Digital Breast Tomosynthesis: A New Diagnostic Method for Mass‐Like Lesions in Dense Breasts

To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass‐like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI‐RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false‐negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI‐RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.     

数字乳腺断层摄影定性诊断乳腺肿块

目的观察数字乳腺断层摄影(DBT)定性诊断乳腺肿块的效能。方法回顾性分析85例女性乳腺肿块患者,以组织病理学结果为诊断金标准,采用受试者工作特征(ROC)曲线分析全数字化乳腺X线摄影(FFDM)、DBT及FFDM+DBT的定性诊断效能。结果于85例共检出89个乳腺肿块,病理诊断良性病变56个、恶性病变33个。FFDM、DBT及FFDM+DBT定性诊断乳腺肿块的敏感度分别为69.64%、87.50%、和87.50%,特异度分别为69.70%、78.79%和84.85%,准确率分别为69.66%、84.27%和86.52%,AUC分别为0.75[95%CI(0.65,0.84)]、0.92[95%CI(0.84,0.97)]和0.93[95%CI(0.86,0.98)];DBT、FFDM+DBT的敏感度、特异度、准确率及AUC均大于FFDM(P均0.05),DBT与FFDM+DBT差异均无统计学意义(P均0.05)。结论 DBT可定性诊断乳腺肿块,且其诊断效能高于FFDM。     

Magnetic resonance imaging of suspicious breast masses seen on one mammographic view

The purpose of this study was to assess the utility of contrast-enhanced breast magnetic resonance imaging (MRI) in identifying lesions unidentified on the craniocaudal projection. The authors reviewed five patients with suspicious mammographic lesions not imaged on the craniocaudal mammogram who were referred for contrast-enhanced MRI and underwent subsequent preoperative needle localization in four of the five cases. Five patients, ages 56 to 69 years, had suspicious lesions identified on mediolateral oblique (MLO) or mediolateral (ML) projections only. Ultrasound did not identify the lesion in any of these cases. MRI identified suspicious breast lesions measuring 5 to 12 mm in size. These were located high on the chest wall or in the upper inner quadrant. Suspicious lesions seen only on the MLO or ML projections may reside high on the chest wall or in the upper inner quadrant. Lesions in these locations may be typically excluded on the craniocaudal projection during mammography. Breast MRI has the advantage of imaging the entire breast and is particularly useful for these lesions. In this series, MRI prevented delay in breast cancer diagnosis.     

术中标本摄片用于乳腺可疑钙化病变组织活检

目的 观察术中标本摄片用于乳腺可疑钙化病变组织活检的价值。方法 对48例乳腺单发可疑钙化病变患者行X线三维立体定位引导活检术,对其中12例行核芯针穿刺活检(SCNB)、22例行真空辅助旋切活检(SVAB)、14例行导丝定位手术切检(SNLB),术中以标本摄影系统对组织标本行X线摄片,之后对标本中的钙化进行标记并送病理检查;评估标本摄片在3种活检方式中显示钙化的清晰度及组织学低估情况,观察SNLB术中标本摄片所示钙化数目及切缘状态,并与术前乳腺X线片进行比较。结果 所有标本均获得目标钙化组织。术中标本摄片显示钙化清晰度优于术前乳腺X线片,显示SNLB组织内钙化数量多于术前乳腺X线片。14例SNLB中,12个术中标本摄片显示切缘阴性,与术后病理结果一致;2个切缘阳性,且钙化呈多灶性分布,术中快速冰冻切片结果均为恶性并切缘阳性,手术计划由保乳手术改为乳腺癌改良根治术。SCNB、SVAB活检结果及SNLB术中冰冻切片结果与手术病理结果均一致。结论 术中标本摄片用于乳腺可疑钙化病变组织活检具有一定价值。     

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

To compare diagnostic performance of contrast‐enhanced dual‐energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast‐enhanced MRI (DCE‐MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3‐5 at imaging or clinically suspicious). CEDM, DBT, and DCE‐MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two‐dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE‐MRI. DCE‐MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE‐MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE‐MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE‐MRI. Dynamic information obtained by time‐intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.     

人工智能辅助低年资放射科医师检出乳腺病变

目的观察人工智能(AI)辅助对低年资放射科医师检出乳腺X线片中乳腺病灶的价值。方法回顾性分析73例接受乳腺X线摄影检查的女性患者。由3名低年资放射科医师首先分别阅片,之后于AI辅助下再次阅片,勾画乳腺病灶区域;统计检出病灶数,记录病灶类型及乳腺影像报告和数据系统(BI-RADS)分类。以病理结果或随访最终临床诊断为标准,对比医师单独阅片与AI辅助阅片检出乳腺病灶的敏感度和准确率及对不同类型、不同BI-RADS分类病灶的诊断效能。结果 73例共121个乳腺病灶,其中软组织病灶(包括肿块、结构扭曲与不对称病灶)88个、钙化病灶33个;BI-RADS 2类17个,3类66个,4类及以上38个。与医师单独阅片相比,AI辅助阅片对全部乳腺病灶、特别是软组织病灶的诊断敏感度和准确率均显著提升(P均0.01),而对乳腺钙化病灶的敏感度和准确率差异均无统计学意义(P均0.05)。结论 AI辅助有助于提高低年资放射科医师检出乳腺X线片中乳腺病灶、尤其软组织病灶的效能。     

Suspicious Findings at Digital Breast Tomosynthesis Occult to Conventional Digital Mammography: Imaging Features and Pathology Findings

To review the imaging and pathologic features of a series of lesions detected at digital breast tomosynthesis (DBT), which are occult to conventional digital mammography (DM). We retrospectively reviewed 268 consecutive breast imaging reporting and data system 4 and 5 lesions imaged with both DM and DBT at our facility from July 2012 through April 2013. For each lesion, we recorded the mammographic finding, breast density, mode of biopsy, and pathology results. A total of 19 lesions were identified at DBT that were occult to DM. Sixty three percent (12/19) of these lesions were identified in dense breasts. Architectural distortion was seen in 74% (14/19) of cases and spiculated masses accounted for the remaining 26% (5/19). The positive predictive value of biopsy was 53% (10/19). Seven cases were infiltrating ductal carcinomas and three were infiltrating lobular carcinomas. High‐risk lesions accounted for 47% (9/19) of the lesions, the majority of which were radial scars 67% (6/9). Eighty four percent (16/19) of the lesions underwent ultrasound guided core biopsy while the remainder underwent magnetic resonance imaging guided core biopsy. DBT may demonstrate suspicious lesions that are occult to DM, particularly in women with dense breasts. Such lesions have a high likelihood of malignancy and warrant biopsy.     

Membranous fat necrosis of the breast: diagnosis by minimally invasive technique

Clinical and mammographic features of membranous fat necrosis (MFN) may simulate breast malignancy and tissue sampling is essential for accurate diagnosis. The aim of our study was to evaluate the clinical and imaging findings in these patients. Retrospective review of the records of breast biopsies (n = 1200) during the 5-year period 1998 to 2002 revealed eight (0.67%) cases of histologically proven MFN. Seven of the eight patients had a history of breast trauma or surgery. Seven patients underwent mammography: normal in two, a mass with curvilinear calcifications in one, and heterogeneous calcifications in four. Four patients underwent surgical excision of a palpable mass, one patient had complete excision of calcifications with large core biopsy technique, and three patients had stereotactic vacuum-assisted mammotome biopsy (VAMB). MFN should be included in the differential diagnosis of lesions in a breast with previous trauma or surgery. A minimally invasive diagnostic procedure should be considered in order to avoid excessive excisional surgery.     

Disparities in the uptake of digital breast tomosynthesis for breast cancer screening: A retrospective cohort study

We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.     

1.5T乳腺专用磁共振诊断乳腺导管内乳头状瘤的应用价值

目的:探讨乳腺专用磁共振诊断导管内乳头状瘤的应用价值。方法:收集我院经手术病理证实的31例乳腺导管内孤立/多发乳头状瘤病例进行回顾性分析。所有病人术前均行乳腺X线、超声检查及AURORA乳腺专用磁共振平扫及动态增强扫描。参照乳腺影像报告和数据系统(BI-RADS),评价其病灶的形态学(包括病灶大小、形状、部位、边缘、多形性及与导管的关系)、动态增强扫描的强化模式及其他相关的特征,并与X线、超声检查相对照。结果:31例病人孤立导管内乳头状瘤23例,多发导管乳头状瘤8例。MRI共检出30个病灶,其中2例导管内乳头状瘤MRI为阴性,1例双侧多发导管乳头状瘤MRI检出双侧病灶。其MRI形态学表现最多见是沿导管分布多发小结节样或环形强化(38.7%),其次为乳晕后区孤立或多发结节样强化(22.6%)及乳晕后方导管样、线状、分支样强化(12.9%),伴或不伴导管扩张,MRI增强信号-时间曲线以平台型和流出型为主,具有一定的特征性。部分(4例)表现为类似恶性肿瘤的MRI征象(12.9%),难以与恶性肿瘤区分。结论:乳腺专用MRI检查对检出导管内乳头状瘤(病)具有较大的优势,能为临床手术治疗提供准确定位,具有较好的应用价值。     

Clinicopathologic update of calcium oxalate in breast: A 15‐year retrospective review

Mammary malignancies are radiologically detected by presence of masses, architectural distortions or microcalcifications. Unlike calcium hydroxyapatite, calcium oxalate (CaOx) deposits have been almost exclusively associated with benign mammary processes. The etiology and mechanism of mammary CaOx deposition remains poorly understood, and the original studies elucidating its histopathologic correlation are dated several decades ago. We reviewed radiopathologic findings of breast biopsies and excisions to re‐examine the clinicopathologic significance of CaOx deposits and to ascertain potential radiologic characteristics for their identification. Fifty patients from 2004 to 2019 with reported “calcium oxalate” were retrospectively reviewed. CaOx was invariably detected with histopathologic changes of nonproliferative ducts/cysts (90%, 45 of 50), and less commonly, ducts/cysts with usual ductal hyperplasia (10%, 5 of 50). CaOx was missed on one biopsy with a subsequent excision showing apocrine cyst with CaOx. Despite the benign pathological findings, mammographic findings corresponding to CaOx ranged from benign to highly suspicious with 20% categorized as benign (round or punctuate), 22% as intermediate amorphous, 14% as suspicious (coarse/heterogeneous), and 18% as highly suspicious/pleomorphic, respectively. Lobular carcinoma in situ (LCIS) was present in separate fields from CaOx containing benign ducts in two cases which were radiologically characterized as “grouped heterogeneous” and “localized linear.” On imaging, more than half of the cases (52.5%) had a corresponding BI‐RADS score of 4 and the calcifications were associated with variable distributions and appearances. In conclusion, this is one of the largest studies of CaOx in breast with radiology and pathology correlation. The radiologic appearances of CaOx are nonspecific from benign to highly suspicious. Identification of CaOx on the biopsy is reassuring for a benign diagnosis. Incidental atypical lesions can occur that are often not directly associated with CaOx. CaOx may be overlooked on pathologic evaluation which results in unnecessary surgery. Our findings support close radiologic–pathologic correlation for clinical decision‐making pertaining to breast calcifications.     

乳腺恶性肿瘤全自动乳腺容积成像系统图像分析

目的评价全自动乳腺容积成像系统（ABVS）对乳腺恶性肿瘤的诊断价值。方法对手术后病理证实的48个乳腺恶性肿瘤的ABVS图像进行回顾性分析,探讨其成像特点,并与手术和病理结果进行对照分析。结果 48个乳腺癌肿中,实性肿瘤38个,囊实性肿瘤4个,弥漫性病变6个。ABVS可探测到所有病变。病灶类型与病理分型有关;36个实性肿瘤在冠状切面上有＂火山口＂征,占实性肿瘤的94.74%（36/38）;43例有钙化,占89.58%（43/48）。结论 ABVS在诊断乳腺癌方面有优势;冠状切面上＂火山口＂征和钙化是乳腺癌的特征性ABVS表现。     

Assessing the Relationship of Mammographic Breast Density and Proliferative Breast Disease

Increased breast density and a history of benign breast biopsy are both considered risk factors for developing breast cancer. Understanding the specifics of these risk factors and their relationship to each other can lead to a better understanding of a patient's propensity for breast cancer development and improved surveillance strategies. We included 245 women who underwent a benign breast biopsy without atypia between October 2011 and June 2013. Biopsies were performed for suspicious calcifications as well as masses and architectural distortion. Lesions biopsied were divided into two groups: calcified and noncalcified lesions. The patient's breast density was assessed on most recent mammogram and was classified using the American College of Radiology BI‐RADS density categories. Based on histologic diagnosis, each case was classified as proliferative or nonproliferative breast disease. The median age of the cohort (n = 245) was 55 years (range, 40–84 years). There were 162 (66%) postmenopausal women in the study. A core biopsy was performed for calcifications in 33.5% cases and for noncalcified lesions in 58% cases. In patients with dense breast tissue, an underlying proliferative histology was found significantly more frequently with calcifications (66.7%) as opposed to noncalcified lesions (35.9%) (RR = 2.3 (1.3–4.0); χ² = 8.7; p = 0.003). In nondense breast patients, there was no significant difference (RR = 1.1 (0.7–1.8); χ² = 0.1; p = 0.738). In the postmenopausal group, women with dense breasts had proliferative histology significantly more frequently than women with nondense breasts (55.3% versus 38.3%; p < 0.05), regardless of the underlying lesion type. Postmenopausal women with dense breasts who underwent a breast biopsy with benign histology had a significantly higher likelihood of having proliferative breast disease, regardless of underlying lesion type. Women with dense breasts also showed proliferative histology significantly more often for calcifications as opposed to noncalcified lesions.     

Three years of experience with advanced breast biopsy instrumentation (ABBI)

This article reports our experience using the advanced breast biopsy instrument (ABBI) system for excisional biopsy of mammographically visible nonpalpable breast lesions. Patients with nonpalpable mammographically detected breast lesions were evaluated as potential ABBI candidates. Selection criteria included noncystic lesions for which complete removal or large sampling was indicated, compressed thickness of the breast of more than 25 mm, and the patient's ability to lie prone for at least 1 hour. During the period August 1997-April 2000 (33 months), 284 patients were found to be potential ABBI candidates. Sixteen patients were subsequently excluded. Biopsies using the ABBI system were performed in 268 cases, yielding an overall technical success rate of 94.4%. The mammographic abnormalities included mass in 125 cases (46.6%), mass with calcifications in 63 cases (23.5%), and microcalcifications without a mass in 80 cases (29.8%). Histologically 56 specimens (20.9%) were malignant (mass in 30 cases, mass with calcifications in 12, and microcalcifications in 14) and 212 (79.1%) were benign. Carcinoma in situ was found in 17 cases (30.4%), invasive carcinoma in 35 cases (62.5%), tubular carcinoma in 2 cases (3.6%), metastatic intramammary lymph node of previously unknown malignant melanoma in 1 case, and malignant lymphoma in 1 case. Open reexcision was performed in 54 cases with primary breast cancer. The histologic investigation revealed that in 26 (48.15%) cases the mammographic lesion was completely excised and in 28 (51.85%) cases the margins involved malignant residue and/or other foci of carcinoma. There were complications in 17 cases: wound infection in 2, ecchymosis in 9, seroma in 5, and a large immediate hematoma in 1 patient. Only the latter patient required immediate revision and drainage; the remainder underwent successful conservative treatment. Most nonpalpable breast lesions, if selected properly, are accessible for ABBI procedure. The biopsy causes minimal complications and minimal distortion of the breast architecture. Should relumpectomy be needed after the ABBI procedure, the tunnel of the cannula path is easily recognized, leaving no need for needle localization.     

Breast molecular imaging: a retrospective review of one institutions experience with this modality and analysis of its potential role in breast imaging decision making

Breast Molecular Imaging (or Breast-Specific Gamma Imaging) has been previously shown to be both sensitive and specific for the detection of breast cancer. The purpose of our study was to retrospectively review all cases of Breast Molecular Imaging (BMI) performed at our institution to determine BMI's potential role in Breast Imaging decision making. A total of 416 cases of BMI from January 2007 to November 2009 were analyzed and the following data were collected: indication for examination, BIRADS assignment after BMI, biopsy outcomes, sensitivity and specificity of the modality and patient follow-up. Fifty-six percent of cases were ordered for an indeterminate asymmetry or focal asymmetry, 14% for evaluation of calcifications, and less than 10% each for the remainder of the indications including palpable lumps with negative imaging, evaluation of extent of disease in patients with known breast cancer and screening of high risk patients who could not undergo MRI. BMI was also shown to be helpful in evaluation of lesions that were difficult to biopsy or for patients that desired further testing rather than biopsy or short term follow-up of abnormalities. Seventy percent of BMI cases performed completed the diagnostic evaluation with BIRADS 1 or BIRADS 2 designations. Only 14% of cases ultimately resulted in biopsy. Contra-lateral findings were discovered in 10% of patients, more than half of which were occult malignancies or high-risk lesions. Of the lesions for which biopsy was recommended, 43% were malignant and 15% were high-risk lesions. Sensitivity of the test at our institution was 93% and specificity 78.9%. Our results show that BMI is both a sensitive and specific test which is useful as an adjunct to standard breast imaging modalities for problem solving in indeterminate cases.     

Preoperative assessment of breast cancer: Multireader comparison of contrast-enhanced MRI versus the combination of unenhanced MRI and digital breast tomosynthesis

PurposeTo compare the sensitivity for breast cancer (BC) and BC size estimation of preoperative contrast-enhanced magnetic resonance imaging (CEMRI) versus combined unenhanced magnetic resonance imaging (UMRI) and digital breast tomosynthesis (DBT).Patients and methodsWe retrospectively included 56 women who underwent DBT and preoperative 1.5 T CEMRI between January 2016–February 2017. Three readers with 2–10 years of experience in CEMRI and DBT, blinded to pathology, independently reviewed CEMRI (diffusion-weighted imaging [DWI], T2-weighted imaging, pre- and post-contrast T1-weighted imaging) and a combination of UMRI (DWI and pre-contrast T1-weighted imaging) and DBT. We calculated per-lesion sensitivity of CEMRI and UMRI + DBT, and the agreement between CEMRI, UMRI and DBT versus pathology in assessing cancer size (Bland-Altman analysis). Logistic regression was performed to assess features predictive of cancer missing.ResultsWe included 70 lesions (64% invasive BC, 36% ductal carcinoma in situ or invasive BC with in situ component). UMRI + DBT showed lower sensitivity (86–89%) than CEMRI (94–100%), with a significant difference for the most experienced reader only (p = 0.008). False-positives were fewer with UMRI + DBT (4–5) than with CEMRI (18–25), regardless of the reader (p = 0.001–0.005). For lesion size, UMRI showed closer limits of agreement with pathology than CEMRI or DBT. Cancer size ≤1 cm was the only independent predictor for cancer missing for both imaging strategies (Odds ratio 8.62 for CEMRI and 19.16 for UMRI + DBT).ConclusionsUMRI + DBT showed comparable sensitivity and less false-positives than CEMRI in the preoperative assessment of BC. UMRI was the most accurate tool to assess cancer size.     

MRI对小乳腺癌的诊断价值

目的:探讨MRI对小乳腺癌的诊断价值。方法:2008年6月至2009年6月间经临床怀疑为小乳腺癌(直径≤2 cm)而行MRI检查,MRI诊断结果按乳腺影像报告及数据系统(breast imaging reporting and data system,BI-RADS)分类为Ⅲ类、Ⅳ类及Ⅴ类者共62例。其中31例近期(1周内)接受了乳腺X线摄影检查(mammography,MG),并按BI-RADS分类法进行分类。所有病例均经病理学证实,比较MRI及MG两种检查方法对小乳腺癌的检出率、灵敏度、阳性预测值的差异。结果:所有62例乳腺小病灶中经病理证实为乳腺癌者50例,31例行MG检查的病例中小乳腺癌为21例,MRI对小乳腺癌的检出率、灵敏度均高于MG,分别为100%比85.7%和94.0%比61.9%(P<0.05)。结论:MRI对小乳腺癌的检出率和灵敏度优于MG。     

Breast tomosynthesis: What do we know and where do we stand?

Digital breast tomosynthesis (DBT) is a new imaging technology that addresses the limitation caused by overlapping structures in conventional two-dimensional digital mammography owing to the acquisition of a series of low-dose projection images. This unique technique provides a dual benefit to patients screened for breast cancer. First, DBT increases the cancer detection rate mostly by highlighting architectural distortions and allowing better assessment of masses shape and margins. Second, DBT helps reduce recall rate by discarding asymmetries related to overlapping tissue. However, DBT is not included in the majority of cancer screening programs worldwide. Several issues still need to be addressed such as over-diagnosis and over-treatment, lack of reduction of interval breast cancer, quality control and storage, and radiation dose. In the diagnostic setting, DBT increases the diagnostic accuracy and reduces the number of indeterminate lesions in symptomatic women. Its aforementioned performances regarding asymmetries, masses and architectural distortions allow reducing the number of additional views while working-up a screening-detected lesion. Tumor size is also better assessed at DBT as well as multicentricity, two significant benefits in the staging of breast cancer. Finally, DBT allows a better analysis of scars and helps reduce the rate of indeterminate findings after surgery. Although somewhat limited by high breast density, DBT globally outperforms digital mammography in both screening and diagnostic breast imaging. Additional research is however needed, particularly on relevant screening outcomes. This review describes the main performances of breast DBT in breast cancer screening and diagnosis and the resulting consequences in both settings.     

乳腺X线在198例青年乳腺癌患者中的应用价值探讨

目的探讨乳腺X线在青年乳腺癌中的应用经验。方法调取2011年1月到2016年12月北大深圳医院初诊初治青年乳腺癌患者的乳腺X线胶片,请专科医生读取并复核乳腺X线的结果,按照乳腺密度、TNM分期和免疫组化分型对结果进行亚组分析。结果共收集符合条件的研究对象198例。按照乳腺密度分组,180例为C类乳腺,18例为D类乳腺,不同密度乳腺在各位相检查阳性率的差异均有统计学意义;按照TNM分期分组,其中0、Ⅰ、Ⅱ、Ⅲ和Ⅳ期病例分别有2例、47例、103例、39例和7例,不同TNM分期病例阳性率之间差异均有统计学意义;按照免疫组化分型分组,其中luminal A,luminal B,三阴和HER-2过表达型分别有17例、106例、54例和21例,不同免疫分型病例阳性率之间差异无统计学意义。结论乳腺X线摄片检查对青年乳腺癌有较高的阳性率,临床分期晚的阳性率高,乳腺结构致密的阳性率低。对于致密型乳腺,可以加做乳腺X线数字断层摄片,提高阳性率。     

Computer-aided diagnosis for surgical office-based breast ultrasound

HYPOTHESIS: The computer-aided diagnostic system is an intelligent system with great potential for categorizing solid breast nodules. It can be used conveniently for surgical office-based digital ultrasonography (US) of the breast. DESIGN: Retrospective, nonrandomized study. SETTING: University teaching hospital. PATIENTS: We retrospectively reviewed 243 medical records of digital US images of the breast of pathologically proved, benign breast tumors from 161 patients (ie, 136 fibroadenomas and 25 fibrocystic nodules), and carcinomas from 82 patients (ie, 73 invasive duct carcinomas, 5 invasive lobular carcinomas, and 4 intraductal carcinomas). The digital US images were consecutively recorded from January 1, 1997, to December 31, 1998. INTERVENTION: The physician selected the region of interest on the digital US image. Then a learning vector quantization model with 24 autocorrelation texture features is used to classify the tumor as benign or malignant. In the experiment, 153 cases were arbitrarily selected to be the training set of the learning vector quantization model and 90 cases were selected to evaluate the performance. One experienced radiologist who was completely blind to these cases was asked to classify these tumors in the test set. MAIN OUTCOME MEASURE: Contribution of breast US to diagnosis. RESULTS: The performance comparison results illustrated the following: accuracy, 90%; sensitivity, 96.67%; specificity, 86.67%; positive predictive value, 78.38%; and negative predictive value, 98.11% for the computer-aided diagnostic (CAD) system and accuracy, 86.67%; sensitivity, 86.67%; specificity, 86.67%; positive predictive value, 76.47%; and negative predictive value, 92.86% for the radiologist. CONCLUSION: The proposed CAD system provides an immediate second opinion. An accurate preoperative diagnosis can be routinely established for surgical office-based digital US of the breast. The diagnostic rate was even better than the results of an experienced radiologist. The high negative predictive rate by the CAD system can avert benign biopsies. It can be easily implemented on existing commercial diagnostic digital US machines. For most available diagnostic digital US machines, all that would be required for the CAD system is only a personal computer loaded with CAD software.