MR动态增强及减影成像对乳腺良恶性疾病的诊断价值

目的探讨MR动态增强成像技术所获得的参数及减影成像在乳腺良、恶性疾病诊断及鉴别诊断中的价值。资料与方法经病理证实乳腺病变50例，共计58个病灶。采用快速小角度激发扰相梯度回波序列（FLASH）行动态增强扫描。观察：时间一信号强度曲线类型，早期增强率，增强后病灶形态学特征及间接征象，于3D减影最大强度投影（MIP）图计数肿瘤血管数目。结果50例58个病灶经病理证实，其中恶性32个，良性26个。良性病变中时间一信号强度曲线57．7％为单向型，38．5％为平台型。恶性病变中71．9％为流出型。良、恶性病变的时间一信号强度曲线类型比较，差异有统计学意义（X^2=32．365，P＜0．05）。良性肿瘤中95％边缘光滑，55％均匀强化；恶性肿瘤中93．8％的形态不规则，78．1％有毛刺和分叶，81．3％不均匀强化。良、恶性肿瘤的形态特点差异有统计学意义（X^2=44．25，P＜0．05）。良性病变中73．1％无肿瘤血管：恶性病变中68．8％有多支肿瘤血管，良、恶性病变肿瘤血管计数差异有统计学意义（X^2=32．288，P＜0．05）。结论乳腺增强MRI及减影成像能够提供清晰、丰富的形态学信息，时间一信号强度曲线反映了病变的血流动力学信息，两者的结合对乳腺良、恶性疾病的正确诊断和鉴别诊断具有重要价值。     

MRI结合数字化钼靶诊断乳腺癌的临床研究

目的:评价数字化钼靶与动态增强MRI检查及其联合应用对乳腺癌的诊断价值.方法:67例患者共78个经手术病理证实的乳腺病灶(恶性32个,良性46个),均经数字化钼靶及MRI检查(包括T1WI、T2WI、DWI和动态增强扫描)并进行BI-RADS分级,计算2种方法以及联合应用诊断乳腺病变的敏感度和特异度.结果:数字化钼靶和MRI对乳腺癌检出的敏感度分别为78.13%和93.75%,差异无统计学意义(P》0.05);两者对乳腺癌诊断的特异度分别为73.91%和89.13%,差异有统计学意义(P《0.05);两种方法联合运用检出病变的敏感度为98.63%,特异度为97.16%.结论:数字化钼靶摄片与MRI的联合应用有助于提高对乳腺癌的诊断准确性.     

吡柔比星在Ⅲ期原发性乳腺癌新辅助化疗中的近期效果观察

目的探讨以蒽环类药物吡柔比星（THP）为主的联合新辅助化疗对Ⅲ期原发性乳腺癌新辅助化疗的近期临床效果。方法对138例手术前确诊的Ⅲ期原发性乳腺癌采用以吡柔比星为主的CTF方案化疗1～4个周期，观察临床疗效、保乳手术率和毒副反应。结果全组总有效率为75．4％（104／138）；其中完全病理缓解1例，临床完全缓解1例（0．7％），部分缓解102例（73．9％），无变化32例（23．2％），进展2例（1．4％）。实施保乳手术7例（5．1％）。施行化疗3＋4周期的疗效和保乳手术率均明显高于1＋2周期者（均P〈0．05）。该方案的脱发反应轻，Ⅰ度脱发28例（20．3％）；心脏毒性较小，室性期外收缩发生率1．4％（2／138），无充血性心衰病例。但骨髓抑制较明显，总发生率55．8％（77／138），其中Ⅱ度骨髓抑制发生率为27．5％（38／138），Ⅲ度骨髓抑制发生率为21．0％（29／138），Ⅳ度骨髓抑制发生率为7．2％（10／138）。结论以吡柔比星为主的CTF方案用于乳腺癌新辅助化疗心脏毒性小，近期疗效较满意；但骨髓抑制发生率高，治疗期间应予支持治疗。     

乳腺癌根治术后两种不同负压引流效果的对比分析

目的探讨乳腺癌根治术后两种负压引流方法的效果。方法我科在1999年1月至2005年12月对359例乳腺癌根治术后不同引流方法下皮瓣坏死及皮瓣下积液的发生率进行回顾性分析。结果两组间皮瓣坏死和皮下积液的发生率比较有显著性差异。结论乳腺癌根治术后单纯低负压瓶Y型管引流效果非常可靠,值得临床推广。     

Studies on SSTR2 mRNA expression and its correlation to steroid receptors in human benign and malignant breast lesions

Objective:This sudy was designed to observe somatostatin receptor subtype 2 (SSTR2) Mrna expression, and investigate the correlations between SSTR2 Mrna expression and steroid receptors in benign and malignant lesions of the breast. Methods: A total of 23 breast carcinomas,16 mammary hyperplasia and 9 mammary adenofibroma samples were analysed. The SSTR2 Mrna expression was examined by in situ hybridization using multiphase oligoprobes.The ER and PR were detected by immunohistochemical staining. A computerized image analysis system was utilized to estimate the relative contents of SSTR2 Mrna. Results: The positive rates of expression (87.0%) and relative contents (0.47) of SSTR2 Mrna in breast cancer were higher than those in benign breast lesions(64%,0.26) respectively( P＜0.05). SSTR2 Mrna expression was closely correlated with ER and PR in breast cancer( P＜0. 05), A positive correlation between SSTR2 Mrna expression and ER was also found in benign breast lesions. Conclusions: SSTR2 Mrna expressed both in benign and in malignant breast lesions, but higher in malignant than in benign ones. There was a significant positive correlation of SSTR2 Mrna expression with ER or PR. The results suggest that conbined treatment with an antiestrogen and a somatostatin analogue for ER-positive breast cancer is feasible.     

Two-dimensional echocardiography in the diagnosis of intracardiac masses: A prospective study with anatomic validation

The accuracy of two-dimensional echocardiography in the detection of intracardiac masses was verified in 334 patients who underwent cardiac catheterization in our laboratory over 21 consecutive months. A complete two-dimensional echocardiographic (2DE) examination was performed a day before catheterization. The presence or absence of a mass was verified at surgery in 77 patients who successively underwent mitral or aortic valve replacement (51), left ventricular aneurysmectomy with or without myocardial revascularization (25), and resection of atrial myxoma (2). In 32 patients 2DE revealed the presence of a mass-left or right atrial thrombi in 12, left atrial myxoma in 2, left ventricular thrombi in 16, and endocardial vegetations in 2. The other 45 patients were free of intracardiac masses on 2DE. Anatomic verification at surgery revealed the presence of an intracardiac mass in 34 patients. In 30 (true positives) of these, 2DE revealed the mass as well, and in 4 (false negatives) the presence of a mass had not been identified by 2DE. In 2 patients (false positives) the predicted mass was not found at surgery. Absence of a mass was correctly predicted by 2DE in 41 patients (true negatives). Thus 2DE detected intracardiac masses with sensitivity of 88.2% and a specificity of 95.3%. We recommend that 2DE be performed in all patients prior to hemodynamic study and/or cardiac surgery to enable safer management of patients with intracardiac masses during cardiac catheterization and/or cardiac surgery.     

Is the grading of breast carcinomas affected by a delay in fixation?

Summary The effect of delay in fixation on the modified Bloom and Richardson grade of eight breast carcinomas was investigated. Topologically shuffled samples of each tumour were immersed in fixative at times of 0.5, 2, 4, 6, 18 and 24 h after surgical removal. The grade of each tumour was assessed at delays of 0.5 and 6 h. The tubule formation and nuclear pleomorphism components of the grade showed no change with a delay in fixation of 6 h. The number of mitotic figures declined by a mean of 53% over the same period and this resulted in a decrease in the histological grade of one of the tumours. The implications of these findings for the handling of breast specimens in a diagnostic histopathological laboratory are discussed.Some of these data were presented at the 162nd meeting of the Pathological Society of Great Britain and Ireland at Cambridge, 3 January 1991. Published as an abstract in J Pathol (1991) 163:154A     

Breast Volume Measurement in Young Chinese Women and Clinical Applications

The authors carried out research on breast volume and body surface anatomy of 125 women. As a result, an average breast volume for Chinese women was obtained (325.36 ± 12.66 ml), and a table with several linear equations for calculating breast volume was derived. The authors applied these results to their clinical work and succeeded in making mammaplasty more precise in 178 patients.     

Intracapsular implant rupture: MR findings of incomplete shell collapse

The objective of this study was to determine the frequency and significance of the MR findings of incomplete shell collapse for detecting implant rupture in a series of surgically removed breast prostheses. MR images of 86 breast implants in 44 patients were studied retrospectively and correlated with surgical findings at explanation. MR findings included (a) complete shell collapse (linguine sign), 21 implants; (b) incomplete shell collapse (subcapsular line sign, teardrop sign, and keyhole sign), 33 implants; (c) radial folds, 31 implants; and (d) normal, 1 implant. The subcapsular line sign was seen in 26 implants, the teardrop sign was seen in 27 implants, and the keyhole sign was seen in 23 implants. At surgery, 48 implants were found to be ruptured and 38 were intact. The MR findings of ruptured implants showed signs of incomplete collapse in 52% (n = 25), linguine sign in 44% (n = 21), and radial folds in 4% (n = 2). The linguine sign perfectly predicted implant rupture, but sensitivity was low. Findings of incomplete shell collapse improved sensitivity and negative predictive values, and the subcapsular line sign produced a significant incremental increase in predictive ability. MRI signs of incomplete shell collapse were more common than the linguine sign in ruptured implants and are significant contributors to the high sensitivity and negative predictive values of MRI for evaluating implant integrity.