乳腺癌CR钼钯与彩色多普勒超声检查的对比与临床应用研究

目的探讨乳腺癌CR与彩色多普勒超声(CDFI)检查的影像学征象并对比。方法回顾性分析经手术病理证实的112例乳腺癌的影像学征象特点。结果112例乳腺癌CR钼钯诊断与CDFI进行检查诊断其敏感性分别为94.7%、83.9%,特异性分别为96.4%、89.3%,准确性分别为92.8%、85.7%。结论CR钼钯及CDFI均为乳腺癌诊断优秀检查方法,肿块及钙化是CR钼钯诊断乳腺癌的特征表现。     

Racial and Geographic Differences in Mammography Screening in St. Louis City: A Multilevel Study

To examine racial differences in mammography use and its determinants in the City of St. Louis, MO, USA, we recruited women age 40 or older using random-digit dialing to (1) examine the difference in mammography use between white women and African American women and (2) identify individual- and census-tract-level risk factors of nonadherence to mammography. During telephone interviews, we inquired about mammography use and several demographic, psychosocial, and health behavior variables. We determined the residential census tracts of study subjects using a geographic information system. The rate of mammography use was 68.0% among white women and 74.7% among African American women (P = 0.022). African American women were more likely to have mammograms than white woman (adjusted odds ratio [OR] = 1.71; 95% confidence interval [CI] = 1.09-2.69). System-level barriers to mammography and heavy smoking were associated with lower mammography use among both white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography use among white women. White women residing within a historic geographic cluster area of late-stage breast cancer were less likely to have mammograms (adjusted OR = 0.42, 95% CI = 0.22-0.80), while African American women residing within a historic geographic cluster area of late-stage breast cancer were equally likely to have mammograms (adjusted OR = 0.79, 95% CI = 0.28-2.24). Neither individual- nor census-tract-level socioeconomic status was associated with mammography screening. These findings suggest that there may be a greater need for increasing mammography use among white women, especially in the historic cluster area of late-stage breast cancer in St. Louis.     

乳腺疾病钼靶X线征象探讨

目的明确乳腺疾病的钼靶摄影征象，探讨钼靶在早期乳腺癌诊断中的价值。方法总结分析我院从512例乳腺疾病钼靶X线摄影中检出，并经手术和病理证实为乳腺肿瘤35例，其中乳腺良性肿瘤26例，乳腺癌9例。结果9例乳腺癌X线显示肿块影5例，有钙化灶1例。良性肿瘤X线征象为密度均匀、边缘光滑、椭圆或圆形肿块，周围有环形透亮带。结论钼靶X线乳腺摄影是诊断乳腺肿瘤的首选方法，特别是乳腺癌的主要直接征象和间接征象在乳腺癌的早期诊断中具有重要意义。     

The Effect of Patient Navigation on Time to Diagnosis,Anxiety, and Satisfaction in Urban Minority Women with Abnormal Mammograms: A Randomized Controlled Trial

Delay in follow-up after an abnormal mammogram is associated with advanced disease stage, poorer survival, and increased anxiety. Despite the implementation of many patient navigator programs across the country, there are few published, peer-reviewed studies documenting its effectiveness. We tested the effectiveness of a patient navigator in improving timeliness to diagnosis, decreasing anxiety, and increasing satisfaction in urban minority women after an abnormal mammogram. Women with suspicious mammograms were randomly assigned to usual care (N = 50) or usual care plus intervention with a patient navigator (N = 55). There were no demographic differences between the two groups. Women in the intervention group had shorter times to diagnostic resolution (mean 25.0 vs. 42.7 days; p = .001), with 22% of women in the control group without a final diagnosis at 60 days vs. 6% in the intervention group. The intervention group also had lower mean anxiety scores (decrease of 8.0 in intervention vs. increase of 5.8 in control; p < .001), and higher mean satisfaction scores (4.3 vs. 2.9; p < .001). Patient navigation is an effective strategy to improve timely diagnostic resolution, significantly decrease anxiety, and increase patient satisfaction among urban minority women with abnormal mammograms.     

不同类型乳腺摄影中受照剂量的现状

随着乳腺摄影技术的不断发展和质量控制技术的不断改进，辐射防护最优化的面临着新的考验和挑战，就针对如何正确的理解和评价数字摄影中的剂量学问题进行了初步探讨。     

乳腺癌钼靶X线表现与p53表达的相关性探讨

目的 初步探讨乳腺癌钼靶X线表现与p53基因表达之间的关系.方法 将84例乳腺癌患者X线征像中肿块、钙化、毛刺、病变区密度及有无结构扭曲与免疫组化测定的p53基因的表达进行对照研究.结果 84例乳腺癌患者中,有肿块者53例,占63.1%,有钙化者42例,占50.0%,有毛刺者25例,占29.8%,病变区高密度者57例,占67.9%,有结构扭曲38例,占45.2%.p53阳性表达44例,阳性表达率为52.4%.钙化与病变区高密度者p53阳性表达率高,毛刺征、有无肿块及结构扭曲与p53阳性表达无关.结论 乳腺癌的一些重要的钼靶X线征象与p53基因的表达之间有密切的关系,从一定程度反映了乳腺癌的生物学行为和预后.     

Comparison of False Negative Rates among Breast Cancer Screening Modalities with or without Mammography: Miyagi Trial

False negative rates were compared in two screening modalities, physical examination with or without mammography, in an intervention study for women aged over 50 in Miyagi Prefecture. Thirty-five breast cancers were detected in 12,515 subjects who participated in the trial consisting of physical examination and mammography, whereas 44 breast cancers were detected in 50,105 subjects who received physical examination alone, so that the detection rates were 0.28% and 0.09%, respectively. Among 50,061 subjects who received physical examination alone, 8 women were diagnosed as having breast cancer within 12 months after the screening, while only one of 12,480 screenees receiving the combined modality was so diagnosed, implying false negative rates of 15.4% and 2.8%, respectively. When the screening sensitivity in the combined system was analyzed according to each single modality, the false negative rate provided by physical examination with mammography turned out to be 2.8%, significantly lower than that (33.3%) by the physical examination alone. Minimal breast cancers represented 25.7% of all screen-detected cancers in the combined modality, compared with 9.1% in the modality without mammography. The trial thus indicates that physical examination combined with mammography may be an appropriate modality for breast cancer screening in women aged over 50 on the basis of screening sensitivity.     

Local breast cancer recurrence caused by mammographically guided punctures

Purpose: To evaluate the risk of needle track seeding or tumor cell implantation as the cause of locally recurrent breast cancer after breast conserving surgery.Material and Methods: We reviewed recurrences from a consecutive series of 303 clinically nonpalpable breast cancers treated with breast conserving surgery after pre-operative localization. The median mammographic follow-up was 5.4 years. The suspicion of seeding or implantation was based on the location of the recurrent lesion in comparison with the needle path in two orthogonal mammographic projections. Pre-operative percutaneous biopsies had been done in 71% (214/303) of the cases. Postoperative radiotherapy was administered to 82% (194/238) of the invasive cancers and to 28% (18/65) of the ductal cancers in situ (DCIS).Results: Locally recurrent cancer occurred in 11% (33/303) of the cases. Radiotherapy demonstrated a protective effect from relapse among invasive cancers but not for DCIS. Seeding or implantation was suspected in 3 recurrent invasive cancers which had not been subject to radiotherapy. The histopathological diagnosis of the primary cancer and the recurrent cancer were the same in these cases: adenoid cystic, mucinous and tubuloductal cancer.Conclusion: Seeding or implantation was suspected as the cause of local recurrence in 7% (3/44) of the invasive cancers which did not receive radiotherapy.     

钼靶X线对乳腺浸润性导管癌与导管内癌钙化灶的研究

目的:探讨浸润性导管癌与导管内癌钙化的钼靶X线表现特点。方法:回顾性分析行乳腺钼靶X线检查并经手术及病理证实的135例乳腺浸润性导管癌患者与17例导管内癌患者。结果:135例浸润性导管癌患者中,72例(53.3%)可见钙化,其中钙化伴有肿块者63例(46.7%),钙化不伴肿块表现者9例(6.7%)。17例乳腺导管内癌中,14例(82.4%)可见钙化,钙化伴有肿块者3例(17.7%),钙化不伴肿块表现者11例(64.7%)。导管内癌钙化的发生率显著大于浸润性导管癌,浸润性导管癌钙化伴有肿块的发生率显著大于导管内癌。结论:仔细分析乳腺的钙化灶,对浸润性导管癌与导管内癌的诊断有一定的价值。     

Screen-Film Mammography and Soft-Copy Full-Field Digital Mammography: Comparison in the Patients with Microcalcifications

Objective

We wanted to compare the ability of screen-film mammography (SFM) and soft-copy full-field digital mammography (s-FFDM) on two different monitors to detect and characterize microcalcifications.

Materials and Methods

The images of 40 patients with microcalcifications (three patients had malignant lesion and 37 patients had benign lesion), who underwent both SFM and FFDM at an interval of less than six months, were independently evaluated by three readers. Three reading sessions were undertaken for SFM and for FFDM on a mammography-dedicated review workstation (RWS, 2K×2.5K), and for FFDM on a high-resolution PACS monitor (1.7K×2.3K). The image quality, breast composition and the number and conspicuity of the microcalcifications were evaluated using a three-point rating method, and the mammographic assessment was classified into 4 categories (normal, benign, low concern and moderate to great concern).

Results

The image quality, the number and conspicuity of the microcalcifications by s-FFDM (on the RWS, PACS and both) were superior to those by SFM in 85.0%, 80.0% and 52.5% of the cases, respectively (p < 0.01), and those by the s-FFDM on the two different monitors were similar in 15.0%, 12.5% and 35.0% of the cases, respectively (p > 0.01). The mammographic assessment category for the microcalcifications in the three reading sessions was similar.

Conclusion

s-FFDM gives a superior image quality to SFM and it is better at evaluating microcalcifications. In addition, s-FFDM with the PACS monitor is comparable to s-FFDM with the RWS for evaluating microcalcifications.