乳腺超声筛查时相关因素对病灶检出率影响的研究

目的探讨乳腺疾病超声筛查工作中不同因素对病灶检出率的影响。方法选取在我院行乳腺超声筛查的患者900例,随机分为3组(检查时间分别为2 min、4 min及6 min),每组300例,扫查后记录每组病灶检出率,分析各组病灶检出率的差异。采用多因素回归分析研究患者年龄、扫查时间及探头频率对病变检出情况的影响。结果 2 min扫查组与4 min、6 min扫查组的病灶检出率比较差异均有统计学意义(均P0.05),而4 min扫查组与6 min扫查组的病灶检出率比较差异无统计学意义。多因素回归分析结果显示,患者年龄、扫查时间及探头频率对超声筛查的病灶检出率均有一定影响,其作用从大到小依次为患者年龄(OR=4.3)、扫查时间(OR=4.1)及探头频率(OR=3.3)。结论在乳腺超声筛查工作中,探头频率、患者年龄及扫查时间均对病灶检出率有显著影响。     

乳腺乳头状癌1例超声表现

患者女 ,47岁 ,发现右乳腺肿块 10余年就诊。既往有双侧乳腺增生病史。外科查体 :双侧乳腺不对称 ,右乳腺外观大于左乳 ,触诊右乳质硬 ,似可触及肿块 ,边界不清 ,无触痛。外院乳腺超声未见明确占位病变。我院超声检查显示 :左乳腺内未见明确肿块。右乳腺腺体结构紊乱 ,失去正常的腺体回声 ,而代之以弥漫增厚的强回声区域 ,范围较大 ,无明显边界及包膜 ,从内上象限蔓延至外上、外下象限 ,并可见弥漫分布的砂粒样钙化 (图 1)。病变区血流信号丰富 (与对侧同一部位相比 )。局部乳腺导管呈不规则扩张。右腋窝测及数枚肿大淋巴结 ,最大约 1.7ｃｍ…     

彩色多普勒超声诊断乳腺叶状肉瘤1例

患者女,48岁,一周前感觉右乳疼痛,自检发现右乳外上象限一约黄豆大小包块,压痛明显,活动度好;左乳外上象限有一直径约3.0cm包块,活动度好,略有压痛感。10年前曾行右乳纤维腺瘤切除。查体:双侧乳腺对称,外观正常,无乳头凹陷。左乳外上象限可触及一圆形包块,大小约3.0cm×2.0cm,边界清,质地中等,与周围组织无粘连,无压痛,局部皮肤无凹陷等。右乳外侧可触及一黄豆大小结节,质地中等,可移动。双侧腋窝、锁骨下未触及肿大淋巴结。实验室检查:CEA2.0ng/ml,血清CA-1537.9u/ml,余未见异常。彩色多普勒超声显示:右乳可见大小分别为1.1cm×0.8cm、0.…     

超声诊断乳汁潴留性囊肿2例

病例例１，女，２４岁，因右侧乳腺肿块１年来院检查。１年以前哺乳期时出现右侧乳痛，当时伴有红肿、发热，经消炎治疗后疼痛消失。自感右乳肿块，且逐渐增大。体检：右乳可探及一约５cm的圆形肿块与皮肤联系不紧密，可活动，无压痛，质硬，全身未触及肿大淋巴结。超声检查显示右侧乳腺外象限可见一５mm×４４mm的椭圆形强回声块影，边界清，形态欠规则，其内可见液性暗区，并可见肿块的一侧呈均匀的强回声，彩色多普勒显示其内无血流信号。同侧腋窝淋巴结无肿大。超声提示：右乳腺囊实性占位，考虑为乳腺积乳性囊肿（图１）。遂即行肿块穿…     

乳腺脂肪坏死38例X线表现特征分析

对我院1990～2006年经手术病理证实的乳腺脂肪坏死38例分析如下。 1临床资料 1.1一般资料 本组男1例，女37例，年龄17～80（平均48．5）岁。病史最短时间2周，最长10a。单发33例，左乳14例，右乳19例，2例为双侧乳腺脂肪坏死，1例为右乳多发。左侧副乳腺内1例。1例为乳腺癌术后胸壁皮下结节。     

乳腺神经鞘瘤伴表皮样囊肿1例的超声表现

女，29岁。发现右乳房肿块3月余来诊。专科检查：双乳房对称，乳头无溢液，右乳房外上象限触及一个鸡蛋大小的肿块，质地硬，边界清，表面光滑，可活动，无压痛。左乳房无异常发现。双侧腋窝未触及肿大淋巴结。临床诊断：右乳纤维腺瘤。超声检查：右乳腺外上象限探及—低回     

超声造影诊断乳腺导管内原位癌1例

患者女,70岁,发现右乳肿物半年住院,无乳头溢液。查体:右侧乳头略凹陷,无明显橘皮外观,右乳外下象限距乳头1.5cm处扪及3cm×3cm肿块,质软、光滑,无压痛,活动度可,双侧腋窝未及肿大淋巴结。超声检查:右侧乳腺外下象限见2.7cm×2.0cm囊实性团块(图1),边界尚清,形态不规则,呈分叶状,彩色多普勒显示实性部分有分支状彩色血流,动脉频谱RI=0.84,双侧腋窝未见明显肿大淋巴结。使用声诺维造影剂的实时动态超声造影显示乳腺病灶实性部分早期快速增强,消退较快,囊性及部分低回声结构始终未增强(图2)。超声诊断:右侧乳腺囊实性占位,考虑导管内来源(恶…     

彩色多普勒超声诊断乳腺巨大表皮样囊肿1例

患者女,82岁,3年前偶然发现右乳肿物,无疼痛、无乳头溢液,近2个月曾有破溃。查体:双乳不对称,右乳变形,体积明显增大,外形失常且皮肤张力增高,局部皮肤破溃,可见暗红色液体流出,可触及多个大小不等肿物,彼此相连,质韧、界清,无压痛,活动度尚可。左乳未触及异常,双侧腋窝未触及肿大淋巴结。超声表现:右乳可探及     

老年女性乳腺癌的临床特征及超声诊断价值

目的探讨老年女性乳腺癌的临床特征及超声诊断价值。 方法回顾性选取2015年6月至2019年12月就诊于北京协和医院乳腺外科行乳腺病灶手术获得明确病理诊断的≥70岁的老年女性288例，共计298个病灶，获取完整的临床、病理及超声影像资料。分析纳入对象的临床表现、病理特征，应用诊断试验四格表计算超声对老年女性乳腺良、恶性病灶及不同就诊原因患者良、恶性病灶的诊断效能，以及对腋窝淋巴结转移的诊断效能。 结果288例患者中，自行触及肿块189例（65.63%）、乳头溢液23例（7.99%）、体检（临床查体、影像学检查）发现肿块76例（26.39%）。298个病灶中，恶性病灶272个（91.28%），良性病灶26个（8.72%）。263例乳腺癌患者中，160例（60.84%）行乳腺肿块局部扩大切除术，71例（27.00%）行乳腺癌改良根治术，31例（11.79%）行乳腺肿块局部扩大切除术及前哨淋巴结活检或腋窝淋巴结清扫术，1例（0.38%）行全乳切除术。其中237例初诊患者术后病理T分期为T1 127例（53.59%），T2 79例（33.33%）。超声对老年女性乳腺癌的诊断敏感度、特异度和准确性分别为95.59%、50.00%和91.61%，其中超声对以肿块为主诉（包括自行触及和体检筛查发现）患者乳腺癌的诊断准确性（94.53%）高于主诉为乳头溢液患者的诊断准确性（58.33%）。102例乳腺癌患者接受了腋窝淋巴结处理，其中45例病理证实为腋窝淋巴结转移。术前超声对于腋窝转移性淋巴结诊断的敏感度、特异度和准确性分别为93.33%、73.68%、82.35%。 结论老年乳腺癌患者大多数因临床症状就诊，肿瘤分期晚。超声对以肿块为主诉的老年乳腺癌患者的诊断准确性较高，但对乳头溢液患者的诊断准确性仍有待提高。超声术前评估对老年乳腺癌患者腋窝淋巴结临床治疗方式的选择有重要价值。     

青春型乳腺巨大纤维腺瘤超声表现1例

患者女,13岁,月经来潮1年,发现右乳包块1年余并逐渐增大.体格检查:右乳局部隆起,表面皮肤高度紧张,内上象限可触及一10 cm×8 cm大小肿块,质硬,活动可,无红肿热痛,无乳头内陷及溢液,左乳腺未触及明显肿块,双侧腋窝未触及肿大淋巴结.超声检查:右乳腺见一巨大实性低回声肿块(图1),大小11.0 cm×9.2 cm×5.5 cm,边界清晰,外形欠规则,内部回声不均匀,未见液化区及团状强回声斑,左乳及双侧腋窝未见异常.彩色多普勒血流成像示:肿块周边及内部可探及较丰富血流信号(图2).超声提示:右乳巨大实性占位性病变(青春型巨大纤维腺瘤可能性大).手术大体标本见肿块完整,有包膜,切面质地均匀,呈灰白色.术后病理诊断:乳腺纤维腺瘤.     

Breast cancer: The appearance as delineated by whole breast water-path ultrasound scanning

The sonographic appearance of 130 breast carcinomas imaged by a dedicated breast scanning system is reviewed. Five separate categories are identified and examples of each category with corresponding xeromammograms are presented.     

Diagnostic ultrasound in breast cancer: analysis of retrotumorous echo patterns correlated with sonic attenuation by cancerous connective tissue.

Echocardiographic diagnosis of breast cancer has been used in clinical medicine for the past several years. Echographic findings and characteristics suggesting differentiation between malignant and benign tumors have been reported by various investigators. These signs are analysed in correlation with histological findings, especially cancerous connective tissue and nonconnective tissue and retrotumorous shadow patterns in clinical echograms of various breast cancers. Special reference is made to ultrasound attenuation related to bioacoustical tissue characteristics. This casual mechanism provides a stepping-stone for further improvements in ultrasound apparatus designed for clinical diagnosis of breast cancer. Furthermore, it may stimulate basic research on the bioacoustical properties of ultrasound reflection, absorption, and velocity.     

Diagnostic Performance of Automated Breast Ultrasound as a Replacement for a Hand-Held Second-Look Ultrasound for Breast Lesions Detected Initially on Magnetic Resonance Imaging

To evaluate the diagnostic performance of automated breast ultrasound (ABUS) after breast magnetic resonance imaging (MRI) as a replacement for hand-held second-look ultrasound (HH-SLUS), we evaluated 58 consecutive patients with breast cancer who had additional suspicious lesions on breast MRI. All patients underwent HH-SLUS and ABUS. Three breast radiologists evaluated the detectability, location, characteristics and conspicuity of lesions on ABUS. We also evaluated inter-observer variability and compared the results with HH-SLUS results. Eighty additional suspicious lesions were identified on breast MRI. Fifteen of the 80 lesions (19%) were not detected on HH-SLUS. Eight of the 15 lesions (53%) were detected on ABUS, whereas the remaining 7 were not detected on ABUS. Among the 65 lesions detected on HH-SLUS, only 3 lesions were not detected on ABUS. The intra-class correlation coefficients for lesion location and size all exceeded 0.70, indicating high reliability. Moderate to fair agreement was found for mass shape, orientation, margin and Breast Imaging Reporting and Data System (BI-RADS) final assessment. Therefore, ABUS can reliably detect additional suspicious lesions identified on breast MRI and may help in the decision on biopsy guidance method (US vs. MRI) as a replacement tool for HH-SLUS.     

乳腺超声分级方法应用的初步探讨

目的探讨乳腺超声诊断的具体分级方法及内容,分析在临床应用中遇到的问题。方法对比129个病灶应用分级诊断的结果与术后病理结果,明确分级系统中各项指标及分值。结果应用分级标准进行诊断,准确度80.6%(104/129),敏感度为94.7%(54/57),特异度为69.4%(50/72)。结论超声分级体系对于乳腺的超声诊断提供了标准化的平台,具有相当的临床应用价值。     

Predicting Prognostic Factors of Breast Cancer Using Shear Wave Elastography

The purpose of the study described here was to investigate the correlation between histologic factors, including immunohistochemical factors, related to the prognosis of breast cancer and shear wave elastography (SWE) measurements. One hundred twenty-two breast cancers from 116 women were subjected to sonoelastography. Of the SWE features, mean and maximum elasticity and SWE ratio were extracted. The SWE ratio was calculated as the ratio of the stiffness of a portion of the lesion to that of a similar region of interest in fatty tissue. High ratios indicate stiffer lesions. The Mann-Whitney U-test, Kruskal-Wallis test and receiver operating characteristic (ROC) curve were used for statistical analysis. Estrogen receptor negativity, progesterone receptor negativity, p53 positivity, Ki-67 positivity, high nuclear grade, high histologic grade and large tumor (invasive) size were associated with a significantly high SWE ratio (p < 0.05). ROC curve analysis yielded SWE ratio cutoff values of 2.74–3.69 for significant immunohistochemical factors and 4.21 for the basal-like subtype by maximizing specificity while ensuring more than 80% sensitivity. Breast cancers with aggressive histologic features had high SWE ratios. Shear wave elastography may provide useful information for determining prognosis.     

多普勒超声对乳腺肿块鉴别诊断的研究

目的评价多普勒超声对乳腺肿块鉴别诊断的临床应用价值. 方法 60例女性患者,术前分别进行二维超声、彩色多普勒超声和能量多普勒超声检查. 结果根据肿块的二维超声图像特征边缘轮廓、包膜、侧方声影、内部回声、后壁回声、肿物后回声、组织浸润及纵横比鉴别诊断乳腺肿块的敏感度为96.7%,特异度为60%,准确度为78.3%.二维超声联合CDFI血流信号分级(恶性Ⅱ～Ⅲ级,良性0～Ⅰ级),RI≥0.7,PI≥1.1 及PDI分型(恶性Ⅲ～Ⅳ型,良性Ⅰ～Ⅱ型),CPD≥21%鉴别诊断乳腺肿块的敏感度为93.3%,特异度为83.3%,准确度为88.4%.二者比较,特异度有显著性差异(P<0.02),敏感度和准确度无显著性差异(P>0.05). 结论在二维超声的基础上联合CDFI和PDI鉴别诊断乳腺肿块,明显提高了诊断恶性乳腺肿块的正确率,有很大的临床应用价值.     

乳腺导管内乳头状瘤的高频超声表现特征

目的：通过分析乳腺导管内乳头状瘤的高频超声表现特征,提高超声医师对该病的认识.材料和方法：回顾性分析经手术病理证实的32例乳腺导管内乳头状瘤的高频超声声像图表现.结果：本组病例的声像图特征可分为5型：Ⅰ型为导管扩张伴管腔内乳头状实性回声或实性回声充填（46.9%）;Ⅱ型为囊实混合型团块（18.8%）;Ⅲ型为局限性导管扩张,远端导管壁不规则或中断（18.8%）;Ⅳ型为导管扩张伴远端中断处实性结节或团块回声（9.4%）;Ⅴ型为腺体内低回声结节,无导管扩张（6.3%）.32例中有23例的超声诊断与手术及病理相符,诊断符合率71.9%.结论：高频超声能显示乳腺导管内乳头状瘤乳管扩张及瘤体情况,对Ⅰ、Ⅱ型病变的诊断准确率最高,Ⅳ型次之.     

Real-time ultrasound elastography: its potential role in assessment of breast lesions

We evaluated whether real-time ultrasound elastography (USE) performed in addition to conventional ultrasound (US) can improve the differentiation of benign from malignant breast lesions. Both conventional US and real-time USE were performed in 112 consecutive patients with 139 breast lesions using a Hitachi EUB-8500 US system. Each lesion was assigned an elasticity score according to the degree and distribution of strain induced manually by mild compression. The USE scores (1 to 5) were compared with the BI-RADS assessment categories (1 to 5) obtained with conventional US. Sensitivity, specificity and overall accuracy of each method were determined with surgical pathology as the gold standard. There were 70 benign and 69 malignant lesions. The mean elasticity score was significantly higher for malignant lesions than for benign lesions (4.33 +/- 0.11 vs. 2.10 +/- 0.13, p < 0.01). When a cutoff point of 4 was used, the sensitivity, specificity and accuracy were 85.5, 88.6 and 87% for USE and 94.2, 87.1 and 90.6% for conventional US, respectively. Of the 64 lesions assessed as BI-RADS 2 or 3(i.e., benign) based on conventional US, two were scored as 4 and 5 (i.e., malignant) using USE and were subsequently proven to be malignant. Of the 75 lesions with BI-RADS 4 or 5 category from conventional US, one was scored as a category 1 (benign) with USE and found to be benign by pathology. Our study results suggest that the addition of USE imaging to conventional US could be helpful in the detection and characterization of breast masses.     

乳腺肿块三维超声成像的临床应用

目的探讨三维超声在乳腺肿块中的应用价值。方法对22例32个乳腺肿块,在二维超声检查的基础上,进行三维重建并与手术、病理结果对照分析。三维各切面方位的确定用水槽内鹌鹑蛋模拟试验和人体颈动脉检查比较。结果三维超声能用多角度、多切面对病灶进行切割,因此能直接提供乳腺肿块的立体形态学特点,使图像更逼真。同时,三维能量图模式上血管的细粗、多少、走行的自然和陡直更提供了一种直观的血流分布模式．对鉴别乳腺疾病提供了帮助。结论三维超声成像可弥补二维超声的不足,提供了直观的、立体的形态学和肿块血供的三维能量图模式特点,对疾病分析又多了一种方法。     

经静脉声学造影剂增强乳腺肿块彩色血流信号的初步研究

本文探讨经静脉声学造影剂对乳腺肿块彩色血流信号的增强作用及鉴别良恶性病变的应用价值。１０例患者中７例为乳腺癌，３例为良性肿块，经静脉注射声学造影剂后，病灶区彩色血流信号显著增强：６例乳腺癌和１例良性肿块病灶内见有片状彩色血流区，血管数增多２～６条；１例直径＜１．０ｃｍ的乳腺癌见有１条彩色血流束；２例良性肿块中１例无彩色信号而另１例仅有１条血管。结果提示：经静脉声学造影剂能显著增强乳腺肿块彩色多普勒血流信号，更准确地反映肿块血供状况；有助于准确鉴别乳腺良、恶性病变。