超声在小体积乳腺叶状肿瘤和纤维腺瘤鉴别诊断中的价值

目的：探讨超声对小体积（直径〈5cm）乳腺叶状肿瘤和纤维腺瘤鉴别诊断的价值。方法：回顾性分析经病理证实、直径均〈5cm的12例乳腺叶状肿瘤和96例纤维腺瘤患者的超声表现。结果：囊性变、Ⅱ级和Ⅲ级血流信号（根据Adler半定量法分级）在2组患者中的检出率差异有统计学意义（P〈0.05）。其中囊性变和Ⅲ级血流信号诊断的特异性和准确性较高,特异性均为99.0%,准确性分别为91.7%和90.7%。结论：囊性变和Ⅲ级血流信号是鉴别诊断直径〈5cm的乳腺叶状肿瘤和纤维腺瘤的重要指标。Ⅱ级血流信号在二者中存在较大重叠,可作为鉴别诊断的参考指标。     

高频彩色多普勒超声在小乳腺癌诊断中的价值

目的探讨高频二维超声及彩色多普勒血流成像(CDFI)诊断小乳腺癌的应用价值。方法回顾性分析经术后病理证实的小乳腺肿块(小于2.0cm)101例,其中小乳癌53例,乳腺良性病变48例。分别就二维超声声像图特征、CDFI等项指标进行对照分析,明确对诊断有肯定价值的诊断指标。结果二维超声检查中,乳腺癌与良性病变在形态、边界、包膜、内部回声、后方回声、纵横比、有无钙化等方面均有显著性差异。CDFI乳腺癌的血流检出率为90.57%,血流信号丰富,以Ⅱ～Ⅲ级为主(占83.02%)。腋窝转移性淋巴结是乳腺癌的间接征象。结论小乳腺癌的二维图像、CDFI及转移性腋窝淋巴结在诊断小乳腺癌上均有特征性表现。综合分析可大大提高小乳腺癌的诊断准确率。     

乳腺导管内乳头状瘤的高频彩色多普勒超声诊断与病理对照分析

目的:探讨乳腺导管内乳头状瘤二维及彩色多普勒超声检查的临床意义。方法:对乳头溢液患者进行二维及彩色多普勒超声检查,分析导管内乳头状瘤超声诊断的特点。结果:87例病理证实的导管内乳头状瘤患者的112个病灶中,彩色多普勒超声检查共发现86个(76.8%)病灶,其中53个(62%)位于乳头旁及乳晕区的大导管内,33个(38%)位于中小导管;单发病灶61例,多发病灶12例,其中11例为2个病灶,1例为3个病灶,14例未发现病灶。彩色多普勒超声检出血流信号9个,频谱多普勒测及动脉频谱2个,测及静脉频谱7个。结论:二维及彩色多普勒超声检查可以对乳腺导管内乳头状瘤作出较明确的诊断和定位,是乳头溢液患者病因诊断的有效手段。     

超微血管显像技术与频谱多普勒技术评价慢性腱病的比较

目的比较超微血管显像技术与频谱多普勒技术评价慢性腱病的效果。方法回顾性分析自2017-07—2018-07采用彩色多普勒超声诊断的62例慢性腱病,分别采用SMI技术(SMI组)及PDI技术(PDI组)检测血流情况,比较2组检查出的血流信号数及血流分级情况。结果 62例均顺利完成检查。SMI组探测到的血流信号均较PDI组多,差异有统计学意义(P 0.05)。SMI组血流信号分级:0级10例,Ⅰ级18例,Ⅱ级29例,Ⅲ级5例;PDI组血流信号分级:0级23例,Ⅰ级27例,Ⅱ级11例,Ⅲ级1例,SMI组血流信号分级情况明显优于PDI,差异有统计学意义(P 0.05)。结论 SMI技术在评价慢性腱病中对低速血流信号敏感,具有较高的临床应用价值。     

Id-1 mRNA在乳腺癌中的表达及与高频彩色 多普勒超声表现和病理对照

目的研究Id-1 mRNA在乳腺癌中的表达,探讨其与彩色多普勒高频超声表现及病理的关系。方法应用实时荧光定量RT-PCR检测80例乳腺癌样本中Id-1 mRNA的表达,并与乳腺癌的高频彩色多普勒超声表现进行对照分析。结果Id-1 mRNA在正常组织中表达低于癌组织（P〈0.01）;WHOⅢ级表达高于WHOⅠ级（P〈0.01）。超声显示具有毛刺征及周边高回声晕的组织,Id-1 mRNA均呈高表达（P〈0.01）;乳腺癌彩色多普勒血流显像Ⅱ～Ⅲ级中Id-1mRNA的表达高于0～Ⅰ级（P〈0.01）。结论乳腺癌的声像图表现与其病理改变密切相关,乳腺癌的彩色多普勒高频超声征象可在一定程度上反应Id-1 mRNA的表达。     

高频彩色多普勒超声联合弹性成像对乳腺癌与良性增生结节的鉴别诊断价值

探究高频彩色多普勒超声联合弹性成像在乳腺癌和乳腺良性结节中鉴别诊断价值。选择2015年1月—2019年1月接受治疗的255例女性乳腺疾病患者进行回顾性研究,根据患者病理结果分为乳腺癌组85例和乳腺良性结节组170例。两组患者在住院治疗期间均行高频彩色多普勒超声联合弹性成像检查。比较联合检查下乳腺癌与乳腺良性结节的钙化类型、乳腺影像报告数据系统(BI-RADS)分级情况和血流信号分级比较。乳腺癌的整体钙化率超过乳腺良性结节,以Ⅰ型钙化灶患者是最多见,而乳腺良性结节患者中Ⅲ型钙化最多,差异有统计学意义(P0.05)。乳腺癌患者的BI-RADS分级主要为4级;而乳腺良性结节主要为3级,且未检测到6级;差异有统计学意义(P0.05)。血流信号分析显示,乳腺癌患者大部分集中于3级,不存在0级;而乳腺良性结节的患者则集中分布在0级,不存在3级血流信号;差异有统计学意义(P0.05)。高频彩色多普勒超声联合弹性成像能够很好地用于乳腺疾病的钙化灶分型、乳腺疾病BI-RADS系统分级的诊断和分型,对乳腺癌和乳腺良性结节血流信号分级进行统计分析,从而在乳腺癌与乳腺良性增生结节的鉴别诊断中起到一定的作用,值得临床推广与应用。     

原发性肝癌动脉血供彩色多普勒超声与DSA的对比研究

目的:探讨彩色多普勒超声与DSA在肝癌血供的半定量及定量诊断中的应用价值。方法:对52例原发性肝癌的64个肿瘤在经动脉导管栓塞化疗术前3d内进行彩色多普勒超声（CDFI）检查，对每一个肿瘤的动脉血流进行分级，CDFI按国内分级标准分为四级：0,Ⅰ,Ⅱ,Ⅲ。同时测量肝固有动脉、门静脉血流参数。在患者进行TACE过程中行肝动脉数字减影造影（DSA），将肿瘤内部血流分为三级：1,2,3。并对其中30例患者于TACE术后7d内进行CDFI复查，观测上述指标变化。分析CDFI与DSA肿瘤血流分级的相关性，以及TACE治疗后肝动脉、门静脉血流动力学改变。结果:(1) CDFI显示64个肿瘤，0级血供6个，Ⅰ级血供3个，Ⅱ级血供18个，Ⅲ级血供37个;DSA显示64个肿瘤中，乏血供者4个，中等血供者13个，富血供者47个。CDFI 四级分级方法与DSA分级方法具有较好的相关性（rs＝0.644，P<0.01），其中CDFI血供分级的0级与DSA血供分级的1级相对应;Ⅰ，Ⅱ级与2级相对应;Ⅲ级与3级相对应。（2）TACE术后肿瘤血流分级大部分较术前减少，肝动脉内径稍变窄，肝动脉血流量减少，而门静脉血流量反应性增加。结论:CDFI博动性血流四级分级方法与DSA分级方法相关性好， CDFI血供分级的0级，Ⅰ和Ⅱ级，Ⅲ级分别与DSA血供分级的1，2，3级相对应，可以反映原发性肝癌肿瘤内动脉血流的丰富程度，CDFI可以间接反映原发性肝癌TACE术前后血流动力学改变。     

高频彩色多普勒超声在乳腺肿块良恶性诊断中的应用

目的探讨高频彩色多普勒超声诊断乳腺良恶性肿块的声像图特征及其诊断价值。方法对61例乳腺肿块住院患者,首先用二维超声明确肿块部位、形态、大小等一般情况,然后用彩色多普勒血流成像(CDFI)观察,记录血流分级,用频谱多普勒测量病灶内多处血管并记录最高的搏动指数(PI)、阻力指数(RI)和峰值流速等参数。结果本组大多数恶性肿块形态不规则,边界不清,无包膜,内部回声不均匀,以低回声为主,部分后方有衰减,侧缘有不规则强回声声晕,肿块纵横比>1。彩色多普勒血流分级大多数为2~3级;PI值>1.2,RI值>0.70,血流丰富。乳腺良性肿块大多表现为形态规则,边缘光滑,有包膜,内部回声均匀,侧缘无声晕,纵横比<1。彩色多普勒血流分级大多数为0~1级,PI值<1.2,RI值<0.70,少量血流。结论高频彩色多普勒超声对乳腺肿块良恶性的鉴别诊断具有较高的临床应用价值。     

乳腺化生性癌临床特点及超声表现

目的 观察乳腺化生性癌(MBC)的临床特点及超声表现。方法 回顾性分析经手术病理证实的37例单发MBC与74例乳腺非特殊型浸润性癌(IC-NST)患者(74个病灶)的临床资料及病灶超声表现。结果 37个MBC病灶中,32个呈低回声、5个呈囊实性回声;9个呈规则椭圆形,28个形态不规则;14个边缘光整,13个内见点状强回声微钙化,2个后方回声衰减;35个肿瘤均呈平行生长;CDFI示29个为AdlerⅡ或Ⅲ级血流。MBC与IC-NST患者之间,Ki-67表达、雌激素受体(ER)阳性、孕激素受体(PR)阳性、就诊原因、自觉肿物生长迅速与否、有无腋窝淋巴结转移,以及肿瘤最大径、回声、形态、边缘、方位及后方回声衰减差异均有统计学意义(P均<0.05);患者年龄、人表皮生长因子受体2(HER-2)阳性及肿瘤微钙化及Adler血流分级差异均无统计学意义(P均>0.05)。结论 MBC临床及超声表现均有一定特异性,有助于诊断。     

46例膀胱癌彩色多普勒血流显像与肿块大小及病理分级的关系

目的:初步探讨膀胱癌彩色多普勒血流显像与肿块大小及病理分级的关系。方法:回顾性分析46例膀胱癌患者的年龄、性别、肿块大小、形态、彩色多普勒血流信号特点及病理诊断、分级结果。结果:46例膀胱癌患者中,Ⅰ级血流12例(26%),Ⅱ级血流14例(30%),Ⅲ级血流20例(44%);影响血流程度的因素有肿块大小、肿块分化程度。结论:膀胱癌彩色多普勒血流显像的相关因素有肿块大小、肿块分化程度。肿块越大,血流越丰富;肿块分化越差,血流越丰富。     

多普勒超声在全训部队人员阴囊疾病诊断中的应用

目的探讨多普勒超声在全训部队人员阴囊疾病诊断中的应用价值。方法回顾分析450例阴囊超声检查阳性的全训部队患者(Ⅰ组)的资料,对担负高原运输任务的152名驾驶员(Ⅱ组)进行阴囊多普勒超声检测,并与150名无临床症状的地方男性青年(Ⅲ组)相对比。结果 I组中附睾炎及附睾睾丸炎占43.33%(195/450),精索静脉曲张占22.44%(101/450);Ⅱ组亚临床型精索静脉曲张和睾丸微石症(TM)发生率高于Ⅲ组(P0.001);Ⅱ组与Ⅲ组睾丸及附睾内动脉血流参数比较差异无统计学意义(P0.05)。结论彩色多普勒超声是诊断全训部队人员阴囊疾病的首选检查方法。     

Mammary hamartoma

For many years, mammary hamartoma was considered to be an under-diagnosed disease. However, with the increasing use of diagnostic procedures in breast tumors (mammography, ultrasound, fine needle aspiration cytology and core needle biopsy), diagnosis of this entity has increased. Mammary hamartomas normally manifest as painless, mobile, palpable lumps without adherence to skin or muscle. Mammography shows well-circumscribed tumors, separated from adjacent normal breast tissue. Macroscopically they are well-defined tumors, consisting of benign mammary glandular tissue, fibrous stroma and fat in variable proportions, sometimes with a pseudoencapulation. Because of the lack of cytological and architectural specificity of hamartomas, correlation between clinical manifestations, imaging techniques and histology is essential. This report describes a case of an 11-cm mammary hamartoma in a 46-year-old woman.     

Hamartoma of the Breast in a Man: First Case Report

Abstract: Mammary hamartomas were reported in 0.7% of all benign tumors of the female breast. Histologically breast hamartomas contain lobular breast tissue with various degrees of fibrous, fibrocystic, and adipose tissue. Rare types include muscular (myoid) and cartilage (chondroid) hamartomas. We report a case of muscular hamartoma in a man. A 36-year-old man was admitted to the psychiatric unit with the diagnosis of schizophrenia. The patient complained of a slowly growing mass in his left breast. He denied any discharge from the nipple, but he complained of itching. A 2 cm × 3 cm nontender mass was palpable. There was no evidence of axillary lymphadenopathy. A needle aspiration was nondiagnostic. The excisional biopsy specimen revealed fatty tissue which was edematous and hemorrhagic. Microscopically it showed multiple bundles of muscles organized randomly. Myoid hamartoma was the diagnosis. Mammary hamartoma is considered a female tumor exclusively. Myoid hamartoma has been reported previously in 25 women. We report a myoid hamartoma in a man and, to our knowledge, it is the first and only such case to be reported.     

Myoid hamartoma of the breast: a case report and review of the literature

Myoid hamartomas of the breast are extremely rare breast lesions, with a poorly understood pathogenesis. A 60-year-old woman presented with a palpable mass in the right breast. Breast ultrasonography and mammography showed the presence of a breast lesion with benign characters, but were not diagnostic. A local excision of the mass was performed; histology revealed that the tumor was composed of epithelial and stromal cells. Histological and immunohistochemical findings established the diagnosis of myoid hamartoma. The patient is well 4 years later without tumor recurrence. Breast myoid hamartomas are exceptionally rare benign lesions; complete surgical excision achieves cure.     

Clinical implications of power Doppler three-dimensional ultrasonography

Power Doppler ultrasonography displays an estimate of the entire power contained in that part of the received radiofrequency ultrasound signal for which a phase shift corresponding to the motion of the target is detected. In contrast, conventional color Doppler imaging displays Doppler frequency shift information. Few reports have been published on the clinical utility of three-dimensional power Doppler ultrasonography in vascular patients. This study analyzed our experience of the clinical utility of this technology. Fifty-three patients selected out of 281 who were referred to our vascular laboratory underwent both conventional color duplex ultrasonography and power Doppler ultrasonography for the following indications: the question of subtotal versus total arterial occlusion, tortuous artery with limited imaging on color duplex ultrasonography, the presence of significant disease by Doppler ultrasonography with limited imaging, deep-lying arteries with an obscure orifice (e.g., renal artery), and heavily calcified arteries. The power Doppler ultrasonography portion of the examination was considered of positive diagnostic value if the final impression was different from that of conventional color duplex ultrasonography. A positive diagnostic value was achieved in 22 of 29 (76%) carotid artery examinations, 10 of 14 (71%) peripheral artery examinations, 4 of 5 (80%) renal artery examinations, and 3 of 5 (60%) aortoiliac examinations. Overall, positive diagnostic value was achieved by adding power Doppler ultrasonography in 39 of 53 patients (74%). Five of six patients (83%) who were felt to have carotid occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Similarly, 6 of 8 patients (75%) with questionable subtotal versus total peripheral arterial occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Four of five patients' (80%) renal examinations had a positive diagnostic value, which included three patients in whom the orifice of renal arteries was not seen by color duplex ultrasonography. Three-dimensional power Doppler ultrasonography can be more readily applied to clinical practice. Power Doppler ultrasonography is capable of defining the severity or extent of vascular disease, particularly in differentiating subtotal from total arterial occlusion.     

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目的探讨食管胃结合部腺癌(AEG)不同Siewert亚型间临床病理特征、手术治疗方式及预后方面的差异。方法回顾性分析北京肿瘤医院2002年1月至2008年12月接受外科手术切除的471例AEG病人的临床资料,比较不同Siewert亚型的临床病理特征、手术治疗方式及预后。结果全组471例病人中,SiewertⅠ型22例(4.7%),SiewertⅡ型237例(50.3%),SiewertⅢ型212例(45.0%)。病人的年龄、性别比和体重指数在各组间差异无统计学意义。Ⅲ型较Ⅱ型更容易出现胃壁深层浸润和胃周淋巴结转移,故Ⅲ型比Ⅱ型具有更晚的TNM分期。组织分化程度为G3/4的病人在Ⅲ型中所占的比例明显高于Ⅱ型,脉管癌栓阳性率在Ⅲ型中同样明显高于Ⅱ型。不同的Siewert亚型通常选择不同的手术路径和切除方式。Siewert各亚型病人的5年存活率差异无统计学意义(P=0.308)。对于行R0切除的Ⅱ型和Ⅲ型病人,经腹手术病人的5年存活率优于经胸手术(49.1%vs.23.3%,P=0.045),而行近端胃大部切除和全胃切除的病人相比,5年存活率差异无统计学意义(40.1%vs.42.5%,P=0.278)。结论Ⅱ型和Ⅲ型AEG具有不同的临床病理学特征,但两组病人的5年存活率差异无统计学意义,可能与随访时间较短有关。对于Ⅱ型和Ⅲ型AEG,建议经腹实施手术,并根据肿瘤的浸润范围选择合适的切除范围。     

高频彩色多普勒血流显像诊断乳腺恶性肿瘤

目的探讨高频彩色多普勒血流显像（CDFI）在乳腺恶性肿瘤诊断的临床应用。方法回顾60例在我院手术治疗的乳腺恶性肿瘤的CDFI高频超声声像图特征,并与手术、术后病理结果对照。结果乳腺恶性肿瘤在形态、边缘、包膜、内部回声、后方回声、纵横比具有特异性,乳腺恶性肿瘤内及周边血流信号丰富,肿瘤内部出现粗大彩色血流信号。结论高频彩色多普勒超声是一种对乳腺恶性肿瘤的诊断具有重要的临床应用价值的无创伤性检查方法。     

Laparoscopic splenectomy for splenic hamartoma: Case management and clinical consequences

Splenic hamartoma is a rare benign tumor, and although minimally invasive surgery may be suitable for this condition, there have only been 2 previous reports of laparoscopic surgery. Here we report the third case of splenic hamartoma managed by laparoscopic splenectomy. A 37-year-old male was incidentally diagnosed by abdominal ultrasonography with a hypoechoic mass measuring 2.5 cm × 2.4 cm in the spleen. Color Doppler sonography showed multiple flow signals within the mass and contrast-enhanced computed tomography revealed strong enhancement of the lesion. On T1- and T2-weighted magnetic resonance images, the splenic mass was demonstrated as isointense and hyperintense respectively. Although a malignant tumor could not be ruled out, a hand-assisted laparoscopic splenectomy was performed because the splenic mass was limited in size and had not invaded adjacent organs. The pathological diagnosis was splenic hamartoma. The postoperative course was uneventful and the patient was discharged by the seventh postoperative day. Although splenic hamartomas have some specific imaging features, more reports and analyses of these cases are required to increase the reliability of the diagnosis and management. Hand-assisted laparoscopic splenectomy may play a pivotal role in the postoperative diagnosis and management of this condition.     

色素沉着息肉综合征患者肿瘤LKB1基因杂合性缺失及其对肿瘤易感性的研究

目的 研究色素沉着息肉综合征（Ｐｅｕｔｚ－Ｊｅｇｈｅｒｓ ｓｙｎｄｒｏｍｅ,ＰＪＳ）患者肿瘤的ＬＫＢ１基因杂合性缺失,探讨其肿瘤易感性机制。方法 以微分离技术分离６例与ＬＫＢ１连锁的色素沉着息肉综合征患者１４个肿瘤和相应正常组织的石蜡切片,提取ＤＮＡ,选择与ＬＫＢ１紧密连锁的Ｄ１９Ｓ８８６和Ｄ１９Ｓ５６５微卫星标志,经聚合酶链反应（ＰＣＲ）扩增,以测序仪检测和分析其杂合性缺失。结果 ５７％的易感肿