弹性成像、二维超声与多普勒超声在乳腺肿块鉴别诊断中比较分析

目的对比在乳腺癌患者的临床诊断中,应用弹性成像、二维超声和多普勒超声的临床诊断价值。方法将2013年6月至2014年12月期间确诊的230例乳腺肿块患者作为研究对象,分别采用弹性成像、二维超声和多普勒超声进行鉴别诊断。所有数据均采用SPSS17.0软件进行统计分析,以病理结果为金标准,良、恶性乳腺病变弹性成像分级间的比较采用配对χ~2检验;二维超声和弹性成像及联合应用的诊断效能,采用χ~2检验,以P0.05认为差异有统计学意义。结果病理结果显示,此次共有良性和恶性病灶各113个和130个。弹性成像结果显示,其敏感度为93.85%(122/130),特异度94.69%(107/113),准确率为94.24%(229/243),其准确率显著高于二维超声(81.89%,199/243)和多普勒超声(213/243,87.65%),差异有统计学意义(P0.05)。结论在乳腺癌患者的临床诊断中,应用弹性成像的诊断价值较高,其准确性显著优于二维超声和多普勒超声,可准确诊断肿块的良恶性,建议广泛推广。     

超声与数字断层摄影检查致密乳腺进展

2009年美国康涅狄格州通过的致密乳腺告知法案,引发对于致密乳腺的关注。目前全球仍无统一的标准或指南来指导如何选择适合致密乳腺的辅助检查。超声与数字乳腺断层摄影技术是目前的研究热点。本文对二者在致密乳腺检查中的进展进行综述。     

优化数字乳腺断层摄影曝光条件的体模显像

目的比较数字乳腺断层摄影(DBT)不同摄影条件下对乳腺体模病灶的检出率。方法对ACR-156体模及MPW-01体模进行DBT,使用有机玻璃板组合模拟5个不同厚度,首先采用自动曝光控制模式(AEC)进行曝光,然后保持相同管电压值,管电流设为AEC曝光时的80%、60%、40%和20%。比较不同厚度、不同曝光条件下辐射剂量及病灶检出率。结果随管电流下降,平均腺体剂量和皮肤吸收剂量及总体病灶检出率下降(P均0.01);相同厚度下,管电流降低20%时,肿块样病灶及钙化样病灶检出率下降平缓甚至无明显变化,纤维样病灶检出率下降较明显,管电流降低20%时,各病灶检出率均随管电流下降而下降;厚度增加对肿块样病灶检出率有一定影响。结论乳腺筛查中适当降低管电流可有效减低辐射剂量而不影响病灶检出率。     

乳腺X线摄影钙化灶对乳腺疾病的诊断意义

目的探讨乳腺X线钙化在乳腺良、恶性疾病诊断中的意义。方法对1998年1月-2005年10月经手术或穿刺活检病理证实的281例乳腺X线片钙化。回顾性分析乳腺良恶性疾病的钙化特点。结果281例乳腺钙化中181例为乳腺癌,占64．4％,良性疾病100例,占35．6％。乳腺恶性钙化一般具有颗粒较细、数目较多、密度较低、分布相对较广的特点。形态多为泥沙样、叉样、短棒状、断针样、多种形状,部分钙化沿导管走行。良性乳腺钙化一般具有颗粒较粗、数目较少、密度较高、分布局限的特点。形态多为沙砾样、斑片状、轨道状、圆孔状。结论乳腺X线摄影钙化在诊断乳腺良恶性疾病中具有重要作用。     

动态增强MRI、超声及X射线对乳腺良恶性病灶诊断的对比研究

目的探讨动态增强MRI、超声及X射线在乳腺良、恶性病变鉴别诊断中的价值。方法回顾性分析四川大学华西医院2008年6月至2009年6月期间对50个乳腺病灶进行动态增强MRI、超声及X射线检查的影像资料,基于乳腺影像报告和数据系统(BI-RADS)分别判定病变的良、恶性,以病理诊断为标准,采用Z检验比较三者的受试者操作特征(ROC)曲线下面积,对比分析三者对乳腺良、恶性肿瘤的诊断效能。结果 44例患者50个乳腺病灶,26个恶性病灶,24个良性病灶。基于BI-RADS,X射线对26个乳腺恶性病灶判定结果为5类5个,4类7个,3类6个,2类3个,1类1个,0类4个;24个良性病灶判定结果为4类1个,3类3个,2类4个,1类13个,0类3个。超声对26个乳腺恶性病灶的诊断结果为5类17个,4类4个,3类1个,2类1个,1类3个;24个良性病灶的诊断结果为5类1个,4类2个,3类4个,2类14个,1类2个,0类1个。MRI对26个乳腺恶性病灶的诊断结果为5类6个,4类18个,3类1个,1类1个;24个良性病灶的诊断结果为1类20个,2类3个,3类1个。MRI、超声、X射线对乳腺肿瘤诊断的ROC曲线下面积分别为0.977、0.835、0.764,MRI与超声、X射线比较,差异有统计学意义(分别P=0.021、P=0.025),超声与X射线比较,差异无统计学意义(P=0.230)。结论动态增强MRI是鉴别乳腺病变良、恶性的一种准确检查方法,对乳腺良、恶性病变的鉴别诊断效能优于超声和X射线。     

彩色多普勒超声与全数字化乳腺摄影对乳腺良恶性病变的诊断价值

目的探讨彩色多普勒超声(CDU)与全数字化乳腺摄影(FFDM)对乳腺良恶性病变诊断与鉴别诊断的价值。方法回顾性分析经手术和病理证实的107例乳腺良性病变和100例乳腺癌患者的临床资料。将患者术前CDU和FFDM检查结果与最后诊断对比,评价两项检查方法各自的准确性及两项联合的诊断效能。结果所有患者术前均行CDU和FFDM检查,CDU、FFDM及两项联合对乳腺癌诊断的敏感性、特异性分别为88%和82.24%;89%和75.7%;97%和88.78%。经ROC分析,对乳腺良恶性病变诊断的整体准确性依次为两项联合>CDU>FFDM。CDU,FFDM对乳腺癌肿块影显示率分别为95%和70%,两者差异有统计学意义(P<0.01)。对绝经前、后乳腺癌检出率,CDU分别为9 3.5%和8 3.3%(P>0.0 5),FFDM分别为8 0.4%和9 6.3%(P<0.0 5)。绝经前乳腺癌检出率CDU与FFDM无明显差异(P>0.05),绝经后乳腺癌检出率FFDM高于CDU(P<0.05)。结论 CDU检查对肿块敏感性高,FFDM对绝经后乳腺癌的检出率高;两者联用可提高对乳腺良恶性病变诊断的整体准确性,降低误诊率和漏诊率。     

乳腺肿块的诊断

乳腺肿块是乳腺疾病患者最常见的主诉,对其诊断在临床上有重要意义.鉴别良恶性肿块对病人来说是最关心的问题,对诊断、治疗和预后有极其重要价值.下述几点可作为乳腺肿块临床诊疗的参考.     

乳腺肿块术前超声诊断的评价

目的评价超声检查对乳腺肿块诊断的临床应用价值。方法对经手术病理证实的137例乳腺肿块与超声结果进行了回顾性对比分析。结果良、恶性肿块均以低回声型为主要图像表现;良、恶性两组间在形态、边界、包膜、后方回声、微小钙化斑检出率、血流检出率比较,差异均有统计学意义(P0.05)。腋窝转移性淋巴结以淋巴结肿大,内部低回声为声像图特征。结论以二维超声为基础,结合彩色多普勒血流显像以及腋窝淋巴结检查,可提高乳腺肿块的术前诊断符合率。     

Sentinel node biopsy for nonpalpable breast tumors requires a preoperative diagnosis of invasive breast cancer

A sentinel node biopsy done at the time of initial tumor resection allows for a one-stage surgical procedure. In addition, sentinel node identification may be impaired when done after a previous tumor excision. This study evaluates the sentinel node biopsy in patients with nonpalpable breast cancer and assesses whether a sentinel node biopsy for mammographically suspect breast lesions is justified when preoperative needle biopsy is inconclusive for invasive malignancy. A sentinel node biopsy was done in 67 patients with nonpalpable breast lesions after injection of radioactive tracer (intraparenchymal in 35 and subdermal in 32) and blue dye (para-areolar). A preoperative core needle biopsy was positive for malignancy in 42 patients. Thirteen patients had positive cytology or ductal carcinoma in situ (DCIS). In 12 patients the needle biopsy was nondiagnostic, but the lesions remained highly suggestive of malignancy on mammography. Sentinel node biopsy was successful in 64 patients (96%). In these, the sentinel node was both radioactive and blue in 58 patients (91%). Only 4 of 13 patients with positive cytology or DCIS on preoperative needle biopsy and only 5 of 12 patients without a preoperative diagnosis had an invasive cancer after resection. Sentinel nodes were positive for nodal metastases in 9 of 49 patients (18%) with a successful sentinel node biopsy for invasive malignancy. None of the eight patients with DCIS had nodal metastases. The sentinel node procedure avoids the potential morbidity of an axillary dissection in more than 80% of patients with nonpalpable breast cancer. A sentinel node biopsy for mammographically detected suspect breast lesions is not justified without a preoperative histologic diagnosis of invasive breast cancer.     

动态增强MRI定性诊断乳腺导管上皮非典型增生

目的 观察动态增强MRI（DCE-MRI）定性诊断乳腺导管上皮非典型增生（ADH）的价值。方法 回顾性分析经穿刺活检或局部切除组织活检诊断的64例乳腺单发ADH患者,以手术病理结果为金标准,比较恶性与良性病变患者临床资料及乳腺X线、DCE-MRI征象,分析DCE-MRI预测乳腺恶性ADH的效能。结果 64例乳腺单发ADH中,28例为恶性（恶性组）,36例非恶性（非恶性组）,组间活检方式、病灶最大径、MRI示乳腺实质背景强化（BPE）、乳腺X线表现差异均有统计学意义（P均<0.1）;将上述因素纳入Logistic多因素回归分析,结果显示仅BPE为乳腺恶性ADH的独立影响因素[OR=7.550,95%CI（1.575,36.197）,P=0.011]。DCE-MRI诊断BI-RADS 4A及以下者27例,其中3例为恶性;4A类以上（4B及4C）37例,25例为恶性,诊断敏感度89.29%（25/28）,特异度66.67%（24/36）,阳性预测值67.57%（25/37）,阴性预测值88.89%（24/27）。结论 DCE-MRI可用于定性诊断乳腺ADH;其所示中重度BPE为术后病理恶性的正相关因素。     

Magnetic resonance imaging of suspicious breast masses seen on one mammographic view

The purpose of this study was to assess the utility of contrast-enhanced breast magnetic resonance imaging (MRI) in identifying lesions unidentified on the craniocaudal projection. The authors reviewed five patients with suspicious mammographic lesions not imaged on the craniocaudal mammogram who were referred for contrast-enhanced MRI and underwent subsequent preoperative needle localization in four of the five cases. Five patients, ages 56 to 69 years, had suspicious lesions identified on mediolateral oblique (MLO) or mediolateral (ML) projections only. Ultrasound did not identify the lesion in any of these cases. MRI identified suspicious breast lesions measuring 5 to 12 mm in size. These were located high on the chest wall or in the upper inner quadrant. Suspicious lesions seen only on the MLO or ML projections may reside high on the chest wall or in the upper inner quadrant. Lesions in these locations may be typically excluded on the craniocaudal projection during mammography. Breast MRI has the advantage of imaging the entire breast and is particularly useful for these lesions. In this series, MRI prevented delay in breast cancer diagnosis.     

超声造影定性诊断直肠肿物

目的分析超声造影(CEUS)对直肠肿物的定性诊断价值。方法对129例直肠肿物患者行常规经直肠超声(ERUS)及CEUS检查。以术后病理结果作为诊断金标准,对比术前ERUS与CEUS定性诊断直肠肿物的正确率,比较恶性、交界性(癌前病变)及良性病变间CEUS灌注参数及CEUS表现。结果 129例均为单发病变,其中恶性病变65例、癌前病变31例、良性病变33例。CEUS对直肠恶性病变、癌前病变及良性病变的正确诊断率均高于ERUS(P均0.05)。恶性病变、癌前病变、良性病变及周围正常肠壁之间,CEUS到达时间(AT)、达峰时间(TTP)及峰值强度(PI)差异均有统计学意义(P均0.001)。恶性病变CEUS多表现为动脉期快速强化,延迟期快速消退;癌前病变表现不一,多见不均匀高增强;良性病变动脉期、延迟期多呈高增强。结论 CEUS可用于定性诊断直肠肿物,且效果好于常规超声。     

近红外扫描结合彩色多普勒超声诊断乳房肿块

作者总结了所在医院１９９３～１９９５年收治的１１７例乳房肿块患者。经手术及病理证实为癌的６９例，良性肿物４８例，术前同时应用近红外扫描和彩色多普勒超声检查，进行综合判断，使术前诊断正确率由临床触诊的６２４％提高到８６３％，两项检查同时误诊者癌仅为４３％，良性肿物６３％，较单项检查降低。作者对误诊原因进行了分析，提出两项检查均有易检、对人体无害、易重复等优点，同时应用有一定互补作用，可显著提高术前判断正确率。     

人工智能辅助低年资放射科医师检出乳腺病变

目的观察人工智能(AI)辅助对低年资放射科医师检出乳腺X线片中乳腺病灶的价值。方法回顾性分析73例接受乳腺X线摄影检查的女性患者。由3名低年资放射科医师首先分别阅片,之后于AI辅助下再次阅片,勾画乳腺病灶区域;统计检出病灶数,记录病灶类型及乳腺影像报告和数据系统(BI-RADS)分类。以病理结果或随访最终临床诊断为标准,对比医师单独阅片与AI辅助阅片检出乳腺病灶的敏感度和准确率及对不同类型、不同BI-RADS分类病灶的诊断效能。结果 73例共121个乳腺病灶,其中软组织病灶(包括肿块、结构扭曲与不对称病灶)88个、钙化病灶33个;BI-RADS 2类17个,3类66个,4类及以上38个。与医师单独阅片相比,AI辅助阅片对全部乳腺病灶、特别是软组织病灶的诊断敏感度和准确率均显著提升(P均0.01),而对乳腺钙化病灶的敏感度和准确率差异均无统计学意义(P均0.05)。结论 AI辅助有助于提高低年资放射科医师检出乳腺X线片中乳腺病灶、尤其软组织病灶的效能。     

术中标本摄片用于乳腺可疑钙化病变组织活检

目的 观察术中标本摄片用于乳腺可疑钙化病变组织活检的价值。方法 对48例乳腺单发可疑钙化病变患者行X线三维立体定位引导活检术,对其中12例行核芯针穿刺活检(SCNB)、22例行真空辅助旋切活检(SVAB)、14例行导丝定位手术切检(SNLB),术中以标本摄影系统对组织标本行X线摄片,之后对标本中的钙化进行标记并送病理检查;评估标本摄片在3种活检方式中显示钙化的清晰度及组织学低估情况,观察SNLB术中标本摄片所示钙化数目及切缘状态,并与术前乳腺X线片进行比较。结果 所有标本均获得目标钙化组织。术中标本摄片显示钙化清晰度优于术前乳腺X线片,显示SNLB组织内钙化数量多于术前乳腺X线片。14例SNLB中,12个术中标本摄片显示切缘阴性,与术后病理结果一致;2个切缘阳性,且钙化呈多灶性分布,术中快速冰冻切片结果均为恶性并切缘阳性,手术计划由保乳手术改为乳腺癌改良根治术。SCNB、SVAB活检结果及SNLB术中冰冻切片结果与手术病理结果均一致。结论 术中标本摄片用于乳腺可疑钙化病变组织活检具有一定价值。     

壶腹周围癌早期诊断和鉴别诊断

Periampullary cancer is a kind of malignant cancer of digestive tract.It arises within 2 cm of the major duodenal papilla and eomprises cancers of the ampulla,distal comliiOll bile duct,pancreas and duodenum.Their clinical features and anatomic locations are similar,as are the therapeutic approaches.However,their long-term outcomes vary.Due to the bad prognosis,it is very important to make an early,accurate diagnosis and differential diagnosis of periampullary cancer.This article summarizes some basic methods and new developments of early and differential diagnosis of poriampullary cancer.     

The influence of knowledge of mammography findings on the accuracy of breast ultrasound in symptomatic women

Breast ultrasound is generally interpreted with knowledge of the mammographic examination. This study examined the influence of knowledge of mammography findings on the accuracy of ultrasound in women with breast symptoms. Subjects were sampled from all women 25-55 years of age consecutively attending a breast clinic. This included all 240 women shown to have breast cancer and 240 age-matched women shown not to have cancer. Ultrasound films were prospectively reviewed and reported by two radiologists independent of each other and in a blinded manner. A two-phase design was used. In the first phase, the radiologists provided an opinion on the ultrasound films. In the second phase, the ultrasound films were reread with consideration of the corresponding mammographic examination. The accuracy of reading the ultrasound with and without knowledge of the findings on mammography was compared using sensitivity and specificity, and receiver operating characteristics (ROC) curves. Reporting the ultrasound with knowledge of mammography (compared to without mammography) improved sensitivity and reduced specificity for both radiologists. For one reader, sensitivity increased from 77.5% to 86.7% (p = 0.0002) and specificity decreased from 89.7% to 85.4% (p = 0.04). For the other reader, sensitivity increased from 81.3% to 87.5% (p = 0.0023) and specificity decreased from 87.1% to 85.0% (p = 0.27). ROC curves for both radiologists showed that reporting ultrasound with knowledge of mammography resulted in small (about 3%), but significant improvement in the area under the ROC curve. Our study indicates that knowledge of the findings of mammography improves the interpretation of breast ultrasound in symptomatic women.