不同临床及影像学特征对良恶性乳头溢液疾病鉴别诊断价值分析

目的 探讨不同临床及影像学特征对良性及恶性乳头溢液疾病的诊断价值。 方法 回顾性分析2011年1月至2016年2月上海交通大学医学院附属瑞金医院因乳头溢液行手术治疗的233例病人的临床资料。乳腺癌33例（14.2%）,乳腺良性疾病200例（85.8%）。分析不同临床及影像学特征病人良性及恶性乳头溢液的检出率,计算乳腺X线摄影、乳腺超声、乳腺MRI及联合检查对乳腺癌诊断的灵敏度。 结果 血性溢液（P=0.008）、乳腺X线摄影伴可疑恶性钙化（P<0.001）、MRI表现为段样强化（P=0.003）、流出型时间-信号强度曲线（P=0.023）的病人乳腺癌检出率明显增高,差异有统计学意义。乳腺X线摄影对恶性乳头溢液诊断的灵敏度较低（57.6%）,劣于超声检查（87.9%,P=0.012）及MRI检查（93.9%,P=0.001）。乳腺X线摄影联合超声或MRI诊断的灵敏度分别为90.9%及100.0%,显著高于单用乳腺X线检查（P=0.004,P<0.001）。结论 对于不伴肿块的乳头溢液,血性溢液、乳腺X线摄影伴可疑恶性钙化、MRI段样强化、时间-信号强度曲线为流出型的病人患乳腺癌的风险较高。乳腺X线摄影对乳头溢液潜在恶性病变的检出率较低,联合超声或MRI检查可提高检出率。     

乳腺钼靶X线摄影和B超筛查资料分析

目的探讨乳腺钼靶X线摄影和超声检查两种方法对乳腺癌筛查的价值,以寻找适宜的乳腺癌筛查方法。方法对本地35~69岁经初筛后387名可疑乳腺异常的妇女,行乳腺钼靶X线摄影,有异常或不能评估者再用超声检查,超声检查阳性或可疑者行穿刺活检以确定乳腺癌诊断。结果 387例中,腺体成分在5 0%以上者占83.22%,经X线摄影发现有22例阳性,2 2例阳性经B超检查亦为阳性,75例不能评估。75例不能评估者B超检查有3例阳性。行穿刺活检25例,确诊乳腺癌17例,其中2例已达III期以上。钼靶X线发现乳腺癌的敏感性为72.73%,B超为6 8.0%,差异无统计学意义(P0.0 5)。结论本地筛查妇女乳腺大部分为腺体致密型。X线摄影在致密型乳腺的乳腺癌筛查中未呈现出比超声检查的优越性。     

超声与钼靶摄片对乳腺癌早期诊断的意义

目的： 评估超声与钼靶摄片检查在乳腺癌早期诊断中的作用,以提高乳腺癌的早期筛查效率。 方法：收集乳腺癌早期诊断的女性患者528例临床资料,其中经B超查出隐匿性乳腺癌132例,经钼靶摄片查出乳癌病灶396例。比较两种检查方式获得初步诊断的乳腺癌患者的临床与影像学特征、手术方式与组织病理学特征、分子生物学标志物与分型的差异。 结果：两者比较显示,绝经前、年青、汉族（相对维吾尔族）女性及致密乳房组织和影像学BI-RADS 4级的乳腺癌超声检查较钼靶摄片更易检出（均P<0.05）;超声检查较钼靶摄片检出的患者更多实行保乳手术,且淋巴结转移阳性率较低,更易发现单发、直径≤1 cm、分化较好的乳腺癌及早期阶段的浸润性乳腺癌（均P<0.05）;超声检查对ER（+）、luminal A乳腺癌检出率高,而钼靶摄片对Her-2（+）、Her-2型乳腺癌检出率高（均P<0.05）。 结论：超声检查较钼钯摄片更容易发现致密乳房组织中的侵袭性与恶性程度较低的早期癌灶,对于检出不同分子分型的早期乳腺癌两者各有优势。故联合应用更利于乳腺癌患者早期筛查。     

绝经后妇女激素替代治疗的乳腺X线摄片密度

激素替代治疗（HRT）的应用正在增加，其与乳腺癌相关的危险仍有争论。亦有提出HRT影响乳腺X线摄片密度和增加良性乳腺疾病的发病率。乳腺X线摄片密度有二个重要意义：致密的实质图像提示乳腺癌的危险，密度可影响乳腺X线摄片的敏感度。任何原因乳腺密度的增加都潜在着乳腺摄片有效性的降低，增加假阴性率。读片者诊断的可信度亦可因乳腺密度增加而降低，可导致假阳性诊断。为此作者检查绝经后妇女HRT和乳腺X线片密度的关系。方法住院女性年龄大于54岁绝经至少12个月，使用HRT不低于6个月或从不使用。记录药品类型、剂量、用药方式和…     

乳腺触诊成像在乳腺癌筛查中的价值

目的 阐述乳腺触诊成像技术（palpation imaging,PI）在乳腺癌筛查中的作用。方法 对PI诊断乳腺癌的最新研究和既往文献进行综述。结果 PI相对临床乳腺触诊在乳腺癌筛查中有更好的诊断效能，联合乳房X线摄影和（或）乳腺超声，可以提高单一检查的诊断效能。结论 PI在乳腺癌筛查中具有重要价值，是现有乳腺癌筛查方法的重要补充。     

高频B超在中国妇女致密型乳腺的乳腺癌筛查中的应用

目的：探讨超声检查及定位在中国妇女致密型乳腺发生的早期乳腺癌筛查中的作用。方法：对2002年2月—2006年4月来湘雅医院乳腺科门诊就诊及体检中心健康检查的5万余名女性行乳腺高频超声检查，筛查出乳腺肿块4 000余例，其中经手术病理证实的致密型乳腺患者乳腺癌142例（肿块最大横径均≤2cm），将患者的超声检查与钼靶片结果资料进行分析对比。结果：在142例致密型乳腺的乳腺癌患者中，超声发现微小钙化47例（33.10％），敏感性达74.60％，准确率为88.73％;钼靶发现泥沙样钙化38例（26.76％），敏感性60.32％，准确率为82.39％。钙化灶的检出率为44.37％。其中超声发现微小肿块110例（77.46％），敏感性88.71％，准确率为90.14％;钼靶片发现100例（70.42％），敏感性80.65％，准确率为83.10％。12例临床上未扪及肿块患者均在超声定位下准确地切除病灶。结论：（1）高频超声检查在中国妇女致密型乳腺的乳腺癌筛查中检出小肿块及恶性钙化的敏感性以及准确率要高于钼靶片检查。（2）高频超声检查可作为年青妇女、致密型乳腺以及扁平型乳腺早期乳腺癌筛查的有效方法之一，它不仅提高早期乳腺癌的诊断率也提高了保乳率，值得推广使用。     

磁共振在乳腺癌临床诊断中的价值

目的：评估磁共振（MRI）检查在乳腺癌中的诊治价值。方法：53例临床和（或）钼靶摄片上疑有乳腺恶性病变的女性病人，行MRI检查：所有病人都接受外科手术和病理学诊断。结果：41例乳腺癌病人中，MRI检查检出乳腺癌37例，检出率为90．24％：钼靶摄片检出乳腺癌33例，检出率为80．48％；二者有显著统计学意义（P〈0．05）；有2例乳腺癌病人．因术前MRI提示有多发病灶而未能行保乳手术。结论：增强MRI诊断乳腺病变有较高的敏感性，对钼靶摄片评价较为困难的致密（型）乳腺尤有一定独到之处。二者联合使用可大为提高乳腺癌的诊断率。MRI检查有利于乳腺癌分期并指导其临床治疗。     

声弹性成像、常规超声及钼靶X线技术在乳腺癌术前诊断和联合诊断中的应用价值

目的探讨声弹性成像、常规超声及钼靶X线技术在乳腺癌术前诊断和联合诊断中的应用价值。方法统计分析本院2017年5月至2019年5月收治的临床检查触及乳腺肿块的患者52例的临床资料。结果声弹性成像、常规超声及钼靶X线技术在乳腺癌术前诊断中的符合率依次降低,但差异均不显著(P0.05);声弹性成像联合常规超声、常规超声联合钼靶X线、声弹性成像联合钼靶X线在乳腺癌联合诊断中的符合率依次降低,但差异均不显著(P0.05),声弹性成像联合常规超声的符合率高于常规超声联合钼靶X线、声弹性成像联合钼靶X线及各单项检查,但差异均不显著(P0.05)。结论声弹性成像、常规超声及钼靶X线技术在乳腺癌联合诊断中具有较高的应用价值。     

多种影像学联合检查诊断早期乳腺癌的临床分析

探讨乳腺X线钼靶、超声及磁共振(MRI)三种医学影像学技术在乳腺癌早期诊断中的临床应用价值。选取2013年3月—2015年3月怀疑为乳腺癌的147例乳腺疾病患者作为研究对象,分别采用乳腺X线钼靶、超声及MRI对147例患者进行乳腺检查,并以术后病理或穿刺活检证实,对比分析三种检测手段的临床应用价值差异。X线钼靶诊断乳腺癌48例,与病理诊断的符合率为82.76%,诊断乳腺癌的灵敏度为81.36%、特异度为88.64%,ROC曲线下面积AUC值为0.814;超声诊断乳腺癌44例,与病理诊断的符合率为68.75%,诊断乳腺癌的灵敏度为74.58%、特异度为77.27%,ROC曲线下面积AUC值为0.789;MRI诊断乳腺癌54例,与病理诊断的符合率为85.71%,诊断乳腺癌的灵敏度为91.53%、特异度为89.77%,ROC曲线下面积AUC值为0.826;X线钼靶联合超声诊断乳腺癌52例,与病理诊断的符合率为88.14%,诊断乳腺癌的灵敏度为88.14%、特异度为92.05%,ROC曲线下面积AUC值为0.872。乳腺X线钼靶、超声可以作为一种方便、低廉的检查方法对乳腺疾病患者进行检查,两者结合诊断效率更高,同时MRI检测可以作为一种重要的补充诊断方法。     

全数字化X线乳腺钼靶、MRI对乳腺癌的诊断价值探讨

目的探讨全数字化x线乳腺钼靶、MRI检查对乳腺癌的诊断价值。方法回顾性分析35例经手术证实的乳腺癌患者的全数字化x线乳腺钼靶及MRI检查资料,分析其影像学特征,并统计对比钼靶、MRI联合和单独应用的诊断准确率。结果全数字化x线乳腺钼靶表现：单发肿块22例,其中分叶20例,毛刺12例,钙化6例,不规则浸润13例,皮肤增厚、皮下水肿4例,肿大淋巴结10例。MRI表现：形状不规则或分叶,边缘不规则毛刺,T1WI相平扫呈低信号,与周围正常腺体无法区分;T2WI呈不均匀等高信号,边缘欠清,周围见长短毛刺征,增强后明显强化,表现为均匀、不均匀及边缘强化。MRI检查诊断准确率（30／35,85．71％）高于全数字化x线乳腺钼靶检查（22／35,62．85％）,X2=4．786,P=0．029。联合应用诊断准确率（34／35,97．14％）高于两者单独应用,差异有统计学意义（P〈0．05）。结论乳腺癌全数字化x线乳腺钼靶、MRI表现具有一定的特征性,两者联合应用有助于提高乳腺癌具有特征性的诊断正确率。     

Role of Breast Ultrasound and Mammography in Evaluating Patients Presenting with Focal Breast Pain in the Absence of a Palpable Lump

To determine if ultrasound and/or mammography is helpful in detecting breast cancers in patients presenting with focal breast pain. Patients who presented between February 2008 and April 2011 with focal breast pain without a lump were included in the study. The mammographic and US findings were retrospectively reviewed. BIRADS 0, 4, and 5 were considered positive on mammogram while BIRADS 4 and 5 were considered positive on US. The efficacy of mammogram‐alone, ultrasound‐alone, and in combination to detect breast cancer was evaluated. The performance of mammography for detecting any mass lesions that were present on subsequent US was also evaluated. A total of 257 patients were evaluated with US and 206 (80.1%) of these also had mammograms prior to the US. Cancer incidence was 1.2% (n = 3). The sensitivity, specificity, PPV, and NPV of mammogram‐alone and US‐alone for detection of breast cancer in these patients were 100%, 87.6%, 10.7%, 100% and 100%, 92.5%, 13.6%, and 100%, respectively, while for combined mammogram and US was 100%, 83.7%, 8.3%, and 100%. The sensitivity, specificity, PPV, and NPV of mammogram for identifying an underlying suspicious mass lesion that was subsequently detected by US was 58%, 91%, 39%, and 95%. The NPV of a BIRADS 1 mammogram for any underlying mass lesion was 75%. Addition of an ultrasound to a mammogram did not detect additional cancers; likely due to low cancer incidence in these patients. However, US detected underlying mass lesions in 25% cases with a BIRADS 1 mammogram result.     

数字化乳腺摄影联合超声与MRI对乳腺良、恶性疾病诊断的对照观察

目的评价数字化乳腺摄影联合超声与MRI在乳腺良恶性疾病诊断中的意义及临床应用价值。方法对105例乳腺疾病患者的数字化乳腺摄影联合超声诊断结果与MRI诊断结果进行回顾性分析。结果 105例患者共110个病灶,其中恶性62个,良性48个。所有病灶均被病理证实。数字化乳腺摄影联合超声对乳腺恶性病变的诊断敏感度、特异度分别为90.32%（56/62）、91.67%（44/48）;MRI对乳腺恶性病变的诊断敏感度、特异度分别为91.94%（57/62）、87.50%（42/48）。结论数字化乳腺摄影联合超声检查诊断准确性高,适用于乳腺疾病的常规检查;MRI空间分辨力及组织分辨力高,适用于前二者检查难以定性的病变及乳腺癌的术前评估。     

Ultrasound is now better than mammography for the detection of invasive breast cancer

OBJECTIVE: This study investigated the use of ultrasound (US) as a first-line diagnostic tool. METHODS: All women attending our breast center underwent bilateral whole-breast US in addition to all other investigations, and results were documented prospectively and preoperatively. RESULTS: Of 796 patients with breast cancer, US was positive in 710 (89%) and mammography in 706 (89%) (P = not significant). Either US or mammogram was positive in 770 (97%). Of 537 (67%) symptomatic patients, US was positive in 497 (93%) and mammography in 465 (87%). Either US or mammography was positive in 515 (96%). Of 259 (33%) screening patients, 220 (85%) had invasive cancer. US was positive in 195 (89%) and mammography in 203 (92%) (P = not significant). Either US or mammography was positive in 217 (99%). Of 39 screening patients with ductal carcinoma in situ (5% of all patients), US was positive in 18 (46%) and mammography in 38 (97%). CONCLUSIONS: US is significantly better than mammography for detecting invasive breast cancer (92% patients). The combination of US and mammography is significantly better than either modality used alone, together resulting in 9% more breast cancers detected.     

Survival rates for breast cancers detected in a community service screening mammogram program

BACKGROUND: This single-institution long-term prospective study was performed in the setting of community service screening mammography to evaluate the association between the methods of breast cancer detection and survival rates. METHODS: From 1994 through 2001, data on 1237 patients with breast cancer were collected concurrent with definitive surgical treatment and entered into a comprehensive database. RESULTS: Mammography was the sole method of detection for 517 (44%) of 1179 Tis-T2 breast cancers. Fifty-seven percent of invasive cancers detectable by mammography alone were less than 1 cm in diameter. For 1049 patients with invasive cancers, the 5-year overall observed survival rates were 94% for 372 whose cancers were detectable by mammogram alone and 87% for 677 whose cancers were detectable by palpation (alone or in combination with mammography) (P = .0002). CONCLUSIONS: Most of the contribution to breast cancer mortality reduction is from the detection of small nonpalpable cancers, not from adjuvant therapy.     

Mammography and breast cancer screening

Breast radiography should be performed only with film-screen mammography or xeromammography. At least two views of each breast should be obtained, and for film-screen mammography, at least one of these should be the oblique view. Quality assurance is becoming a significant concern in breast cancer screening. The ACR Mammography Accreditation Program takes into account the qualifications of the personnel, the performance of the x-ray equipment, and a peer review of the final product: the diagnostic image. The mammographic signs of malignancy can be divided into primary, secondary, and indirect. The accuracy of mammography depends on several factors, but the greatest limitation is the density of the breast tissue. Very dense tissue makes detection of breast cancer difficult, and a negative mammogram should never deter one from a biopsy of a clinically suspect mass. New consensus guidelines for breast cancer screening were developed to bring uniformity to the recommendations of the American Cancer Society, the National Cancer Institute, and various professional medical societies. These new guidelines reflect the encouraging results from recent clinical trials, as well as some discouraging reports on breast self-examination and the baseline mammogram. The underutilization of screening mammography is a problem of significant concern to both private and public health agencies. Barriers to mammographic screening include lack of awareness of the benefits of screening, physicians' misconceptions about patient compliance, concerns about radiation risk and overdiagnosis, fear of mastectomy, a perception that a mammogram involves great discomfort, and relatively high cost. Nationwide educational programs are under way to counter misconceptions about mammography, and various strategies are evolving to overcome the other barriers. Sonography is a useful adjunct to mammography for cyst-solid differentiation, but mammography is the only imaging modality effective for the early detection of breast cancer.     

乳腺X线摄影、超声与MRI增强检查在乳腺疾病诊断中的比较

目的:比较乳腺X线摄影、超声与磁共振增强检查在乳腺良恶性病变中的诊断价值。方法:回顾分析2008年1月至2009年1月107例乳腺疾病病人的影像学资料,所有病人均进行乳腺X线摄影、超声与MRI动态增强检查,按照美国放射学会推荐的"乳腺影像报告和数据系统"(BI-RADS)进行分类,以手术病理诊断为金标准,应用受试者工作特征曲线(ROC)评价不同检查方法及联合检测的价值。结果:107例病人共检出117个病灶,以BI-RADS分级4类以上为检查阳性,结果显示MRI增强检查的灵敏度优于乳腺X线摄影(97.06%比80.88%,P=0.003)和超声(97.06%比88.24%,P=0.049),而其特异度不低于乳腺X线摄影和超声(P=0.274和P=0.798)。ROC分析结果显示,MRI增强检查的曲线下面积明显大于乳腺X线摄影(0.935比0.867,P=0.001)和超声(0.935比0.886,P=0.001),而联合3种检查方法曲线下面积最大,明显大于单独行乳腺X线摄影(P=0.001)、超声(P=0.005)和MRI增强检查(P=0.008)。结论:MRI增强检查在有症状的乳腺疾病病人中的诊断价值高于乳腺X线摄影和超声,联合运用三种检查方法,诊断价值可进一步提高。     

The Potential Role of Dedicated 3D Breast CT as a Diagnostic Tool: Review and Early Clinical Examples

Mammography is the gold standard in routine screening for the detection of breast cancer in the general population. However, limitations in sensitivity, particularly in dense breasts, has motivated the development of alternative imaging techniques such as digital breast tomosynthesis, whole breast ultrasound, breast‐specific gamma imaging, and more recently dedicated breast computed tomography or “breast CT”. Virtually all diagnostic work‐ups of asymptomatic nonpalpable findings arise from screening mammography. In most cases, diagnostic mammography and ultrasound are sufficient for diagnosis, with magnetic resonance imaging (MRI) playing an occasional role. Digital breast tomosynthesis, a limited‐angle tomographic technique, is increasingly being used for screening. Dedicated breast CT has full three‐dimensional (3D) capability with near‐isotropic resolution, which could potentially improve diagnostic accuracy. In current dedicated breast CT clinical prototypes, 300–500 low‐dose projections are acquired in a circular trajectory around the breast using a flat panel detector, followed by image reconstruction to provide the 3D breast volume. The average glandular dose to the breast from breast CT can range from as little as a two‐view screening mammogram to approximately that of a diagnostic mammography examination. Breast CT displays 3D images of the internal structures of the breast; therefore, evaluation of suspicious features like microcalcifications, masses, and asymmetries can be made in multiple anatomical planes from a single scan. The potential role of breast CT for diagnostic imaging is illustrated here through clinical examples such as imaging soft tissue abnormalities and microcalcifications. The potential for breast CT to serve as an imaging tool for extent of disease evaluation and for monitoring neo‐adjuvant chemotherapy response is also illustrated.     

数字化钼靶X线与彩超应用BI-RADS分级诊断乳腺癌的价值比较

目的：通过对彩超与钼靶X线应用BI-RADS分级在乳腺癌诊断上的比较并分析其优缺点,以探讨结合二者应用于临床上诊断乳腺癌的价值。方法通过分析我院手术与病理结果证实的82例乳腺癌患者的钼靶X线和彩超影像表现及其BI-RADS分级,两者检查结果与病理检查结果对照。结果诊断率比较中彩超组（a）为87.80%,钼靶X线组（b）为75.60%,两者联合组（c）为95.24%,差异组间比较Pa：b=0.237,Pa：c=0.014,Pb：c=0.017;恶性诊断率彩超组为66.66%,钼靶X线组为73.33%,两者联合组为86.66%,差异组间比较Pa：b=0.164,Pa：c=0.003,Pb：c=0.001;BI-RADS等级比较中联合应用组2~3级与4级诊断率高于彩超组及钼靶X线组,差异有统计学意义（P＜0.05）。结论两者联合应用可相互补充,对BI-RADS分级具有很高的灵敏度,将两者联合应用于临床可以提高乳腺癌患者的诊断率。     

Accuracy of combined breast imaging in young women

This is a study of the accuracy of combined breast imaging (mammography and ultrasound) in young women with breast symptoms. We performed an appraisal of the literature, and improved our study design by avoiding biases identified in published work. Our study presents the sensitivity and specificity of mammography and breast ultrasound, individually and in combination, using different thresholds for categorizing test results, in a population of consecutive women. We show that combining the two imaging tests does improve sensitivity without significantly reducing test specificity. However, the number of additional cancers correctly identified using combined imaging, relative to the number of false positives, is highly dependent on breast cancer prevalence.