不典型乳腺癌的X线诊断

目的:探讨不典型乳腺癌的临床表现及钼靶X线片特征,提高不典型乳腺癌的诊断水平。方法:15例不典型乳腺癌均为手术病理证实。均为女性,年龄28～66岁,平均45岁。有9例临床可扪及肿块状或结节感,另6例未扪及包块,在X线检查时被发现。15例均拍摄乳腺钼靶X线片。结果:15例X线表现:小结节状肿块影7例,钙化9例,局灶性致密影6例,腺体结构不良4例,血管影增粗3例。结论:不典型乳腺癌的临床及X线表现相对不典型,诊断乳腺癌除了重视特征性征象:肿块影和钙化,还应重视局灶性致密影、局部结构紊乱等间接征象。阅片时应仔细观察,要双侧对比,诊断时应综合分析,结合病人触诊情况,这对提高乳腺癌的诊断率有重要意义。     

乳腺囊性增生病不典型增生与乳腺癌细胞超微结构变化的…

应用透射电子显微镜对５３例正常乳腺、乳腺囊性增生病不典型增生和乳腺癌细胞超微结构观察。发现随着乳腺囊性增生病不典型增生程度加重，细胞超微结构出现发育不良及未分化现象；Ⅲ级不典型增生的部分超微结构变化与乳腺癌细胞相似。提示前者向后者衍变的内在联系。研究乳腺癌细胞以及在衍变过程中癌前细胞的形态结构变化特点及规律，对于深入了解癌前细胞的演变过程及其与乳腺癌发生的关系具有重要意义。     

甲状腺不典型良性结节超声声像图特征的回顾性分析

目的 探讨甲状腺不典型良性结节的超声声像图特点,以提高鉴别甲状腺良恶性结节的准确性.方法 回顾性分析405例行甲状腺超声检查并行手术切除患者的临床资料,对患者的405个甲状腺结节进行超声检查,并与术后病理结果进行对照研究.结果 经术后病理证实,405个甲状腺结节中,362个为恶性结节,43个为良性结节,超声诊断准确率为89.4％.良性结节中以结节性甲状腺肿为主,结节形态不规则、边界不清晰及结节内点状强回声为其最主要的表现.结论 常规超声辅助其他超声技术有助于提高对甲状腺结节良恶性诊断的准确性.     

不同分子分型乳腺癌超声BI-RADS征象分析及其相关性研究

目的：回顾性分析乳腺癌患者的乳腺影像报告和数据系统（Breast Imaging Reporting and Data System,BI-RADS）超声征象,探讨无创的超声检查与乳腺癌分子分型生物学指标的相关性。方法：选取160例女性乳腺癌患者,均有完整的术前超声诊断资料和术后病理组织学和免疫组织化学检查结果,对肿瘤术前超声检查征象采用BI-RADS术语进行描述和评估分类,按免疫组织化学检查结果对肿瘤进行分子分型,对比分析肿瘤的超声BI-RADS征象与其分子分型的相关性。结果：各型乳腺癌中,Luminal A型和Luminal B型后方回声衰减所占比例最高,HER2过表达型癌组织边缘有毛刺征的比例最低、出现微钙化的比例最高,三阴性型肿块边缘光整、后方回声增强比例最高,差异均有统计学意义（P<0.05）。结论：乳腺癌的BI-RADS超声征象对判断其分子分型有一定诊断价值,了解乳腺癌各分子分型的典型超声征象,有助于超声医师更早、更准确的诊断乳腺癌,为临床医师制定治疗方案和评估肿瘤预后提供更有价值的影像学依据。     

乳腺癌超声征象与病理组织学类型及组织学分级的临床关系研究

目的研究乳腺癌超声征象和病理组织学类型及组织学分级的临床关系。方法对127例乳腺癌患者进行前瞻性研究,在实施手术后进行包括组织学分类、浸润性导管癌组织学分级的病理分析。结果浸润性小叶癌和浸润性导管癌在毛刺、钙化、形态、后方回声衰减等方面比较,差异均具有统计学意义(P<0.05),高低分化型在血流及形态学方面差异具有统计学意义(P<0.05)。结论乳腺癌超声征象和病理组织学变化具有关联性,超声形态特点对病理组织分型和组织学分级具有预测提示作用。     

乳腺癌64例超声诊断分析

目的：总结超声诊断乳腺癌的经验，为乳腺癌的早期诊断、早期手术治疗提供依据。方法：对1998年10月至2002年12月间手术治疗，并经病理证实的64例乳腺癌的术前超声检查的声像进行分析，总结超声检查诊断乳腺癌的正确率。结果：46例术前超声检查为典型的乳腺癌声像图，17例因声像图表现不典型，仅提示为乳腺内肿块，I例为隐性乳腺癌。结论：超声诊断乳腺癌是一种方便、无创性、准确率较高的方法。     

乳腺癌X线征象分析

目的：分析乳腺癌X线表现,提高乳腺癌X线诊断水平。方法：对46例经病理证实的乳腺癌X线表现作回顾性分析。结果：46例中肿块影28例,微小钙化14例,局限浸润7例,结构紊乱5例、乳管造影乳管不规则、管腔截断、显影间断2例,皮肤局限性增厚9例,乳头下陷及漏斗征7例,血管增多增粗15例,大导管征7例、腋下淋巴结13例。结论：钼靶乳腺X线摄影是诊断乳腺癌的最主要方法。肿块和微小钙化是乳腺癌主要X线征象,局限浸润、结构紊乱为不典型征象。对乳头溢液者行导管造影,结合间接征象,综合分析,可提高诊断率。     

不典型临床表现的21例肺癌误诊分析

肺癌是最常见的恶性肿瘤,其临床表现复杂,首发症状亦多种多样。济南钢铁集团总公司总医院于保科收治以不典型临床表现为首发症状而被误诊的肺癌患者21例,结果总结报道如下。     

临床不典型乳腺癌的诊断

本文报道我院经手术病理证实乳腺癌患者面临床体征或X线、红外线影像不典型的病例118例。全部病人都有双乳腺结节状或团块状增生。其中病灶为孤立性肿物的46例,结节状增厚的32例,片状增厚的40例。病理结果导管癌48例,单纯癌31例,增生恶变16例,髓样癌15例,其它8例。通过分析这组病例,作者认为对临床无症状的单乳存在的较明显的结节状增生成高度重视积极用药治疗,无效则应立即手术作组织学检查是早期发现不典型乳腺癌的关键。     

高低分级乳腺癌及导管上皮不典型增生γ-tubulinNek2 mRNA表达分析及其意义

  目的  研究不同分级乳腺癌及不典型增生病变中心体γ-tubulin和调控因子Nek2 mRNA表达情况及其意义。  方法  选取正常乳腺、导管上皮不典型增生、高低级别导管内癌、高低级别浸润性导管癌6组样本, 采用原位杂交定性及半定量检测180例γ-tubulin和Nek2 mRNA表达情况, 采用实时定量RT-PCR测定80例γ-tubulin和Nek2 mRNA表达水平, 并行统计学分析。  结果  各组癌γ-tubulin mRNA、Nek2 mRNA表达均明显高于正常组织（P均 < 0.01）; 各组间差异具有统计学意义（χ2=37.519、36.912, P < 0.001）; 在不同癌组织之间, γ-tubulin或Nek2表达的两两比较, 差异无显著性（P均>0.05）; 在各组中两指标mRNA表达无显著性差异（P均>0.05）; 两指标各自定量和半定量表达总体变化趋势具有一致性; 原位杂交分析显示导管上皮不典型增生中γ-tubulin或Nek2 mRNA表达与低级别癌比较无统计学差异（χ2分别为1.200、0.659、1.148、2.700, P值分别为0.273、0.417、0.284、0.100）; 但在定量分析显示导管上皮不典型增生与低级别癌比较有显著差异（P均 < 0.01）。  结论  γ-tubulin及Nek2 mRNA过表达及协同作用, 与乳腺上皮细胞的异常增殖、不典型增生向低级别乳腺癌恶变转化可能具有相关性。      

乳管镜图像特征在伴乳头溢液乳腺癌中的诊断价值

目的探讨乳管镜图像特征多元参数在伴乳头溢液乳腺癌中的诊断价值。方法回顾性分析1159例病理资料完整的伴乳头溢液乳腺病患者的乳管镜资料,通过）（2检验筛选出乳管镜下诊断乳腺癌的相关图像特征,用Logistic回归分析评价它们在伴乳头溢液乳腺癌中的诊断价值。结果乳管镜诊断相关的图像特征包括病变的位置、管腔改变、管壁弹性、管壁表面形态、乳管末稍出血、病变在乳管内的位置、病变形状、病变颜色、病变表面形状、病变数量及病变表面出血等（P〈0．05）,行Logistic回归分析筛选出各乳管镜图像特征的DR值分别为：DR管壁表面形态=3．05,OR乳管末梢出血=2．22,OR病变数量=2．09,0R病变颜色=1．53,OR病变表面形状=1．53,DR病变形状=1．41,OR管壁弹性=0．43。根据OR值对各孚L管镜图像特征在伴乳头溢液乳腺癌中的诊断价值进行排序：管壁表面形态〉乳管末梢出血〉病变数量〉病变颜色=病变表面形状〉病变形状〉管壁弹性。结论乳管镜图像特征对伴乳头溢液乳腺癌的诊断有重要价值。     

乳腺髓样癌的X线表现

目的 研究乳腺髓样癌的X线表现,并比较不同病理分型的X线特点,提高对该病的影像诊断水平.方法 回顾性分析经手术病理证实、有完整乳腺X线资料的乳腺髓样癌32例共33个病灶,其中典型髓样癌27个病灶,不典型髓样癌6个病灶;观察其X线特点.结果 33个病灶中表现为不伴钙化的肿块30个(90.9%),伴钙化肿块2个(6.1%)...     

The use of atypical antipsychotics and the risk of breast cancer

To determine whether atypical antipsychotics, when compared to typical antipsychotics, increase the risk of breast cancer. We conducted a retrospective cohort study using a nested case–control analysis within the United Kingdom General Practice Research Database population. We identified all female patients prescribed at least one antipsychotic (either typical or atypical), between 1 January 1988 and 31 December 2007, with follow-up until 31 December 2010. All incident cases of breast cancer were identified and matched up to 10 controls. Adjusted rate ratios (RR) of breast cancer associated with ever use of atypical antipsychotics was compared to ever use of typical antipsychotics. The cohort included 106,362 patients prescribed antipsychotics during the study period. During a mean follow-up of 5.3 years, 1237 patients were diagnosed with breast cancer (overall rate: 2.7 per 1000/year). Compared to patients who only used typical antipsychotics, exclusive users of atypical antipsychotics were not an increased risk of breast cancer (RR: 0.81, 95% CI: 0.63, 1.05). These results remained consistent after considering specific atypical antipsychotics known to significantly increase prolactin levels such as risperidone (RR: 0.86, 95% CI: 0.60, 1.25). Furthermore, no dose–response was observed in terms of cumulative duration of use and cumulative dose in olanzapine equivalents. The results of this study should provide reassurance that compared to typical antipsychotics, atypical antipsychotics do not increase the risk of breast cancer.     

鞘氨醇激酶1在乳腺不典型增生及乳腺癌中的表达及意义

目的探讨鞘氨醇激酶1(SPHK1)在乳腺癌发生过程中的表达情况及意义。方法收集本院2008年3月至2009年10月手术后切除经病理证实的各级乳腺不典型增生标本30例、乳腺癌标本36例及正常乳腺组织11例,用免疫组织化学法检测各类组织的SPHK1表达,了解其在乳腺癌发生过程中不同组织改变阶段的表达情况。定量资料采用Spearman等级相关分析或Mann-Whitney检验。结果 SPHK1在正常乳腺组织中无表达,在不典型增生组织中表达呈逐渐增强趋势,在乳腺癌中有强表达(r=0.797,P=0.000)。在乳腺癌组织中SPHK1表达与临床病理学特征无明显关系(P0.050)。结论 SPHK1可能与乳腺癌的发生有关。     

The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions

Women with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and severe ADH are at increased risk of breast cancer, but a systematic quantification of this risk and the efficacy of chemoprevention in the clinical setting is still lacking. The objective of this study is to evaluate a woman??s risk of breast cancer based on atypia type and to determine the effect of chemoprevention in decreasing this risk. Review of 76,333 breast pathology reports from three institutions within Partners Healthcare System, Boston, from 1987 to 2010 using natural language processing was carried out. This approach identified 2,938 women diagnosed with atypical breast lesions. The main outcome of this study is breast cancer occurrence. Of the 2,938 patients with atypical breast lesions, 1,658 were documented to have received no chemoprevention, and 184/1,658 (11.1?%) developed breast cancer at a mean follow-up of 68?months. Estimated 10-year cancer risks were 17.3?% with ADH, 20.7?% with ALH, 23.7?% with LCIS, and 26.0?% with severe ADH. In a subset of patients treated from 1999 on (the chemoprevention era), those who received no chemoprevention had an estimated 10-year breast cancer risk of 21.3?%, whereas those treated with chemoprevention had a 10-year risk of 7.5?% (p?<?0.001). Chemoprevention use significantly reduced breast cancer risk for all atypia types (p?<?0.05). The risk of breast cancer with atypical breast lesions is substantial. Physicians should counsel patients with ADH, ALH, LCIS, and severe ADH about the benefit of chemoprevention in decreasing their breast cancer risk.     

Estrogen receptor expression in atypical hyperplasia: lack of association with breast cancer

Estrogen receptor (ER) is expressed in normal and malignant breast epithelium, and expression levels have been found to increase with age in normal breast epithelium but not in atypical hyperplasia (AH) and carcinoma in situ. Here we assess ER expression in AH and its association with later breast cancer. ER expression was assessed immunohistochemically in archival sections from 246 women with AH who had open benign breast biopsy from 1967 to 1991. The ACIS III (Dako) was utilized to calculate ER expression in all atypical foci. Using multivariate linear regression, we examined associations of ER expression with age at biopsy, indication for biopsy, type of atypia, number of atypical foci, involution status, and family history. Breast cancer risk across levels of ER expression was also assessed compared with the Iowa SEER control population. Among 246 women, 87 (35%) had atypical ductal hyperplasia (ADH), 141 (57%) had atypical lobular hyperplasia (ALH), and 18 (7%) had both. Forty-nine (20%) developed breast cancer (median follow-up of 14.4 years). Multivariate analysis indicated that type of atypia and age at diagnosis were significantly associated with ER percent staining and intensity (P < 0.05). ER expression was increased in women with ADH and/or those over age 55. ER expression did not significantly impact breast cancer risk in patients diagnosed with atypia. We found increasing ER expression in AH with increasing age. ER expression in AH does not further discriminate breast cancer risk in women with atypia.