乳腺癌前病变的临床诊断研究

目的：探讨乳腺癌前病变的各种检查方法的应用价值。方法：对131例乳腺癌的癌前病变的B超、钼靶摄片及纤维乳管镜检查等诊断方法进行分析。评价其各自的诊断价值。结果：全组病例均经手术切除活检诊断为乳腺癌的癌前病变。纤维乳管镜检查对乳头溢液病人病灶检出率为93．75％（45／48）；B超对癌前病变的检查符合率为39．69％（52／131），肿块组、溢液组及无肿块无溢液组分别为52．94％（27／51）、10．41％（5／48）和62．50％（20／32）；钼靶摄片对癌前病变的检查符合率为53．41％（47／88），肿块组、溢液组及无肿块无溢液组分别为53．33％（16／30）、28．13％（9／32）和84．62％（22／26）。结论：合理应用B超、钼靶摄片及纤维乳管镜等检查手段。是早期检出乳腺癌的癌前病变的有效措施。     

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。     

早期乳腺癌30例分析

目的 探讨早期乳腺癌的临床特点及诊断方法，为提高早期乳腺癌的诊断率提供参考依据。方法 回顾性分析30例早期乳腺癌的临床资料。结果 30例病人中乳腺局限性增厚18例（60％），可触及结节者仅11例（37％）；有乳腺增生病史伴增生症状加重者22例（73．3％）。钼靶X线单纯钙化12例（40％），肿块结节影5例（17％）。24例（80％）超声检出边界不规则低回声结节，79％的结节内或周围可测到血流信号。11例通过空芯针穿刺获得诊断，19例由超声或钼靶定位后手术活检确诊。结论 高危年龄妇女乳腺增生伴症状加重、乳腺局限性增厚是早期乳腺癌的重要表现；彩色多普勒超声对早期乳腺癌的诊断价值优于钼靶X线检查；及时对乳腺结节、局限性增厚、钼靶X线致密影等可疑病灶行组织学穿刺活检或超声以及钼靶定位后手术活检，可提高早期乳腺癌的诊断率。     

钼靶摄片所发现的乳腺癌行立体定位粗针活检与切除活检的比较

钼靶摄片可以检出临床上不能扪及的隐匿性乳腺癌，并由此可降低其死亡率。但钼靶所检出的乳腺隐匿性病灶有60％～90％为良性病变。为明确诊断需作进一步检查。目前立体定位粗针穿刺活检（SCNBx）正逐渐取代穿刺定位外科切除活检（NLBx）。为对这两种检查进行比较，作者开展了以下对照研究。SCNBx组21例，NLBx组对削。均为同期浸润性乳腺癌（仅有原位癌者予除外）。根据钼靶摄片X线征象可将病灶分为良性组、可疑组及高度可疑组，本研究仅后两者入组。SCNBx方法为：先采用乳腺立体定位仪进行定位。穿刺处皮肤予以消毒，局部麻醉。皮肤…     

高频彩超和数字化钼靶摄片联合MRI在乳腺癌早期诊断中的价值

乳腺癌是危害妇女身心健康最常见的恶性肿瘤之一,近年来流行病学资料显示其发病率呈不断上升的趋势[1].目前乳腺彩超、乳腺X线钼靶摄片仍然是乳腺癌诊断及普查广泛采用的检查方法,但对于＜2 cm的早期乳腺癌诊断比较困难,具有较高的漏诊率.近年来,随着核磁共振成像(magnetic resonance imaging,MRI)技术的不断发展,MRI特别是增强MRI已成为最有前途的乳腺癌诊断手段,甚至能够检出彩超、钼靶摄片及临床体征阴性的隐匿性早期乳腺癌.为了探讨高频彩超、数字化钼靶摄片联合乳腺MRI在乳腺癌早期诊断中的价值,对224例早期乳腺癌患者的影像资料进行回顾性分析和总结,报道如下.     

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。     

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。     

全数字钼靶提高同时性双侧乳腺癌检出率的临床研究

目的 评价全数字钼靶在临床上检测同时性双侧原发乳腺癌的准确率,探讨其在同时性双侧原发乳腺癌的临床诊断和治疗中的价值。方法 选取本院2006年6月～2011年12月间收治的12例同时性双侧原发乳腺癌患者,所有病例均行全数字钼靶X线摄影、彩色多普勒超声和MRI检查,并与术后病理结果对比分析;术后进行为期2年的随访。结果 总检出灵敏度：全数字钼靶诊断的灵敏度为83.3%,超声和MRI检查的灵敏度分别为54.2%、45.8%,与全数字钼靶比较差异均具有统计学意义（P<0.01,P<0.05）;第一原发癌的检出灵敏度：全数字钼靶为83.3%,超声和MRI检查分别为66.7%、50.0%,与全数字钼靶相比差异均无统计学意义（P>0.05）;第二原发癌的检出灵敏度：全数字钼靶诊断的灵敏度为83.3%,超声和MRI检查的灵敏度均41.7%,与全数字钼靶相比,差异均具有统计学意义（P<0.05）。术后随访的结果表明,未发现漏诊的对侧乳腺癌患者。结论 全数字钼靶对双侧原发癌中较早期的一侧及第二原发癌的检出率均高于超声及MRI检查,能够更早更准确地发现病灶。     

隐匿性乳腺癌36例诊治分析

目的探讨隐匿性乳腺癌的诊断和治疗方法。方法对36例隐匿性乳腺癌患者分别采用乳房X线、MRI检查,对肿块切除活检病理免疫组化检查;治疗采用乳腺癌根治术、改良根治术或保乳术后加放疗。结果乳腺钼靶的阳性率45．8％（11／24）,MRI的阳性率70％（7／10）;免疫组化检查阳性率62％（18／29）;乳腺癌根治术、改良根治术和保乳术后加放疗的5年生存率分别73．9％、77．8％（P〉0．05）。结论乳腺钼靶和MRI有重要诊断价值,切检和免疫组化检查有助于确诊;乳腺癌根治术或改良根治和保乳术后放疗的5年生存率相同。     

常用乳腺影像诊断方法的比较研究

目的 比较彩色多普勒超声、钼靶和近红外线在乳腺癌及乳腺良性疾病诊断中的作用。方法 以术后病理结果为金标准，比较术前3种检查方法的诊断准确性。结果 共计565例乳腺疾病患者接受检查，其中乳腺癌274例，良性乳腺疾病291例。对乳腺癌彩超、钼靶和近红外线检查的灵敏度分别为83．7％（200／239）、84．2％（64／76）和76．9％（100／130），特异度分别为88．6％（226／255）、93．2％（69／74）和82．6％（114／138），诊断符合率分别为86．2％（426／494）、88．7％（133／150）和79．9％（214／268），其中彩超和钼靶检查的诊断符合率优于近红外线（P〈0．05），尤其对≤2cm的乳腺癌，近红外线对其诊断有较高的假阴性率（48．8％，21／43）。对乳腺炎性病变和导管瘤，彩超的检出率分别为58．8％（10／17）和69．2％（18／26），高于近红外线的检出率[分别为0和23．5％（4／17），P〈0．05和P〈0．01]。对乳腺癌在无查体配合诊断情况下行近红外线检查，其灵敏度和诊断符合率明显下降[灵敏度从76．9％（100／130）降到56．9％（74／130），P〈0．01；诊断符合率从79．9％（214／298）降到61．9％（166／268），P〈0．01]。结论 彩色多普勒超声和钼靶是有价值的常用乳腺影像诊断方法。     

MRI对小乳腺癌的诊断价值

目的:探讨MRI对小乳腺癌的诊断价值。方法:2008年6月至2009年6月间经临床怀疑为小乳腺癌(直径≤2 cm)而行MRI检查,MRI诊断结果按乳腺影像报告及数据系统(breast imaging reporting and data system,BI-RADS)分类为Ⅲ类、Ⅳ类及Ⅴ类者共62例。其中31例近期(1周内)接受了乳腺X线摄影检查(mammography,MG),并按BI-RADS分类法进行分类。所有病例均经病理学证实,比较MRI及MG两种检查方法对小乳腺癌的检出率、灵敏度、阳性预测值的差异。结果:所有62例乳腺小病灶中经病理证实为乳腺癌者50例,31例行MG检查的病例中小乳腺癌为21例,MRI对小乳腺癌的检出率、灵敏度均高于MG,分别为100%比85.7%和94.0%比61.9%(P<0.05)。结论:MRI对小乳腺癌的检出率和灵敏度优于MG。     

Improved prognosis in breast carcinoma by excision of non-palpable carcinoma-suspected lesions. Analysis of 319 ambulatory surgery operations

A retrospective study is described according to which 319 outpatients had been operated on for suspected carcinoma because of breast lesion, in the course of three years in this hospital. In 113 cases (35.4%) the lesion was palpable, in 206 cases (64.6%) it was not. In the non-palpable cases, mammography was indicated in 98 patients (47.6%) undergoing controls for mastopathy, in 41 patients (19.9%) undergoing a first mammography in the course of preventive check-ups, and in 33 patients (16.0%) undergoing a check-up after operative therapy of breast cancer. Prior to operation, 84.0% (n = 173) of the non-palpable lesions were marked by mammography, 11.2% (n = 23) by sonography, and 4.8% (n = 10) by magnet resonance imaging (MRI). Intraoperative specimen mammography was made in every case marked by mammography. In 19.4% (n = 40) out of the 206 cases of marked though non-palpable focuses a tumour was found. 25% (n = 10) of all marked tumours were diagnosed and treated as in-situ stage tumours, 65% (n = 26) were diagnosed and treated as tumours in the pT1 stage. As regards the nodal stage, 85% (n = 34) of the tumours were diagnosed and treated as being pN0 tumours, and 100% (n = 40) were found to be free from any distant metastases. Consequently, for improving prognosis and, at the same time, for reducing the rate of breast amputations as a means of curative therapy of breast cancer, regular screening in defined risk groups is necessary. Surgical treatment of patients with small and non-palpable findings should be reserved for departments with marking and quick-freezing facilities.     

Improvement in DCIS detection rates by MRI over time in a high-risk breast screening study

Although magnetic resonance imaging (MRI) is much more sensitive than mammography for detecting early invasive breast cancer, in many high-risk screening studies MRI was less sensitive than mammography for detecting ductal carcinoma in situ (DCIS). We reviewed our experience detecting DCIS in our single center study of annual MRI, mammography, ultrasound and clinical breast examination (CBE) for screening very high-risk women. All cases of DCIS±microinvasion and invasive cancer were compared in two time frames: before (period A) and after (period B) July 2001-when we acquired expertise in the detection of DCIS with MRI-with respect to patient demographics, method of detection, and rates of detection of invasive cancer and DCIS. In period A there were 15 cases (3.1% of 486 screens) in 223 women, of which 2 (13%) were DCIS-one with microinvasion-neither detected by MRI. In period B there were 29 cases (3.3% of 877 screens) in 391 women, of which 10 (34%) were DCIS±microinvasion (p=0.04), all 10 detected by MRI but only one by mammography. No DCIS cases were detected by ultrasound or CBE. Specificity was lower in period B than in period A but acceptable. The ability to detect DCIS with screening MRI improves significantly with experience. MRI-guided biopsy capability is essential for a high-risk screening program. In experienced centers the increased sensitivity of MRI relative to mammography is at least as high for DCIS as it is for invasive breast cancer.     

The role of magnetic resonance imaging mammography in the surgical management of the index breast cancer

HYPOTHESIS: Preoperative magnetic resonance imaging (MRI) mammography, after positive fine-needle aspiration (FNA) or stereotactic biopsy, may alter surgical management of the index breast cancer. DESIGN: Review of MRI mammograms compared with conventional mammograms and clinical examination. SETTING: Rural community hospital. PATIENTS: Consecutive cohort of 27 patients with breast cancer who underwent prebiopsy or preoperative MRI mammography. INTERVENTION: Surgical management of breast cancer. MAIN OUTCOME MEASURE: Change in surgical management prompted by findings on MRI mammography. RESULTS: Prebiopsy or preoperative MRI mammography changed surgical management in 13 (48%) of 27 patients with breast cancer by discovering multicentric cancers or more extensive cancer. Of the 27 patients, 9 with positive FNA biopsy results of palpable masses underwent preoperative MRI; in 6 of the 9, ipsilateral multicentric cancers or more extensive cancer was discovered that necessitated mastectomy rather than breast conservation. Eighteen of the 27 patients had category 4/5 mammograms. Ten of these patients had stereotactic biopsies followed by MRI; 4 of the 10 had changes on the MRIs that required mastectomy rather than breast conservation. Eight of the 27 patients had MRI before stereotactic biopsy; 3 of the 8 had MRI abnormalities that required mastectomy. One patient had contralateral, multicentric cancers not seen on conventional mammography, necessitating bilateral mastectomies. CONCLUSIONS: We recommend that patients who desire breast conservation undergo MRI mammography before biopsy of a category 4/5 mammogram or immediately after a positive FNA biopsy result of a palpable mass.     

Magnetic Resonance Imaging Facilitates Breast Conservation for Occult Breast Cancer

Introduction: Occult primary breast cancer, i.e., isolated axillary adenocarcinoma without detectable tumor in the breast by either physical exam or mammography, represents up to 1% of operable breast cancer. Modified radical mastectomy (MRM) is generally the accepted treatment for this condition although tumor is identified in only two-thirds of mastectomy specimens. Breast magnetic resonance imaging (MRI) can identify occult breast carcinoma and may direct therapy. This study examined the ability of breast MRI to detect occult breast cancer and to facilitate breast conservation therapy.Methods: Forty women with biopsy-proven metastatic adenocarcinoma to an axillary lymph node and no evidence of primary cancer were studied. All patients had a physical examination, mammography, and MRI of the breast. Using a dedicated breast coil, MRI imaging was performed with and without gadolinium enhancement. Positive MRI scans were compared with histopathologic findings at the time of operation (n 5 21).Results: MRI identified the primary breast lesion in 28 of 40 women (70%). Of these 28 patients, 11 had MRM, 11 had lumpectomy/axillary lymph node dissection (ALND)/radiotherapy (XRT), 2 had ALND/XRT alone, and 4 had no local treatment secondary to stage IV disease. Two women initially treated with lumpectomy/ALND subsequently had mastectomy for positive margins. Of the women with positive MRI who had breast surgery, 21 of 22 (95%) had tumor within the surgical specimen. Twelve women had negative MRI of the breast. Five of these 12 underwent MRM, of whom 4 had no tumor in the mastectomy specimen. The remaining 7 patients had ALND and whole breast radiation (ALND/XRT) (n 5 5), or were observed (n 5 2). Overall, 18 of 34 women surgically treated had MRM, while 16 (47%) preserved their breast. Tumor yield for patients having breast surgery was 81%.Conclusions: MRI of the breast can identify occult breast cancer in many patients and may facilitate breast conservation in select women. Negative breast MRI predicts low tumor yield at mastectomy.     

Women's acceptance of MRI in breast cancer surveillance because of a familial or genetic predisposition

Magnetic resonance imaging (MRI) of the breasts is a promising screening modality for early detection in women at increased breast cancer risk. We investigated the subjective experiences with MRI and the preferences for MRI, mammography or clinical breast examination in 178 high-risk women adhering to a breast cancer surveillance programme. MRI was reported to cause limited discomfort. About 44% preferred MRI as a screening test (mammography: 14%). MRI provided the most reassurance of breast cancer being absent in case of a favourable test result. MRI seems to be acceptable as a screening test for women at increased breast cancer risk and is preferred by them over mammography.     

In Newly Diagnosed Breast Cancer,Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer,Even in Elderly Women: The Mayo Clinic in Florida Experience

Abstract: The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution. MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary‐tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors. A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016). We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis.     

Breast cancer screening in surgical patients]

Between January and August 1996, 304 patients of the Department of General and Abdominal Surgery of the University of Mainz who were at least 40 year old, were interviewed about their breast cancer screening behavior. The aim of our investigation was to evaluate the attitude of the target population to breast screening and the value of breast palpation, completed with mammography, during the women's treatment in hospital. 168 (55%) of the interviewed women reported that they had a yearly clinical breast examination in the past. All patients underwent a clinical breast examination. 185 (60%) did not have a mammography in the past or within the past 2 years. These women were offered a mammographic examination during their treatment in the hospital. The investigation revealed one invasive breast cancer. 13 patients had abnormal mammographic or sonographic findings. Our investigation shows, that the compliance of the target population for breast cancer screening is low. Therefore it is necessary to point out the value of breast cancer prevention with clinical examination and mammography also for patients treated in the hospital for an other disease. Every female patient should undergo breast examination. But early detection of breast cancer before micrometastases have occurred is only possible by mammography.     

Is there a role for routine use of MRI in selection of patients for breast-conserving cancer therapy?

BACKGROUND: The role of preoperative bilateral breast MRI in breast cancer patients being considered for breast-conserving therapy has been controversial. We hypothesized that preoperative MRI, along with an active program in MRI-directed biopsies, would lead to a change in multidisciplinary treatment planning for patients being considered for breast-conserving cancer therapy, and it would be associated with reduced rates of margin-positive partial mastectomies. STUDY DESIGN: A retrospective review of a consecutive series of patients who were treated for breast cancer at a single center between January 2005 and July 2007 was conducted. Patients in the study were candidates for breast-conserving cancer therapy based on physical examination, mammography, and ultrasonography. All patients were evaluated by a preoperative breast MRI. Analysis included number and result of MRI-directed biopsies, impact of MRI on treatment planning, and incidence of margin-positive partial mastectomy within the series of patients. RESULTS: Seventy-nine female patients were analyzed. Median age was 57 years. MRI led to the performance of 25 MRI-directed biopsies for previously unrecognized suspicious lesions in 21 patients. Forty-four percent of MRI-directed biopsies were positive for cancer. MRI was associated with a change in management in 15 patients (19%) for multicentric ipsilateral cancer (n = 7), a more extensive primary lesion size (n = 6), or contralateral breast cancer (n = 2). Incidence of margin-positive partial mastectomy requiring additional resective operation was very low in this series (10%). CONCLUSIONS: Bilateral breast MRI, when used in conjunction with MRI-directed biopsy procedures, can be helpful in planning multidisciplinary treatment of candidates for breast-conserving cancer therapy. By allowing more accurate local staging of tumors, MRI is a tool that can be used to help reduce high reexcision rates for margin-positive partial mastectomies.