乳腺癌个人史患者乳腺X线监测中补充乳腺超声的附加价值
该回顾性单中心研究分析了992例有乳腺癌个人史（PHBC）女性的1089次乳腺X线联合补充乳腺超声（SBU）监测检查。SBU未检出额外乳腺癌，仅检出3例腋窝淋巴结复发，但增加了额外活检和短期随访率。在保乳术和全乳切除亚组中，SBU的敏感度均为100%，特异度均为97.9%，ICDR均为3.3例恶性/1000次检查。
要点
- SBU对检出额外乳腺癌无附加价值，仅有助于发现腋窝淋巴结复发。
- SBU敏感度100%，但特异度略低于乳腺X线（97.9% vs 99.7%）。
- SBU导致额外活检和短期随访率增加，需权衡利弊。
关键影像表现/征象
- SBU未检出额外乳腺癌（保乳术组0.2%，全乳切除组1.0%），但检出3例额外腋窝淋巴结复发（保乳术组0.2%，全乳切除组0.3%）。
诊断标准与关键数值
- 保乳术组：乳腺X线敏感度75.0%（95%CI: 19.4,99.4），特异度99.7%（95%CI: 98.1,99.9）；SBU敏感度100.0%（95%CI: 39.8,100.0），特异度97.9%（95%CI: 95.7,99.3）；SBU的ICDR为3.3例恶性/1000次检查。
- 全乳切除组：乳腺X线敏感度75.0%（95%CI: 19.4,99.4），特异度99.7%（95%CI: 98.1,99.9）；SBU敏感度100.0%（95%CI: 39.8,100.0），特异度97.9%（95%CI: 95.7,99.3）；SBU的ICDR为3.3例恶性/1000次检查。
临床应用与阅片要点
- 对PHBC患者进行监测时，应认识到SBU对额外乳腺癌检出价值有限，重点关注腋窝淋巴结复发。
- SBU会增加额外活检和短期随访，报告时需结合临床病史谨慎建议。
局限性
- 回顾性单中心研究设计。
- 样本仅来自2015-2016年，可能存在选择偏倚。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To evaluate the diagnostic value of supplemental breast ultrasound (SBU) in women with a personal history of breast cancer (PHBC) undergoing mammography surveillance.
MATERIALS AND METHODS: This retrospective single-center study analyzed the data of women with PHBC and mammography with SBU between 2015 and 2016. Inclusion criteria were: BI-RADS 1-2 with at least 24 months follow-up, BI-RADS 3 with at least 36 months follow-up, and BI-RADS 4-5 with histopathologic confirmation. Performance measures included sensitivity, specificity and incremental cancer detection rate (ICDR) for mammography and SBU, separately.
RESULTS: Of the 1089 examinations in 992 women (mean age 62.9 ± 11.9 years), 75.7% had breast-conserving surgery (BCS) and 24.3% mastectomy. SBU did not detect additional cancers in the breast (0.2% in BCS and 1.0% in mastectomy) but identified three additional axillary lymphnode recurrences, (0.2% in BCS and 0.3% in mastectomy). In women with BCS mammography and SBU had sensitivity 75.0% (95%CI: 19.4,99.4) and 100.0% (95%CI: 39.8,100.0), specificity 99.7% (95%CI: 98.1,99.9) and 97.9% (95%CI: 95.7,99.3), respectively. The ICDR for SBU was 3.3 malignancy/1000 examinations. In women with mastectomy, mammography and SBU had sensitivity 75.0% (95%CI: 19.4,99.4) and 100.0% (95%CI: 39.8,100.0), specificity 99.7% (95% CI: 98.1,99.9) and 97.9% (95% CI: 95.7,99.3), respectively. The ICDR for SBU was 3.3 malignancy/1000 examinations. Overall, SBU led to increased rates of additional biopsies and short-term follow-ups.
CONCLUSION: Compared with mammography alone, SBU provided added value only for detecting axillary recurrences but not for identifying additional breast cancers. Its use should be balanced against increased rates of biopsy and recall.
引用
- Zanetti G, Nikolova E, Weber J, et al. Additional value of supplemental breast ultrasound in women with a personal history of breast cancer undergoing mammography surveillance. Eur J Radiol. 2026. PMID: 42140128. doi:10.1016/j.ejrad.2026.112932
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。