超声未能诊断乳腺癌的原因回顾分析【摘要】目的回顾分析在先前乳腺超声诊断为假阴性（假阴性），而在超声随访中进展诊断为乳腺癌的病人患者临床资料，并分析可能产生假阴性的原因。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），两人取得一致意见。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，分析表明：①其中7例为漏诊，初次诊断全部由低年资医生做出。②27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-RADS3级的有27例（64.29%）。③）。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错误失误所致。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-RADS3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】AUndiagnosedbreastcanceratultrasoundimaging:analysisofcauses【Abstract】ObjectiveToretrospectivelyreviewthecausesoffalse-negativeresultsonpriorultrasound(US)imagingstudiesinpatientswhodevelopedbreastcancerasrevealedonafollow-upUSimagingstudyandtodeterminethepresumptivecausesofthesefalse-negativefindings.MethodsToscreenedthebreastcancercaseswhichwerediagnosisinpathologicalinourhospital’sPictureArchivingandCommunicationSystems(PACS).Weselected56casesdiagnosedbyfollow-upexaminationwithpreviousultrasonicnegativediagnosis.TwoassociateprofessorultrasounddoctorsretrospectivelyanalysisedbreastultrasoundimagessavedinthePACSsystemwithotherdateasMammography,MRI,andthereasonsofmisdiagnoseandmisconduct,thentheytwogottogether.Results56casesofbreastcancerin14cases,unabletoobtaincompleteimagingdata,theremaining42breastcancerBI-RADSclassificationis3～5,Itwasshownthat:In7caseswithofmisseddiagnosis,initialdiagnosedbyjuniordoctors.In27casesofmisdiagnosed,themaincauseofmisdiagnosisweremasseswithregularedges(8cases),sizestability(3cases),internalechoishomogeneous(2cases),multiplelesions,benignandmalignantoverlap(5cases);pregnancy,lactationperiod(n=3);thepreviousbreastlesionsbyBI-RADScategoryweregrade3In27cases(64.29%).Thetreatmentof8caseswasmismanagement,mainlyfromnotenoughcorrelationwiththemolybdenumtargetandMRIimaging.Twocaseswerecausedbyimproperbiopsyguidedbyultrasound.ConclusionsInpatientswithbreastcancerseenatUSimaging,retrospectiveevaluationofthepriorUSimagingstudiesshowed:thejuniordoctorsshouldincreasetheexperienceofultrasonicdiagnosisofbreastcancer;resultingmorefrommisdiagnosedthanfromnonrecognitionormismanagementofcancers，andBI-RADS3lesionswashighestrateofmisdiagnosed.USimagingshouldbeenoughcorrelationwiththemammographymolybdenumtargetandMRIimaging.,inordertoeducetheoccurrenceofmisseddiagnosis,misdiagnosis.【Keywords】Breastcancer;BI-RADScategoryclassification;Ultrasonography乳腺超声对于鉴别良恶性局限性病变在临床实践中非常有用乳腺超声在鉴别乳腺良恶性局限性病变的临床工作中非常有用，属于乳腺癌筛查的常规必要检查，但必然其存在假阴性的可能【1～2】。目前较多的研究的文献多为回顾分析误诊的乳腺癌的声...