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随着社会发展,人民生活水平飞速提高,生活方式不断变革,男性乳腺疾病的发病率与女性一样,几乎每年都在提高。其中,最常发生的2种疾病分别是恶性病变中的乳腺癌,以及良性病变中的男性乳腺发育症。男性乳腺癌的发病率仅占男性癌症的1%,约占全球所有乳腺癌的1%,且男性乳腺癌病人在公众意识和合理治疗决策方面落后于女性,乳腺癌文献、研究、临床试验和开发新的治疗方案主要侧重于女性乳腺癌,而男性与女性的生理结构方面有很大差异,所以这些以女性乳腺癌为对象的研究结果,并不能完全适用于男性乳腺癌[1-2]。故本研究收集了经全数字化乳腺钼靶摄影(full-field digital mammography,FFDM)检查并经病理证实的男性乳腺疾病21例及同时期女性乳腺癌65例,回顾性分析其临床、病理及FFDM检查资料,旨在为男性乳腺疾病的诊断提供一定依据。
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21例男性乳腺病变病人年龄34~88岁,平均(64.48±15.55)岁。其中良性病变组13例,年龄34~85岁,平均(59.62±15.48)岁;恶性病变组8例,年龄48~88岁,平均(72.38±12.84)岁。男性病人良恶性病变2组间的发病年龄比较,差异无统计学意义(P>0.05)。
65例女性病人年龄26~74岁,平均(50.46±9.96)岁,均为恶性病变。男性乳腺癌与女性乳腺癌2组间发病年龄比较,差异有统计学意义(t′=3.88,P < 0.01)。
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21例男性乳腺病变中,良性13例,其中男性乳腺增生性病变7例,慢性炎症3例,乳头状瘤、脂肪瘤及良性叶状肿瘤各1例;恶性8例,均为浸润性导管癌,其中Luminal-A型3例,Luminal-B型2例,另3例未取得免疫组化结果。65例女性乳腺癌均为浸润性导管癌,其中Luminal-A型18例,Luminal-B型23例,非Luminal型24例。
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男性乳腺恶性病变组病灶肿块以及有无周围血管增粗(或增多)发生率均高于良性病变组,局灶不对称影发生率低于良性病变组,差异均有统计学意义(P < 0.05);2组结构扭曲、乳头凹陷发生率比较,差异均无统计学意义(P>0.05)(见表 1)。
分组 n 肿块 局灶不对称影 血管增粗(或增多) 结构扭曲 乳头凹陷 恶性病变组 8 5(62.50) 3(37.50) 6(75.00) 4(50.00) 3(37.50) 良性病变组 13 1(7.69) 12(92.31) 2(15.38) 4(30.77) 4(30.77) P — 0.014* 0.014* 0.018* 0.645* 1.000* *示确切概率法 表 1 男性乳腺良恶性病变2组病人的FFDM图像特征比较[n; 百分率(%)]
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男性乳腺癌组乳头凹陷发生率高于女性乳腺癌组,可疑恶性钙化发生率低于女性乳腺癌组,差异均有统计学意义(P < 0.05);2组肿块、局灶不对称影、周围血管增粗(或增多)、结构扭曲、肿块边缘模糊和肿块毛刺征发生率比较,差异均无统计学意义(P>0.05)(见表 2)。
分组 n 肿块 局灶不对称影 血管增粗(或增多) 结构扭曲 乳头凹陷 可疑恶性钙化 肿块边缘模糊 肿块毛刺征 男性乳腺癌组 8 5(62.50) 3(37.50) 6(75.00) 4(50.00) 3(37.50) 0(0.00) 1(12.50) 1(12.50) 女性乳腺癌组 65 37(56.92) 25(38.46) 23(35.38) 19(29.23) 5(7.69) 28(43.08) 30(46.15) 15(23.08) χ2 — 0.01* 0.01* 3.16* 0.62* — 3.92* 2.07* 0.05* P — >0.05 >0.05 >0.05 >0.05 0.04# < 0.05 >0.05 >0.05 *示矫正χ2值;#示确切概率法 表 2 男性乳腺癌与女性乳腺癌2组病人的FFDM图像特征比较[n; 百分率(%)]
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ROC曲线下面积(AUC)为0.885、敏感度100%、特异性76.9%、符合率85.7%、阳性预测值72.7%、阴性预测值100%(见图 1)。
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病人1,男,62岁,因右乳肿胀增大就诊,FFDM图像示右乳晕后区斑片样腺体影,术后病理男性乳腺发育(见图 2);病人2,男性,52岁,自觉左乳肿块伴疼痛不适,FFDM图像示左乳晕后区局灶不对称影,伴乳头轻度凹陷,术后病理乳腺慢性炎症(见图 3);病人3,男性,75岁,左乳质硬肿块数月,FFDM图像示左乳晕后区高密度肿块,形态不规则,边界较清伴明显分叶,周围血管增粗,术后病理浸润性乳腺癌(见图 4);病人4,女性,43岁,体检超声提示右乳结节,FFDM图像示右乳外上象限局灶不对称影,术后病理示浸润性乳腺癌(见图 5)。
全数字化乳腺钼靶摄影对男性乳腺病变良恶性的鉴别诊断
Value of the full-field digital mammography in the differential diagnosis of benign and malignant male breast lesion
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摘要:
目的探讨全数字化乳腺钼靶摄影(full-field digital mammography,FFDM)对男性乳腺病变良恶性的鉴别诊断价值。 方法收集2018年7月至2021年10月经FFDM检查并取得病理结果的21例男性乳腺肿块病人及65例女性乳腺癌病人资料。回顾性分析其临床及影像学特征并进行比较,采用受试者工作特征性(ROC)曲线下面积(AUC)来评估FFDM对男性乳腺病变的诊断效能。 结果21例男性乳腺病变中良性13例,恶性8例。男性乳腺恶性病变组肿块以及有无周围血管增粗(或增多)发生率均高于良性病变组,局灶不对称影发生率低于良性病变组,差异均有统计学意义(P < 0.05);2组结构扭曲、乳头凹陷发生率比较,差异均无统计学意义(P>0.05)。男性乳腺癌组乳头凹陷发生率高于女性乳腺癌组,可疑恶性钙化发生率低于女性乳腺癌组,差异均有统计学意义(P < 0.05);2组肿块、局灶不对称影、周围血管增粗(或增多)、结构扭曲、肿块边缘模糊和肿块毛刺征发生率比较,差异均无统计学意义(P>0.05)。FFDM对于男性乳腺疾病诊断的AUC为0.885,敏感度100%,特异度76.9%,符合率85.7%,阳性预测值72.7%,阴性预测值100%。 结论FFDM对男性乳腺良恶性病变具有较好地诊断价值,肿块及周围血管增粗(或增多)是诊断男性乳腺癌最重要的影像表现,良性病变以男性乳腺发育最常见,多表现为局灶不对称影。 -
关键词:
- 全数字化乳腺钼靶摄影 /
- 乳腺病变 /
- 男性 /
- 鉴别诊断
Abstract:ObjectiveTo evaluate the value of full-field digital mammography(FFDM) in the differential diagnosis of benign and malignant male breast lesions. MethodsTwenty-one male patients with breast mass and 65 female breast cancer patients detected by FFDM and pathology from July 2018 to October 2021 were investigated.The clinical and radiographic features of all cases were retrospectively analyzed.The area under the receiver operating characteristic curve(AUC) was used to evaluate the differential diagnosis efficacy of FFDM for benign and malignant breast lesions. ResultsAmong the 21 cases, 13 cases were benign, and 8 cases were malignant.The incidence rates of mass and peripheral vascular thickening(or increase) in the male breast malignant lesions groups were higher than those in the benign lesions group, and the incidence rate of focal asymmetric shadow of which was lower than that in the benign lesions group(P < 0.05).There was no statistical significance in the incidence rate of structural distortion and nipple depression between two groups(P>0.05).The incidence rate of nipple depression in male breast cancer group was higher than that in female breast cancer group, and the incidence rate of suspected malignant calcification of which was lower than that in female breast cancer group(P < 0.05).The differences of the incidence rates of the mass, focal asymmetric shadow, peripheral vascular thickening(or increase), structural distortion, blurred mass margin and mass burr features between two groups were not statistically significant(P>0.05).The AUC of FFDM for the diagnosis of male breast disease was 0.885, and the sensitivity, specificity, incidence rate, positive predictive value and negative predictive value were 100%, 76.9%, 85.7%, 72.7% and 100%, respectively. ConclusionsFFDM has a good diagnostic value for benign and malignant male breast lesions.The mass and thickening(or increase) of peripheral blood vessels are the most important imaging findings in the diagnosis of male breast cancer.Male mammary gland development was the most common benign lesion, and the benign lesions are mostly manifested as focal asymmetric shadows. -
Key words:
- full-field digital mammography /
- breast lesion /
- male /
- differential diagnosis
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表 1 男性乳腺良恶性病变2组病人的FFDM图像特征比较[n; 百分率(%)]
分组 n 肿块 局灶不对称影 血管增粗(或增多) 结构扭曲 乳头凹陷 恶性病变组 8 5(62.50) 3(37.50) 6(75.00) 4(50.00) 3(37.50) 良性病变组 13 1(7.69) 12(92.31) 2(15.38) 4(30.77) 4(30.77) P — 0.014* 0.014* 0.018* 0.645* 1.000* *示确切概率法 表 2 男性乳腺癌与女性乳腺癌2组病人的FFDM图像特征比较[n; 百分率(%)]
分组 n 肿块 局灶不对称影 血管增粗(或增多) 结构扭曲 乳头凹陷 可疑恶性钙化 肿块边缘模糊 肿块毛刺征 男性乳腺癌组 8 5(62.50) 3(37.50) 6(75.00) 4(50.00) 3(37.50) 0(0.00) 1(12.50) 1(12.50) 女性乳腺癌组 65 37(56.92) 25(38.46) 23(35.38) 19(29.23) 5(7.69) 28(43.08) 30(46.15) 15(23.08) χ2 — 0.01* 0.01* 3.16* 0.62* — 3.92* 2.07* 0.05* P — >0.05 >0.05 >0.05 >0.05 0.04# < 0.05 >0.05 >0.05 *示矫正χ2值;#示确切概率法 -
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