全数字化乳腺摄影与乳腺三维断层摄影对乳腺钙化的对比研究

目的:研究全数字化乳腺摄影（FFDM）及数字乳腺断层摄影（DBT）对于钙化征象及其在乳腺疾病诊断效能的对比。 方法:收集福建医科大学附属第二医院2013年6月~2017年4月期间就诊的97例经FFDM及DBT检查发现有钙化征象,并具有病理结果的患者,根据乳腺影像报告和数据系统进行阅片诊断,同时计算出在FFDM及COMBO（DBT结合FFDM）两种摄片模式下的钙化分数。 结果:通过秩和检验分析两种方法下钙化分数存在显著性差异（P<0.05）。通过ROC曲线分析两种方法在乳腺疾病诊断效能发现,两者曲线下面积均大于0.5,具有诊断价值,FFDM与COMBO敏感度（95.7%）一致;COMBO特异性（92%）较FFDM特异性（76%）高。 结论:COMBO相对于FFDM能更好地观察钙化征象,提高诊断效能。     

乳腺三维断层摄影与乳腺彩超在乳腺疾病诊断中的效能对比

【摘 要】 目的:研究数字乳腺三维断层技术（DBT）和乳腺超声在诊断乳腺病变效能的不同以及联合应用对于乳腺诊断的价值。 方法:收集1 065例乳腺病变患者,其中333例有完整的病理检查资料。以乳腺影像报告和数据系统（BI-RADS）分类为标准,分析DBT、超声、DBT+超声在乳腺病变诊断中的分布差异。根据333例病理结果,比较3种诊断模式的诊断效能。 结果:DBT与超声的BI-RADS分布有显着性差异（P=0.001）,DBT与DBT+超声或超声与DBT+超声的BI-RADS分布无显著性差异（P=0.258, 0.394）。3种诊断模式均可明显区分恶性和良性乳腺病变（P<0.001）。多组独立样本Kruskal-Wallis秩和检验分析显示3种诊断模型存在差异（[χ2]=14.982, P=0.001）。DBT的特异性、误诊率、准确性和阳性预测值明显优于超声。超声显示囊性病变优于DBT,且超声对确定良性肿块的敏感性优于DBT。DBT+超声的特异性为99.5％,误诊率为0.5%,阳性预测值也达到99%。DBT+超声的检查模式优于单独使用DBT或超声。 结论:与单独的DBT或超声相比,DBT和超声的组合可以提高乳腺病变的诊断效能。     

计算机辅助系统在诊断乳腺良恶性肿瘤中的应用

目的:探讨计算机辅助诊断系统在良恶性肿瘤检测与特征提取基础上的分类对于乳腺肿瘤的诊断价值。方法:回顾性分析乳腺超声检查发现肿瘤且经过病理学证实的617例患者影像资料,采用手工提取的方式得到乳腺超声图像的感兴趣区域及病灶轮廓,再利用方向梯度直方图（HOG）、局部二值模式（LBP）和灰度共生矩阵（GLCM）3个特征进行乳腺肿瘤的良恶性病变真假阳性检测;最后用受试者操作特征曲线（ROC）分别分析每个特征对于两类病变判别的诊断性能和应用所有特征集合的分类诊断性能。结果:多特征融合方法的各项诊断效能及ROC曲线下面积（AUC）值均优于单特征LBP、HOG、GLCM（P值均<0.05）。与人工诊断相比,多特征融合的敏感性无显著差异,但特异度显著升高达98.57%（Z值=2.25, P<0.05）,同时AUC值为0.985,显著优于人工诊断的0.910（Z值=1.99, P<0.05）。结论:计算机辅助系统乳腺超声肿瘤良恶性检测的算法是有效的,能够对乳腺癌鉴别诊断提供有益的参考。     

压迫式弹性成像与声脉冲辐射力成像技术在乳腺肿瘤良恶性鉴别中的价值比较

目的:探讨分析压迫式弹性成像（CE）与声脉冲辐射力成像（ARFI）技术在乳腺肿瘤良恶性鉴别中的价值。方法:选择门诊或住院行超声检查发现的有乳腺肿块患者71例共89个病灶,经病理组织学确认良性病灶57个,恶性病灶32个。对各病灶进行彩色多普勒超声检查,并采取CE及ARFI技术,分别计算病灶弹性应变率比值（SR）及声触诊组织定量（VTQ）值,采用ROC曲线分析SR、VTQ对良恶性肿瘤的诊断效能。结果:恶性组病灶VTQ值与SR值均显著高于良性组（P<0.05）。采用ROC曲线分析VTQ、SR对乳腺良恶性肿瘤诊断效能,VTQ诊断曲线下面积（AUC）为0.918,95% CI为0.871~0.980（P<0.05）,最佳截断值为3.97,在此最佳截断值下,VTQ诊断敏感性94.64%、诊断特异性90.63%;SR诊断AUC为0.899,95% CI为0.854~0.956（P<0.05）,最佳截断值为4.12,在此最佳截断值下,SR诊断敏感性92.86%、诊断特异性84.38%。VTQ和SR诊断敏感性、特异性比较差异无统计学意义（P>0.05）。结论:两种超声诊断技术对乳腺良恶性肿瘤均具有较高的诊断价值,其诊断效能相似,临床上可联合使用,以实现优势互补,提高对乳腺癌的早期检出率。     

3M和5M显示器对不同分辨率乳腺影像图中微钙化识读的影响EI北大核心CSCD

通过使用高、低两种分辨率的乳腺影像图来比较3M与5M医用专业显示器对乳腺微钙化识读的影响。选择高、低两种分辨率的乳腺影像图各100例(各含微钙化病例40例、正常对照病例60例)。由1名高年资和1名低年资放射科医师评估两种显示器对乳腺微钙化的显示率,识别效能用ROC曲线判断,并使用Kappa分析检验两名医生的判读一致性。在低分辨率影像图组中,两名医生在3M与5M医用专业显示器上对微钙化的识别效能相同(P=0.451及0.559);在高分辨率影像图组中,高年资医生使用5M医用专业显示器对乳腺微钙化的识别率明显高于3M(P=0.022),低年资医生的识别率无显著差异(P=0.141)。两名医生在5M显示器上判读的一致性都好于3M显示器,在5M显示器上判读高分辨率影像图时,两名医生的判读有极好的一致性(K=0.862)。因此,对不同分辨率的乳腺影像图,应配套相应分辨率的显示器,高年资医师识读高分辨率影像图组时应配套5M显示器更利于微钙化的检出。     

血清心肌型脂肪酸结合蛋白快速检测急性心肌梗死的敏感度和特异度分析

目的:分析血清心肌型脂肪酸结合蛋白(H-FABP)快速检测对急性心肌梗死(AMI)早期诊断的敏感度和特异度。方法:53例胸痛患者,经确诊分为AMI组(包括发病<6h和6～12h两亚组)和非AMI组,平行检测H-FABP、肌红蛋白(MYO)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB),计算H-FABP等指标诊断AMI的敏感度和特异度。结果:H-FABP诊断发病<6h AMI的敏感度为85.71%,与MYO的80.95%相近,明显高于cTnI的47.62%和CK-MB的52.38%,差异有统计学意义(P<0.05);AMI发病6～12h,H-FABP诊断AMI的敏感度为100.00%,略高于MYO、cTnI和CK-MB(均为92.86%),但差异无统计学意义(P>0.05)。H-FABP等指标诊断AMI的特异度无论非AMI组还是健康对照组,各指标间差异均无统计学意义(P>0.05)。结论:H-FABP对AMI早期诊断有较高的敏感度和特异度,可作为AMI早期筛查及诊断指标。     

计算机辅助诊断软件联合多学科建立甲状腺结节恶性风险预测模型

目的:应用计算机辅助诊断（CAD）软件量化分析甲状腺结节的超声特点,结合临床及实验室指标,建立甲状腺结节恶性风险预测模型,检测预测模型诊断效能并与不同年资医师诊断对比。方法:模型建立组多中心、前瞻性地纳入2019年1月~9月在福建医科大学附属第二医院、厦门大学附属中山医院、漳州市医院接受甲状腺手术及术前超声检查的364例患者（共388个结节）,采用CAD软件分析超声图像。收集CAD软件图像分析信息、临床信息及实验室信息作为相关因素。以病理为金标准,对比21种相关因素的良恶性组间差别,筛选出组间差异具有统计学意义的11种相关因素进行Logistic回归分析,筛选出对结节良恶性预测有统计学意义的6种相关因素进行模型建立。模型验证组纳入同期于3所医院行甲状腺细针穿刺（FNA）及穿刺前检查的105例患者（共105个结节）。由预测模型及3位不同年资的医师分别判断结节良恶性,对照病理结果,绘制受试者工作曲线（ROC）,计算曲线下面积（AUC）、敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）,对比预测模型与不同年资医师的诊断效能。结果:建立预测模型为Logit（p）=-5.218+2.601×（低回声指数）+1.981×（强回声指数）+3.079×（边缘模糊指数）+1.267×（纵横比>1）+0.614×（TSH）-0.071×（结节最大径）。计算可得模型的AUC为0.884,敏感度为85.50%,特异度为81.97%,PPV为91.1%,NPV为72.5%。预测模型的AUC、敏感度介于中、高年资医师间,特异度介于低、中年资医师间。结论:该模型具有较好的甲状腺结节恶性风险预测能力,可认为总体诊断效能介于中、高年资医师之间。     

MRI与MSCTA诊断胰腺癌胰周血管侵犯的价值比较

目的:研究磁共振成像（MRI）与多层螺旋电子计算机断层扫描血管造影（MSCTA）诊断胰腺癌胰周血管侵犯的应用 价值。方法:选择86例胰腺癌患者,根据手术结果发现其中胰周血管侵犯63例,无血管侵犯23例,所有患者均进行MRI与 MSCTA检测。统计两种方式检查胰周血管受侵犯的诊断效能、对不同等级血管侵犯检出率、对不同类型血管侵犯情况检出 率。结果:MSCTA的灵敏度及特异度分别为96.83%、91.30%,MRI为85.71%、86.96%,差异无统计学意义（P>0.05）;MSCTA 诊断准确度为95.35%,高于MRI的86.05%（P<0.05）;MSCTA对1、2、3、4级血管侵犯与手术结果比较符合率分别为94.29%、 98.04%、96.36%、95.83%,MRI分别为88.57%、92.16%、92.73%,87.50%,差异无统计学意义（P>0.05）;两种检测方式对不同 类型血管侵犯检出率无明显差异（P>0.05）。结论:MSCTA检测胰腺癌胰周血管侵犯准确率更高。     

超声造影在乳腺恶性病变诊断中的价值探讨及影响因素分析

目的 探究超声造影（CEUS）在乳腺恶性病变诊断中的价值及影响因素。方法 回顾性分析2018年1月至2021年2月在简阳市人民医院收治的乳腺病变患者（126例）的临床资料。以病理检查为金标准，对CEUS进行诊断效能、影像表现以及诊断结果一致性分析。Logistic回归分析影响CEUS局限性的相关因素，绘制森林图并进行模型评价。结果 CEUS检查结果显示，乳腺良性病变的假阳性率（27.03%）显著高于乳腺恶性病变的假阴性率（11.54%）(P<0.05)。CEUS的诊断灵敏度、特异度和准确度分别为88.46%、72.97%和79.37%，其诊断效能较高。Logistic回归分析结果显示：年龄≤45岁、病变最大直径（LMD）≤10mm、病变到乳头距离（DtP）≤20mm以及高危病变均是CEUS诊断错误的独立危险因素（P<0.05）。预测模型的受试者操作特征（ROC）曲线的曲线下面积（AUC）、灵敏度和特异度分别为0.885(95%CI:0.832～0.943,P<0.01)、0.816和0.755，表明模型的区分度较好。预测模型的内部数据验证结果显示，预测情况与实际情况一...     

超声、增强CT诊断甲状腺癌颈部淋巴结转移比较的Meta分析

目的通过Meta分析对超声和增强CT（CECT）诊断甲状腺癌颈部淋巴结转移的临床价值进行评价。方法在美国生物医学数据库、荷兰医学文摘、Cochrance协作网和中国生物医学文献数据库中检索1995年1月-2012年12月以病理结果为金标准的关于超声、CECT诊断甲状腺癌颈部淋巴结转移的中英文文献,对纳入文献进行质量评价。采用Meta—Disc 1．4软件计算出汇总敏感度和特异度及95％可信区间,并绘制ROC曲线,得出Q^＊值,进行X检验。结果共17篇（1682例）文献被纳入。超声、CECT的合并敏感度和合并特异度分别为0．62、0．61和0．92、0．86。二者的ROC曲线下面积分别为0．84、0．82,二者Q^＊值（0．7718和0．7561）差异无统计学意义（P=0．78）。结论诊断甲状腺癌颈部淋巴结转移,超声与CECT诊断价值相当,但超声的特异度高于CECT。     

Comparison of slot scanning digital mammography system with full-field digital mammography system

The purpose of this study was to evaluate and compare microcalcification detectability of two commercial full-field digital mammography (DM) systems. The first unit was a flat panel based DM system (FFDM) which employed an anti-scatter grid method to reject scatter, and the second unit was a charge-coupled device-based DM system (SSDM) which used scanning slot imaging geometry to reduce scatter radiation. Both systems have comparable scatter-to-primary ratios. In this study, 125-160 and 200-250 microm calcium carbonate grains were used to simulate microcalcifications and imaged by both DM systems. The calcium carbonate grains were overlapped with a 5-cm-thick 50% adipose/50% glandular simulated breast tissue slab and an anthropomorphic breast phantom (RMI 165, Gammex) for imaging at two different mean glandular dose levels: 0.87 and 1.74 mGy. A reading study was conducted with seven board certified mammographers with images displayed on review workstations. A five-point confidence level rating was used to score each detection task. Receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (A(z)) was used to quantify and compare the performances of these two systems. The results showed that with the simulated breast tissue slab (uniform background), the SSDM system resulted in higher A(z)'s than the FFDM system at both MGD levels with the difference statistically significant at 0.87 mGy only. With the anthropomorphic breast phantom (tissue structure background), the SSDM system performed better than the FFDM system at 0.87 mGy but worse at 1.74 mGy. However, the differences were not found to be statistically significant.     

B超与X线对中国人乳腺癌诊断价值的对照研究

目的 比较X线摄影、B超及两者联合应用对中国人乳腺癌的诊断价值,为临床选择检查方法提供参考。方法 根据体检结果,把473例经病理证实的乳腺占位病人分为可触及肿块与未触及肿块两组,采用诊断性试验的方法分别比较两组中X线摄影、B超及两者联合应用(串联、并联)的诊断准确率。结果 可触及肿物组,灵敏度:并联>B超>X线>串联;特异度:串联>B超>X线>并联。未触及肿物组,灵敏度:并联>X线>B超>串联;特异度:串联>B超>X线,并联。B超、X线乳腺摄影及联合应用的灵敏度与特异度亦无明显差异,结果与病检高度一致。结论 B超应作为中国人乳腺癌诊断的首选检查,联合应用X线检查不能提高诊断效率。     

Bisphosphonate-functionalized gold nanoparticles for contrast-enhanced X-ray detection of breast microcalcifications

Microcalcifications are one of the most common abnormalities detected by mammography for the diagnosis of breast cancer. However, the detection of microcalcifications and correct diagnosis of breast cancer are limited by the sensitivity and specificity of mammography. Therefore, the objective of this study was to investigate the potential of bisphosphonate-functionalized gold nanoparticles (BP-Au NPs) for contrast-enhanced radiographic detection of breast microcalcifications using two models of breast microcalcifications, which allowed for precise control over levels of hydroxyapatite (HA) mineral within a low attenuating matrix. First, an in vitro imaging phantom was prepared with varying concentrations of HA uniformly dispersed in an agarose hydrogel. The X-ray attenuation of HA-agarose compositions labeled by BP-Au NPs was increased by up to 26 HU compared to unlabeled compositions for HA concentrations ranging from 1 to 10 mg/mL. Second, an ex vivo tissue model was developed to more closely mimic the heterogeneity of breast tissue by injecting varying concentrations of HA in a Matrigel carrier into murine mammary glands. The X-ray attenuation of HA-Matrigel compositions labeled by BP-Au NPs was increased by up to 289 HU compared to unlabeled compositions for HA concentrations ranging from 0.5 to 25 mg/mL, which included an HA concentration (0.5 mg/mL) that was otherwise undetectable by micro-computed tomography. Cumulatively, both models demonstrated the ability of BP-Au NPs to enhance contrast for radiographic detection of microcalcifications, including at a clinically-relevant imaging resolution. Therefore, BP-Au NPs may have potential to improve clinical detection of breast microcalcifications by mammography.     

基于乳腺钼靶侧斜位图像的近期乳腺癌风险预测研究

探讨乳腺钼靶侧斜位图像双侧不对称性与近期乳腺癌风险之间的关联性。回顾性分析556例连续两年进行乳腺普查的样本,当前年患癌与阴性样本各278例,且两组样本年龄匹配。对前一年乳腺钼靶侧斜位图像进行预处理获取双侧局部对应区域及全局区域后分别提取空间差异性、结构相似性及位置信息等85维影像特征。删除相关性较高的特征后剩余78个特征,采用留一法与逐步回归分析进行特征选择,并建立基于广义线性模型的近期乳腺癌风险预测模型。结果显示,全局及局部不对称性特征相结合进行风险预测AUC值为0.666 7±0.022 6,对其进行混淆矩阵分析,特异性为0.690 6,灵敏度为0.521 6。对风险预测值进行回归分析,优势比(Odds Ratio)随风险的增加而显著增加,P值为0.002 033。3个基于年龄的子集(37~49岁,50~65岁,66~87岁)进行近期乳腺癌风险预测,AUC值分别为0.681 0±0.043 2,0.671 6±0.030 0及0.678 2±0.054 7,对应3个年龄段的特异性分别为0.702 7,0.694 3和0.723 4,灵敏度分别为0.554 1,0.490 4和0.574 5。两个基于乳腺X线分型的子集(BIRADS 2、BIRADS 3) AUC值分别为0.654 5±0.036 9及0.694 4±0.03,特异性分别为0.676 2和0.733 3,灵敏度分别为0.522 9和0.536 9。结果表明,乳腺钼靶侧斜位图像全局及局部不对称性相结合对近期乳腺癌风险预测具有潜在有效价值。     

Clinical Significance of Microcalcifications Detection in Invasive Breast Carcinoma

Background

Recently, a lot of cases with microcalcifications of the breast are pointed by the images of mammography (MG), because breast screening using MG become common. Although MG is a gold standard modality for detecting microcalcifications, images of ultrasonography (US) are now feasible to detect microcalcifications with recent improvements to ultrasound diagnostic devices. In this report, we analyzed clinical significance of microcalcifications detected with US images in invasive breast carcinoma.

Methods

Eighty-eight patients with invasive breast carcinoma who underwent MG and US before surgery at the Division of Breast and Endocrine Surgery of Tottori University Hospital between January 2012 and August 2013. After reviewing US images, the association between the presence of echogenic spots that indicate microcalcifications and images of MG or pathological findings was assessed.

Results

Patients without microcalcifications on US images were significantly more likely to have the Luminal A subtype and a lower nuclear grading. Conversely, patients with microcalcifications on US images were significantly more likely to have higher level of MIB-1 index, lymphovascular invasion, comedonecrosis and lymph node metastasis. The rate of detecting microcalcifications on US images was relatively good, with 81.8% of sensitivity, 94.5% of specificity and 89.8% of diagnostic accuracy. Among the calcifications detected by MG images, detected rate of calcifications with US images was higher in necrotic type (92.6%) than secretory type (33.3%).

Conclusion

This study suggest that microcalcifications of tumors detected by US images could serve as an useful prediction to evaluate the degree of malignancy for patients with invasive breast carcinoma.     

Preoperative diagnostic accuracy of fine-needle aspiration in the management of breast lesions: Comparison of specificity and sensitivity with clinical examination,mammography, echography,and thermography in 249 patients

Two hundred and forty-nine women suffering from breast problems underwent a complete series of tests including clinical examination, mammography, echography, thermography, and fine-needle aspiration (FNA). Ninety-four of these patients were shown to be positive or to have suspected malignancy. Accordingly, they underwent surgical excision followed by histologic examination, while the remaining patients were re-examined after 12 to 18 mo in order to exclude false negatives. The analysis of specificity and sensitivity of every single procedure showed that FNA describes the best degree of sensitivity and specificity but no procedure allows, by itself, the detection of all carcinomas. When considered in combination, clinical examination, mammography, and fine-needle aspiration have a sensitivity of 100% and a specificity of 49%, and are the best diagnostic tests for a correct assessment of mammary lesions. Thermography and echography showed a low degree of sensitivity and should not be included in the routine diagnostic procedure of breast lesions. Diagn Cytopathol 1994; 11:4–8. © 1994 Wiley-Liss, Inc.     

Performance of combined clinical mammography and needle biopsy: a nationwide study from Denmark

Clinical mammography and needle biopsy are key tools for non-operative assessment of breast lesions. We evaluated the performance of all combined tests undertaken in Denmark in 2000. Clinical mammography and needle biopsy data were collected and linked to final cancer outcome, to determine sensitivity, specificity, and predictive values of clinical mammography, needle biopsy, and combined test. In 2000, 6709 combined tests were performed in 36 mammography clinics in Denmark. The combined test was consistently more sensitive than any single test, increasing the proportion of women correctly identified with breast cancer by 9% compared with clinical mammography alone. For concordant combined tests (i.e. either both benign or both malignant), specificity and positive predictive value were 100%, sensitivity was 99.1%, and positive predictive value was 99.6%. Therefore, Danish patients with a malignant concordant combined test can proceed directly to definitive surgery without fear of a false-positive diagnosis, and Danish women with a concordant benign combined test can omit surgery without fear of a false-negative diagnosis. In discordant cases, our results showed that any of the two tests with a suspicious or malignant result indicated a high risk of cancer, and excisional diagnostic biopsy therefore still has an important role to play.