predictive value was 93.9%. When combining sonography and FNAC in serial testing, the diagnosis accuracy was 88.1 %, sensitivity was 67.8%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 84.1 %. Conclusions: Combining sonography and FNAC in breast cancer diagnosis can increase the accuracy, decrease false positive ratio and false negative ratio. These two methods can be conducted during outpatient visit and are fast, accurate and cost-effective tools for breast cancer diagnosis. These two methods particularly appropriate for younger female patients for early screening, early intervention, and may increase the survival rates.