浸润性乳腺癌肿块的X线表现与病理分级关系的探讨

[目的]分析浸润性乳腺癌肿块的X线表现与病理学分级二者之间的关系.[方法]经乳腺X线检查、手术、病理证实的漫润性乳癌95例患者共98个病灶,肿块69个.按肿块的X线表现和大小分组,与病理分级对照.[结果](1)肿块的大小与病理学分级无相关性(X2=4.43,P＞0.05).(2)Ⅲ级的肿块率高于Ⅰ、Ⅱ级(X2=5.17,P＜0.05).(3)肿块伴毛刺45个,肿块毛刺的有无与病理学分级无关系(X2=0.05,P＞0.05).(4)69个肿块中有钙化28个,肿块型浸润性乳腺癌的病理分级与有无钙化无明显关系(X2=0.21,P＞0.05).[结论]Ⅲ级浸润性乳腺癌较多见于肿块型,非肿块型较肿块型预后相对较好,生存率相对较高;肿块周围的毛刺的出现并不代表较高的恶性程度,这只是癌肿的浸润性生长方式.     

乳腺浸润性导管癌钼靶征象回顾性分析

目的 分析乳腺浸润性导管癌的高频钼靶X线特征,提高术前X线诊断正确率.方法 回顾性分析经手术病理证实的36例乳腺浸润性导管癌的X线表现.结果 36例乳腺浸润性导管癌中,显示结节或肿块影30例,占83.33%,X线测量肿块大小比临床扪及小有27例,占显示肿块的病例90%;显示毛刺状改变20例,占55.56%;有微小钙化15例,占41.67%.结论 乳腺浸润性导管癌在X线上有特征性表现,乳腺高频钼靶X线检查在此病的早期诊断中有重要意义.     

浸润性乳腺癌X线表现与病理学分级的相关性研究

目的:分析浸润性乳腺癌的X线表现与病理学分级之间的关系。方法:经乳腺X线检查、手术、病理证实的浸润性乳腺癌98个,按X线表现和肿块大小分组,与病理分级对照。结果:①Ⅲ型(索带导管型)和Ⅳ型(中间混合型)共80例,占82.1%。②肿块69个,肿块的大小与病理学分级无相关性(x~2=4.43,P>0.05)。③Ⅲ级的肿块率高于Ⅰ、Ⅱ级(x~2=5.17,P<0.05)。肿块伴毛刺45个,肿块毛刺的有无与病理学分级无相关性(x~2=0.05,P>0.05)。④有钙化50例,浸润性乳腺癌的病理分级与有无钙化无明显关系(x~2=0.06,P>0.05)。⑤结构:扭曲20个,Ⅰ、Ⅱ级结构扭曲率高于Ⅲ级(x~2=3.85,P<0.05)。结论:结构扭曲Ⅰ、Ⅱ级的发生率高于Ⅲ级,提示预后较好,生存率较高。Ⅲ级浸润性乳癌的肿块率高于Ⅰ、Ⅱ级。浸润性乳腺癌肿块周围毛刺的出现并不代表较高的恶性程度,肿块的大小、钙化的有无与病理分级无明显关系。     

乳腺钼靶“边缘征”鉴别乳腺肿块良恶性病变的临床分析

目的探讨乳腺钼靶“边缘征”对乳腺肿块良恶性病变的鉴别价值。方法选取2018年1月-2019年12月该院接收的98例乳腺肿块患者为研究对象,所有患者术前均给予全数字化乳腺摄影X线进行检查,分析其乳腺肿块的“边缘征”,并以手术病理结果作为金标准,探讨乳腺钼靶“边缘征”对乳腺肿块良恶性病变的诊断价值。结果98例乳腺肿块患者中,经病理检查确诊48例为乳腺恶性病变,占48.98%;50例乳腺良性病变,占51.02%。据病理检查结果,全数字化乳腺X线摄影乳腺“边缘征”检出恶性病变的符合率为97.92%,检出良性病变的符合率为96.00%;其检查乳腺肿块良、恶性与手术病理结果具有极好一致性(Kappa=0.939);乳腺钼靶“边缘征”诊断乳腺肿块的良、恶性的灵敏度为97.92%、特异度为96.00%、准确度为96.94%、阳性预测值为95.92%、阴性预测值为97.96%。经病理检查50例乳腺良性病变中,钼靶“边缘征”主要表现为边缘清晰、边缘模糊;48例恶性病变中,钼靶“边缘征”主要表现为星芒状、浸润;良性组边缘清晰、边缘模糊检出率高于恶性组,且浸润、星芒状检出率低于恶性组,差异有统计学意义(P<0.05)。结论数字X线乳腺钼靶“边缘征”诊断乳腺肿块良恶性病变具有操作简单、快捷等优点,其诊断具有较高灵敏度、准确度,为临床早期诊治提供重要依据。     

乳腺浸润性导管癌的X线诊断分析

目的:分析乳腺浸润性导管癌的钼靶X线征象,研究各类征象的X线诊断价值,提高乳腺浸润性导管癌的诊断水平。方法:乳腺手术后病理证实的48例浸润性导管癌,回顾性研究术前乳腺钼靶X线征象。结果:48例乳腺浸润性导管癌中,肿块41例,伴有毛刺32例,恶性钙化灶29例,局部结构扭曲11例,局部血运增加13例,局部皮肤增厚12例,乳头凹陷5例,腋下淋巴结肿大13例。     

乳腺浸润性导管癌钼靶X线表现与ER、PR及C-erbB-2表达的相关性研究

目的:通过分析乳腺浸润性导管癌的X线表现,预测乳腺浸润性导管癌的雌激素受体(ER,estrogen receptor)、孕激素受体(PR,progesterone receptor)、人类上皮生长因子受体-2(C-erbB-2,human epithelium growth receptor 2)的表达。方法:选择30例资料完整的乳腺浸润性导管癌患者,术后对标本进行免疫组织化学染色并判断这些免疫因子的表达情况;将X线表现中的肿块伴有的恶性钙化、肿块边缘的毛刺和有无合并乳腺腺体增生症与ER、PR及C-erbB-2表达情况进行对比分析。结果:毛刺组的ER阳性率较无毛刺组高(P<0.05);伴有腺体增生症组ER阳性率较无腺体增生症者高(P<0.05);钙化组的C-erbB-2阳性率较无钙化组高(P<0.05)结论:通过对乳腺癌钼靶X线征像的分析可以反映ER、PR及C-erbB-2的表达情况,指导临床治疗和效果评价。     

超声与钼靶X线对浸润性导管癌临床诊断价值的比较

目的:对比超声与钼靶X线检查在乳腺浸润性导管癌中的诊断价值。方法:对420例乳腺肿块患者按绝经前后分两组比较超声及钼靶X线检查对乳腺浸润性导管癌的诊断准确性,并对病理证实122例乳腺浸润性导管癌的超声及钼靶X线征象进行对比分析。结果:绝经前组超声符合率89.7%,钼靶X线诊断符合率74.8%;绝经后组超声的诊断符合率为89.7%,钼靶X线诊断符合率为89.1%。绝经前超声诊断乳腺浸润性导管癌比钼靶X线的诊断符合率高(P<0.05),绝经后两者诊断符合率差异无统计学意义(P>0.05)。绝经前乳腺浸润性导管癌患者中的超声检查对乳腺肿块影、钙化灶检出率均高于钼靶X线(P<0.05)。结论:超声与钼靶X线对绝经前、后浸润性导管癌均有较高诊断价值,乳腺超声成像对绝经前浸润性导管癌患者的诊断价值更大。     

钼靶结合超声检查对早期乳腺癌病灶位置和深度的诊断价值

目的分析应用钼靶结合超声检查对早期乳腺癌病灶位置及深度的诊断价值。方法选取2016年1月-2020年1月在台州市路桥区中医院就诊并经手术病理证实的女性乳腺肿物患者120例为研究对象,术前均行X线钼靶检查和高频超声检查。对比分析X线钼靶检查、高频超声检查征象,统计两种方法单用及联合应用对不同年龄、不同大小及不同类型肿块诊断准确率,比较两种检查方法对早期乳腺癌的诊断价值。结果 X线钼靶检查征象主要表现为肿块或结节影,部分呈微小钙化、分叶状、毛刺征或边缘模糊,少数患者出现皮肤改变、血管改变及结构紊乱;高频超声检查征象以不规则团块为主,边界不光滑,血流紊乱,实质性弱回声或后方回声衰减。X线钼靶联合高频超声鉴别诊断不同年龄患者乳腺肿块良恶性准确性显著高于两种方法单用,差异有统计学意义(P<0.05);X线钼靶诊断不同大小乳腺肿块准确性优于高频超声,两种方法联用对直径<1.0 cm肿块诊断准确率高于高频超声,差异有统计学意义(P<0.05)。X线钼靶联合高频超声诊断导管内癌、小叶原位癌、早期浸润性导管癌及早期浸润性小叶癌的病理符合率高于两种方法单用,漏误诊率低于两种方法单用。各组间总体灵敏度、特异度、准确率、阳性预测值和阴性预测值比较,差异均有统计学意义(均P<0.05)。结论 X线钼靶检查与高频超声联合应用可明显提高早期乳腺癌鉴别诊断准确性,具有较高推广价值。     

乳腺肿块139例钼靶X线诊断分析

目的探讨乳腺钼靶X线检查在乳腺肿块鉴别诊断中的临床意义。方法选择2 0 1 2年1月~2 0 1 3年6月在本院就诊并有完整影像资料的乳腺肿块患者1 3 9例,回顾分析其钼靶X线征象特点及临床表现,最后与手术病理学检查进行对照。结果 6 0例为良性肿块(乳腺增生2 8例、纤维腺瘤2 0例、积乳囊肿5例、炎性肿块3例、脂肪坏死2例、乳腺创伤2例),经X线检出5 6例,检出率为9 3.3%。7 9例为恶性肿块(单纯癌3 4例、浸润性导管癌2 0例、浸润性小叶癌1 4例、腺癌6例、髓样癌5例),X线共检出6 8例,检出率为8 6.1%。结论钼靶X线对乳腺良、恶性肿块的诊断具有重要意义,可以成为临床上诊断乳腺肿块的首选方法。     

应用钼靶X线对乳腺分叶状肿瘤的病理诊断与鉴别分析

目的:探讨分析钼靶X线对乳腺分叶状肿瘤的病理诊断与鉴别分析.方法 选取我院于2009年1月至2010年9月收治的38倒乳腺分叶状肿瘤,且38例患者均经手术病理确诊,与钼靶X线影像表现进行对比分析.结果 钼靶X线影像图表现为:多数病灶密度均匀、边缘光滑的分叶状肿块.在此基础上患者的癌组织体积较大,多为圈形或近似圆形,由此证明,患者的肿瘤有恶性与良性之分.结论 钼靶X线诊断乳腺分叶状肿瘤准确性较高,在临川诊断上具有较高的应用价值.     

簇状钙化在钼靶X线诊断乳腺癌中的临床意义

目的:探讨乳腺钼靶X线片中簇状钙化的影像特征,评估簇状钙化对早期乳腺癌诊断的临床意义。方法:对我院经手术和病理证实为乳腺良、恶性肿瘤,钼靶X线片发现以簇状钙化为主要征象的97例乳腺病例,就其钙化密度、数量、大小、形态及与肿块的关系分析乳腺癌钼靶X线片内簇状钙化的特征。结果:①97例乳腺分型显示,Ⅲ型索带导管型和Ⅳ中间混合型占86.6%,且乳腺癌居多。②乳腺癌94例,其中非浸润性有导管内癌和小叶原位癌共39例,占41.5%;浸润性有浸润性导管癌、浸润性小叶癌、硬癌、单纯癌、粘液癌和髓样癌共55例,占58.5%。乳腺良性病变3例,其中2例乳头状瘤病合并中度导管上皮不典型增生,1例乳腺纤维囊性增生症。③94例乳腺癌所见簇状钙化的形态特征主要呈杆状、细砂状、针尖状和混合钙化,钙化数目>20枚/cm2;在合并肿块的77例中肿块内外均有簇状钙化灶的34例,无合并肿块20例,占20.4%.结论:成簇钙化是1种中性分布形态,良、恶性均可,根据乳腺钼靶X线片内的钙化特征可作为临床评价其良、恶性的较可靠依据。成簇微小钙化在临床诊断乳腺癌方面具有重要意义。     

Magnetic resonance imaging in the diagnosis of breast diseases]

Authors report about the role of contrast medium enhanced magnetic resonance imaging in diagnosis of breast diseases, and experiences with this method. The aim of the study was to determine the diagnostic accuracy of the method. The results was correlated with the histopathological findings, and compared to the diagnostic accuracy of the conventional X-ray mammography in breast lesions. X-ray and MR-mammography were evaluated in 220 patients (238 breasts) scheduled for breast surgery. The breasts were examined with T1-weighted transversal images using contrast medium enhanced semidynamic technique with 3D fast low angle shot (FLASH) sequence. Each breast was given a routine examination with 3 mammographic views. Contrast enhanced MR-mammography is a highly sensitive method for the detection of breast cancer, it has a higher diagnostic accuracy (84.5%), than conventional X-ray mammography (82.4%). When MRI and conventional X-ray mammography were used together, very high sensitivity but a lower diagnostic accuracy (81.5%) was achieved. MRI was effective in revealing mammographically equivocal or occult lesions and multifocal tumors even in dense breasts, but it was less reliable for some invasive lobular cancers, non-invasive ductal carcinomas, fibroadenomas and hyperplastic breast changes. Presently accepted indications for MRI of the breast are: (1) patients with breast implants--to demonstrate prothesis complications and tumor relapses; (2) postoperative imaging in patients after tumorectomy and radiation therapy--in these cases MRI allows differentiation between tumor relapses and extensive scars; (3) proven axillary lymph node metastasis from an unknown primary carcinoma; (4) preoperative MR imaging in cases suspected or verified carcinomas within dense breasts to exclude multicentricity/multifocality; (5) follow-up in chemotherapy of breast cancer; (6) patients with high-risk constellation.     

Problems of minor surgery for the early breast cancer--from the clinicopathological study

In 183 mastectomy specimens, performed for invasive or noninvasive carcinomas, histologic study was performed to assess the local extension of carcinoma. A wide carcinomatous extension, reached up to more than 4.5 cm from the margin of tumor, was found in 21 of 87 cases (24%) of breast cancer with tumor size less than 2 cm. There was 3 cases, having double palpable tumors in the same breast, no carcinomatous continuity between the 2 foci. The results have supported a concept of multicentric development of the cancer in the same breast. Carcinomatous involvement of the nipple and/or areola was found in 44 of 141 specimens (31%). These findings indicate that the possibility of leaving a carcinomatous residue if a partial mastectomy was performed.     

Mammography screening rates decline: a person-time approach to evaluation

OBJECTIVES: Early detection through mammography can reduce breast cancer mortality. This cohort study evaluated trends in mammography screening, demonstrating a person-time approach. METHODS: Included were women HMO members aged 50-69 from 1999 to 2002 who had not had breast cancer, dysplasia, fibrocystic disease, or implant. The amount of person-time covered by mammography as a percent of the time eligible for mammography screening (the prevention index (PI)) was calculated using electronic data. The denominator was the time during which the guidelines recommended that each participant should have been covered by a mammogram (every 24 months), excluding times when breast mass, abnormal mammogram, galactorrhea, or other breast disorders were under evaluation. The numerator was the time during which she was covered by a mammogram. RESULTS: The number of women who contributed person-time increased from 43,283 to 49,512 and the number of screening mammograms declined from 23,586 to 22,719. The overall PI for screening mammography declined from 67.0 (67% of eligible person-time was appropriately covered by a mammogram) to 62.5, and the proportion of women with no coverage during a given year increased 16%. CONCLUSIONS: This study shows a declining pattern of mammography screening using a person-time approach, a decline greater than that shown by methods that include diagnostic mammograms. The study highlights opportunities for use of the PI and quality improvement initiatives to improve breast cancer outcomes.     

Factors associated with repeat adherence to breast cancer screening

This study identified barriers and facilitators of repeat participation in mammography and breast physical examination among women ages 50 years and over. Telephone interviews were conducted with 910 women in this age group. Forty percent of respondents had never had a mammogram. Only 38% had had one in the past 12 months. Of women who had a prior mammogram, 43% had had only one. Only 60% of women had had a breast exam in the past 12 months. A physician recommendation was the single best predictor of adherence to mammography. However, only 60% of women reported that their physicians had ever recommended mammography. Several other barriers to mammography were revealed, including anxiety, embarrassment, and concerns about cost and radiation. Both a family history of breast cancer and heightened perceived vulnerability to breast cancer were associated positively with repeat mammography participation; anxiety about screening reduced the likelihood of this outcome. These findings suggest that physicians can play a powerful role in motivating women to participate in initial and subsequent breast cancer screening. Reassurance may reduce women's anxiety and embarrassment and increase utilization further.     

Use of mammograms among women aged > or = 40 years--United States, 2000-2005

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death (after lung and bronchial cancer) among women in the United States. In 2002, at least 182,125 women in the United States had a diagnosis of invasive breast cancer, and 41,514 died from the disease. Screening mammography can reduce mortality from breast cancer by approximately 20%-35% in women aged 50-69 years and approximately 20% in women aged 40-49 years. Organizations including the American Medical Association, American College of Obstetricians and Gynecologists, and American Cancer Society support mammography screening beginning at age 40 years, although these groups vary in their recommendations regarding intervals for rescreening. The U.S. Preventive Services Task Force, an independent panel of private-sector experts in prevention and primary care convened by the Department of Health and Human Services, recommends that women aged < or = 40 years be screened for breast cancer with a mammogram every 1-2 years. Although mammogram use increased substantially during the 1990s, results from a recent cohort study of health maintenance organization members revealed declining screening rates during 1999-2002. This report describes Behavioral Risk Factor Surveillance System (BRFSS) findings that indicate a similar decreasing trend in self-reported use of mammograms among women aged < or = 40 years during 2000-2005. Continued declines in mammography use might result in increased breast cancer mortality.     

565例乳腺癌的临床病理学研究

目的:分析乳腺癌不同组织学类型的发病率,并进行预后相关性研究。方法:应用2003年版世界卫生组织(WHO)乳腺癌分类,对1998～2001年经治疗并有完整随访资料的565例原发乳腺癌重新进行组织学分析,并利用NPI值进行预后相关因素分析。结果:565例乳腺癌患者平均年龄52.86岁,79.3%的患者年龄位于40～69岁,小于40岁占11.3%。临床分期0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别占5.3%、27.1%、55.0%、11.3%、1.2%。导管原位癌30例(5.3%),浸润癌535例(94.7%)。其中浸润性导管癌(非特殊类型)432例,占76.5%,位居首位。混合型癌31例(5.5%),黏液癌23例(4.1%),浸润性小叶癌22例(3.9%),浸润性筛状癌13例(2.3%),其他14例(2.5%)。浸润性乳腺癌患者,淋巴结转移率为42.4%。10年总生存率及无瘤生存率分别为90.76%和84.10%。经单因素分析显示,肿瘤的大小及临床分期与10年总生存率及无瘤生存率呈负相关(P均0.01)。经Cox多因素分析显示,NPI值与10年总生存率呈负相关(P0.001),组织学分级(P=0.0271)和淋巴结分期(P0.001)与无瘤生存率负相关。结论:该院经治乳腺癌年轻患者所占比例高于欧美,浸润性小叶癌的发生率低于欧美国家,与亚洲其他国家接近。肿瘤组织学分级、淋巴结分期、肿瘤大小、临床分期,尤其是NPI值可以作为判断预后的指标。严格鉴别特殊类型的乳腺癌对判断预后有一定的指导意义。     

The effect of information in the utilization of preventive health-care strategies: an application to breast cancer

This paper investigates the net benefit of mammography. A theoretical expected utility (EU) model shows that increases in breast cancer risk, decreases in false-negative and false-positive rates, decreases in cost and increases/decreases in quality of life with early/late-stage breast cancer increase the net benefit of mammography. The theoretical findings are tested in an empirical analysis using Canadian data. The empirical results are broadly consistent with the EU hypothesis. Results suggest that women at higher risk are more likely to obtain a mammogram. In particular, individuals are significantly more likely to have had a time-appropriate mammogram if the mother's cause of death was breast cancer, and if the sister had breast cancer. The results also show that older age (related to higher risk and more accurate mammograms) increases mammography use, and that decreases in time and opportunity costs, and better health behaviours generally have the same effect.     

Breast Cancer Risk Perception,Benefits of and Barriers to Mammography Adherence Among a Group of Iranian Women

The study aimed to assess associations between Health Belief Model variables, stages of change, and participation in mammography for early detection of breast cancer in a sample of Iranian women. A total of 414 women, aged 40 to 73 years, were recruited by random sampling. The study took place in the winter of 2007, using a self-report questionnaire and structured interviews, designed to measure the five Health Belief Model constructs and stages of adoption for mammography. The study indicated that 45.8% of the women were in the pre-contemplation and contemplation stages of a mammogram, and 29% of participants reported having had at least one mammogram. Screening behavior was associated with older age, familial history of breast cancer, history of breast disease, health insurance coverage, and living in an urban area. Furthermore, the perceived susceptibility to breast cancer, perceived benefits and barriers for mammography, and cues to action variables defined by the Health Belief Model were four factors related to having a mammogram. The study concludes that health care professionals must provide women with more fear appeals that outline vulnerability to developing breast cancer, remove cognitive barriers to seeking mammography, and apply effective guidance on the participation of women in breast cancer screening programs.     

Breast cancer risk perception, benefits of and barriers to mammography adherence among a group of Iranian women

The study aimed to assess associations between Health Belief Model variables, stages of change, and participation in mammography for early detection of breast cancer in a sample of Iranian women. A total of 414 women, aged 40 to 73 years, were recruited by random sampling. The study took place in the winter of 2007, using a self-report questionnaire and structured interviews, designed to measure the five Health Belief Model constructs and stages of adoption for mammography. The study indicated that 45.8% of the women were in the pre-contemplation and contemplation stages of a mammogram, and 29% of participants reported having had at least one mammogram. Screening behavior was associated with older age, familial history of breast cancer, history of breast disease, health insurance coverage, and living in an urban area. Furthermore, the perceived susceptibility to breast cancer, perceived benefits and barriers for mammography, and cues to action variables defined by the Health Belief Model were four factors related to having a mammogram. The study concludes that health care professionals must provide women with more fear appeals that outline vulnerability to developing breast cancer, remove cognitive barriers to seeking mammography, and apply effective guidance on the participation of women in breast cancer screening programs.