台灣近年來女性乳癌發生率和死亡率逐年增加，乳癌發生率為女性十大癌症發生率的第一名，乳癌死亡率為女性癌症死因的第四位。台灣女性乳癌好發年齡的高峰在40-50歲，造成個人、家庭及社會沉重的負擔。在眾多乳癌的診斷工具研究中，常提及乳房超音波以及細針抽吸細胞學檢查，本研究之目的是探討乳房超音波以及細針抽吸細胞學檢查在乳癌診斷中的效益，期能提供臨床醫師參考。
本研究採病歷資料分析法。研究對象2776人次均來自南部某區域教學醫院乳房門診，接受超音波及細針抽吸細胞學檢查( fine needle aspiration cytology)的個案。超音波診斷分三組：惡性腫瘤、良性腫瘤、可能良性病變；細胞學診斷分三組：惡性腫瘤、良性腫瘤、疑似惡性腫瘤。乳癌的診斷是以乳房開刀病理結果為根據。
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2.6cm、1.8cm、1.3cm，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%。
超音波及超音波引導細針抽吸細胞學檢查在乳癌診斷方面，是可信賴的診斷工具。兩種檢查合併使用，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。可減少女性個案就診時間、減少醫療費用支出、減輕個案的焦慮情緒、降低乳房良性腫瘤開刀的比例。臨床醫師在選擇乳癌之診斷工具時，可考慮使用三合一檢查(醫師理學檢查、乳房超音波、細針抽吸細胞學檢查)，進而選擇治療的方式。超音波及細針抽吸細胞學檢查做為年輕女性乳癌篩檢的工具，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。

Objective: The incidence rate and mortality of breast cancer are increasing in Taiwan during recent years. The incidence rate of breast cancer is ranked number one among top ten female cancers, and the mortality of breast cancer is ranked fourth among cause of death for female cancer sufferers. The most common age group for breast cancer is between 40 and 50 years old. Breast cancer causes huge disease burdens for individual, family and society. 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.
Method: 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%.
Conclusion: 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.

第一章 緒論 1
第一節 台灣十大死因之現況 1
第二節 台灣十大癌症死因之現況 1
第三節 台灣癌症發生率之現況 1
第四節 台灣乳癌之現況 1
一、乳癌的發生率逐年增加 2
二、乳癌之死亡率逐年增加 2
第五節 乳癌之預防與篩檢 2
第六節 乳癌之診斷方法 3
第七節 研究目的 3
第二章 文獻回顧 4
第一節 乳癌 4
第二節 乳癌早期診斷之重要性 4
第三節 乳癌之診斷方法 4
一、醫師病史詢問、理學檢查(Physical examination) 4
二、乳房超音波( breast sonography) 4
三、乳房X光攝影術(mammography) 5
四、細針抽吸細胞學檢查( fine needle aspiration cytology，FNAC) 5
五、粗針切片病理檢查(core biopsy) 5
六、局部切除病理檢查(excision biopsy) 6
第四節 乳癌之診斷策略 6
一、乳癌之診斷策略 6
二、臨床之建議 6
第五節 細針抽吸細胞學檢查(fine needle aspiration cytology，FNAC) 7
一、細針抽吸細胞學檢查之歷史 7
二、細針抽吸細胞學檢查之報告分組( reporting categories) 7
三、超音波引導細針抽吸細胞學檢查之好處 9
四、細針抽吸細胞學檢查之相關研究 10
五、細針抽吸細胞學檢查之準確度 11
第六節 研究假設 12
第三章 研究材料與方法 13
第一節 研究對象 13
第二節 研究架構 13
第三節 研究變項的操作型定義 14
第四節 研究方法 15
第五節 統計分析 16
第四章 研究結果 18
第一節 研究個案基本資料 18
一、年齡層分組 18
二、腫瘤大小(超音波測量)分組 18
三、臨床醫師之超音波疾病診斷分組 19
四、病理科專科醫師之細胞學診斷分組 20
第二節 乳房開刀手術個案的基本資料 21
一、乳房開刀手術病理報告良、惡性在看診年齡上的分布 21
二、乳房開刀手術病理報告良、惡性在腫瘤大小上的分布 21
第三節 乳房開刀手術病理結果之相關因素分析 22
第四節 乳房開刀手術病理結果之相關因素勝算比 ( Odds ratios ) 23
一、乳房開刀手術病理報告良、惡性結果與個別因素之相關性 ( Crude Odds ratios ) 23
二、乳房開刀手術病理報告良、惡性結果與所有因素調整後之相關性 ( Odds ratio ) 25
第五節 乳房超音波 ( sonography ) 檢查在乳癌診斷之準確度 26
第六節 細針抽吸細胞學檢查( fine needle aspiration cytology，FNAC) 在乳癌診斷之準確度 27
第七節 超音波與細胞學檢查合併使用在乳癌診斷之準確度 27
一、超音波與細胞學檢查平行使用之診斷準確度 27
二、超音波與細胞學檢查系列使用之診斷準確度 28
第八節 超音波與細胞學檢查單獨或合併使用在乳癌診斷之特性 28
第五章 討論 31
第一節 細針抽吸細胞學檢查之特性 31
一、細針抽吸細胞學檢查方法 31
二、超音波引導細針抽吸細胞學檢查之結果 31
第二節 超音波與細胞學檢查合併使用在乳癌診斷之特性 32
一、超音波與細胞學兩種檢查平行使用之診斷準確度 32
二、超音波與細胞學兩種檢查系列使用之診斷準確度 32
第三節 超音波與細胞學檢查之好處 33
第四節 本研究之限制 34
第六章 結論與建議 35
一、本研究之結論 35
二、本研究之臨床應用 35
三、公共衛生方面 35
四、本研究之貢獻 36
五、未來研究之方向 36
參考文獻 37

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