乳腺X线摄影引导下导丝定位在触诊阴性病灶切除术中的综合评价

目的 综合评价导丝导向定位术在触诊阴性乳腺病灶中的应用价值.方法 对84例触诊阴性乳腺病灶行导丝导向定位术103处,记录病灶大小、分布特征、标本体积、剂量参数和患者术中反应,评价病灶大小、特征、定位准确度对切除标本大小的影响以及定位术中辐射剂量和患者的耐受程度.结果 定位适中74处,过深14处,过浅9处,完全偏离病灶靶点6处.1次性切除病灶99处,4处病灶2次切除,标本平均体积为11.47cm^3.检出良性病变占59.2％（61/103处）;不典型增生8.7％（9/103处）;乳腺癌32.1％（33/103处）.定位术中辐射剂量近似为常规摄影辐射剂量的2倍,11例患者发生迷走反应.结论 立体定位导丝导向定位术可在完整切除病灶的同时缩小手术范围,是目前应用于触诊阴性的乳腺病灶的有效方法.病灶大小、分布特征和定位准确度是影响病灶切除体积大小的重要因素,且术中的高辐射剂量及患者在术中的护理均值得关注.     

The positive predictive value of the breast imaging reporting and data system (BI-RADS) as a method of quality assessment in breast imaging in a hospital population

Evaluation of the diagnostic performance of mammography and US in our hospital, based upon the positive predictive value (PPV) for breast cancer of the breast imaging reporting and data system (BI-RADS) final assessment categories, has been performed. A follow-up study of 2,762 mammograms was performed, along with 955 diagnostic exams and 1,807 screening exams. Additional US was performed in 655 patients (23.7%). The combined reports were assigned a BI-RADS category. Follow-up was obtained by pathologic examination, mammography at 12 months or from PALGA, a nationwide network and registry of histo- and cytopathology. Overall sensitivity was 85% (specificity 98.7%); sensitivity of the diagnostic examinations was 92.9% (specificity 97.7%) and of the screening examinations 69.2% (specificity 99.2%). The PPV of BI-RADS 1 was 5 of 1,542 (0.3%), and of BI-RADS 2, it was 6 of 935 (0.6%). BI-RADS 3 was 6 of 154 (3.9%), BI-RADS 4 was 39 of 74 (52.7%) and BI-RADS 5 was 57 of 57 (100%). The difference between BI-RADS 1 and 2 vs. BI-RADS 3 was statistically significant (P<0.01). Analysis of BI-RADS 3 cases revealed inconsistencies in its assignment. Evaluation of the BI-RADS final assessment categories enables a valid analysis of the diagnostic performance of mammography and US and reveals tools to improve future outcomes.     

Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation

Aim

Assess accuracy of contrast enhanced spectral mammography (CESM) versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation.

高频X线钼靶摄影对乳腺病变的诊断价值

目的探讨乳腺钼靶摄影在乳腺癌诊断中的应用价值。方法回顾性分析经手术、病理证实,资料较完整的46例乳腺癌的钼靶X线表现。结果46例乳腺癌X线表现直接显示肿块35例,占76．09％;钙化24例,占52．17％;局限性致密及结构紊乱5例,占10．87％;大导管相6例,占13．04％;乳头内陷8例,占17．39％;异常血管7例,占15．23％。结论乳腺钼靶摄影在乳腺癌的诊断中具有很较高的应用价值。     

多模态X线影像组学模型对乳腺BI-RADS4类肿块良恶性的辅助诊断价值

目的 探讨多模态X线影像组学模型在鉴别乳腺BI-RADS 4类肿块型病变良恶性方面的价值.方法 回顾性分析山东省千佛山医院2017年8月至2020年4月,经全屏数字化乳腺X线摄影(FFDM)和数字乳腺断层合成摄影(DBT)检查诊断为BI-RADS 4类乳腺病变并经病理证实的120例女性患者(4A 41例,良性34例、恶...     

乳腺专用磁共振成像、乳腺X线摄影及超声检查对乳腺癌诊断价值的对照研究

目的回顾性比较研究乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)、超声(ultrasound,US)及乳腺X线摄影(mammography,MG)3种检查方法对乳腺癌的诊断价值。方法搜集我院行手术治疗并于术前同时行DBMRI、MG及US 3种检查的患者共612例,剔除36例于检查时已行新辅助化疗的患者,共576例患者纳入本研究,所有入组患者均以病理学结果作为金标准。数据分析与统计采用SPSS 13.0统计软件。以P<0.05为差异有统计学意义。结果 DBMR对乳腺癌病灶检出的敏感性为97.1%,高于MG(77.6%)(χ2=53.904,P=0.000)及US(91.0%)(χ2=10.370,P=0.001);MG对乳腺癌病灶检出的特异性为88.8%,高于DB-MR(82.8%)(χ2=3.925,P=0.048)及US(82.5%)(χ2=4.383,P=0.036)。对于导管内癌,DBMRI检出的敏感性为97.9%,高于US(77.8%)(χ2=29.445,P=0.000)及MG(71.1%)(χ2=9.680,P=0.002)。在致密型乳腺中,DBMRI诊断灵敏度高为96.0%,高于MG(66.7%)(χ2=35.806,P=0.000);US诊断敏感性为92.1%,高于MG(66.7%)(χ2=24.812,P=0.000)。在非致密型乳腺中,DBMR诊断敏感性为97.9%,高于MG(85%)(χ2=19.684,P=0.000)及US(90.4%)(χ2=19.684,P=0.002)。DBMRI、MG、US对伴钙化的乳腺癌检出的敏感性分别为98.3%、94.0%和94.8%。结论 DBMRI对乳腺癌的检出敏感性高,但特异性较低;对于导管内癌的诊断,DBMRI具有显著优势;在致密型乳腺乳腺癌的检出中,DBMRI与US均具有高敏感性,优于MG。     

Outcome of breast lesions detected at screening ultrasonography

Objective

To assess the final outcome of breast lesions detected during screening ultrasonography (US) and categorized by BI-RADS final assessment.

Materials and methods

During a 1-year period, 3817 consecutive asymptomatic women with negative findings at both clinical breast examinations and mammography underwent bilateral whole breast US and BI-RADS categories were provided for US-detected breast lesions. The reference standard was a combination of histology and US follow-up (≥12 months), and the final outcomes of 1192 US-detected lesions were analyzed.

Results

Of 904 category 2 lesions, 890 remained stable for 12–60 months. Biopsies of 14 lesions revealed no malignancies (NPV = 100%). Of 247 category 3 lesions, 232 remained stable for 12–60 months. Biopsies of 15 lesions revealed 2 malignancies, which were diagnosed within 6 months of the index examination and were node negative (NPV = 99.2%). Of 41 category 4 lesions, biopsies of 38 lesions revealed 5 malignancies (PPV = 12.2%), and 3 remained stable for 37–51 months. No US-detected lesion was classified as category 5.

Conclusion

The rates of malignancy for US-detected BI-RADS categories 2, 3, and 4 lesions were 0%, 0.8%, and 12.2%, respectively. The final assessment of US BI-RADS categorization showed it to be an appropriate predictor of malignancy for screening US-detected breast lesions.     

Comparison of the diagnostic performance of Magnetic Resonance Imaging (MRI), ultrasound and mammography for detection of breast cancer based on tumor type,breast density and patient's history: A review

ObjectiveBreast cancer is the most common malignancy in women. Mammography and ultrasound are commonly used in a clinical environment as the first choice for breast cancer detection. Magnetic Resonance Imaging (MRI) has been reported to reveal additional information. In the following review MRI, Ultrasound (US) and Mammography (MM) are all compared in terms of their diagnostic performance on breast cancer detection, depending on tumor type, breast density and patient's history.Key findingsEvaluating each modality alone, MRI provided an overall sensitivity and specificity of 94.6% (range 85.7%–100%) and 74.2% (range 25%–100%) respectively, while mammography showed that the overall sensitivity was at 54.5% (range 27%–86.8%) and specificity was 85.5% (range 62.9%–98.8%). The overall sensitivity and specificity of ultrasound was 67.2% (range 26.9%–87.5%) and 76.8% (range 18.8%–96.9%). When combining the results of all three techniques, it resulted in a sensitivity of 97.7% (range 95%–100%) and a specificity of 63.3% (range 37.1%–87.5%). In addition, contrast-enhanced mammography (CE-MM) and MRI (CE-MRI) illustrated an overall sensitivity and specificity for CE-MM was 90.5% (range 80.9%–100%) and 52.6% (range 15%–76.1%) and for CE-MRI, the overall sensitivity and specificity was 91.5% (range 89.1%–93.8%) and 64.7% (range 43.7%–85.7%).ConclusionAs modalities alone, the highest sensitivity has been observed for MRI and the lowest sensitivity for mammography regardless breast type, density, and history. Sensitivity is even more increased from the combination of US + MRI or MM + MRI or MRI + MM + US. The specificity seems to be affected by the size, type of the tumor and patient's history, however based on breast density, the highest specificity was observed by US alone.Implications for practiceBreast cancer screening is of outmost importance and identifying the best technique will improve cancer management. Combining techniques increases diagnostic ability compared with using modalities alone. CE-MM can be a viable option in dense breast tissue when there are contraindications to MRI as it also has high sensitivity based on the type of breast cancer.     

乳腺癌的影像学检查

随着现代影像技术的长足发展，以钼靶检查为主、诸多检查手段已用于乳腺癌的筛查，本文就各种乳腺影像检查的特点作一综述。     

Magnetic resonance imaging of breast vascularity in medial versus lateral breast cancer

Objective

Breasts with malignant tumors can demonstrate a general increased vascularity compared to the contralateral breast and a prominent blood vessel adjacent to the tumor on magnetic resonance imaging (MRI). The aim of the study was to further characterize these alterations in blood supply by location of the tumor within the breast using MRI.

Materials and methods

The study group included 105 patients who underwent breast MRI for suspicion of a malignancy over a 2-year period. Fifty-one had pathologically verified malignant tumors (study group), 11 had pathologically verified benign lesions (control), and 43 had negative scans (control). The malignant lesions were distinguished by location, medial or lateral, within the breast. Origin of the vascular supply and vessel diameter was recorded in a blinded manner. When available, MRI scans performed 2 years after treatment were reviewed as well.

Results

Of the 24 medial malignant tumors, 21 (87%) had a predominantly medial vascular supply and 3 (13%), a predominantly lateral supply; of the 23 lateral tumors, 11 (48%) had a predominantly medial vascular supply and 8 (35%), a predominantly lateral supply (p = 0.03). In 4 cases, no dominant vessel was noted. Maximum vessel diameter was 3.6 ± 1.1 mm in the patients with malignancy and 2.6 ± 0.8 mm in the controls (p < 0.0005). General increased vascularity was demonstrated in 91% of the medial tumor subgroup and 83% of the lateral tumor subgroup, as opposed to 36-37% in the control groups (p < 0.0005). Follow-up MRI, performed in 8 patients in the malignant-tumor group after treatment, revealed a considerable decrease in the prominent vessels, to a size close to that of the controls.

Conclusion

Breasts with malignant tumors are characterized by an altered general vascular supply, a prominent feeding vessel, and increased regional vascularity. Both the presence and location of the tumor affect the vascular supply. The vascular change apparently diminishes after treatment, although this finding requires further investigation in a larger sample.     

乳腺癌影像诊断的研究现状

近年来,随着我国女性乳腺癌发病率及死亡率的上升,提出了早期诊断乳腺癌的要求.对乳腺癌病人进行更为准确的术前分期,有利于治疗方案的制定.对化疗后疗效的监测,有利于后续方案的及时调整.在这些需求中,影像学检查的作用日益突出.目前常用的方法主要包括乳腺X线摄影、超声、CT、MRI等,了解它们在乳腺癌诊断中的研究现状,合理有效地选择检查方法,能够为临床提供更多有价值的信息.     

全数字化乳腺摄影在乳腺病变中的临床应用价值

目的探讨全数字化乳腺摄影(FFDM)在乳腺病变中的临床应用价值。资料与方法搜集经手术病理证实有完整临床资料的乳腺病变共102例,所有患者均行FFDM,结合病理进行影像学分析。结果 102例乳腺病变中乳腺癌31例,乳腺良性病变71例。临床触及肿块者63例,未触及肿块者39例。影像表现为肿块80例,单纯成簇微小钙化4例,结构紊乱并粗长毛刺2例,结构紊乱并微小钙化1例,局部片状致密影14例,无明显影像表现1例。FFDM对乳腺癌诊断敏感性为90.3%,特异性为94.4%,准确性为93.1%。结论 FFDM能清晰显示乳腺病变的X线征象,尤其能够显示乳腺癌的主要X线征象,为临床早期诊断乳腺病变创造了条件,尤其对临床未触及肿块的早期乳腺癌具有重要的临床价值。     

Analysis of 107 breast lesions with automated 3D ultrasound and comparison with mammography and manual ultrasound

Objectives

Our aim was to investigate the diagnostic potential of an automated ultrasound (US) breast scanner prototype and compare it with manual US and mammography.

Methods

Ninety-seven patients with a total of 107 breast lesions had mammograms, manual US and an automated breast US scan. Multiplanar reconstructions in coronal, axial and the sagittal view were reconstructed from the automated dataset and visualized. After biopsy, all lesions were confirmed histologically. The data were evaluated according to the BIRADS (Breast Imaging Reporting and Data System) classification. The sensitivity and specificity were analyzed.

Results

The BIRADS criterion “margin” was significantly related to the overall BIRADS classification, independently of the US method being used. The sensitivity of mammography was significantly lower than of each US method (Fisher's exact test with p < 0.05). There were no significant differences between the US methods.

Conclusions

The reconstructed third (axial) image plane of the whole breast, which corresponds to a craniocaudal mammogram, can give additional information about both, site and differential diagnosis of a lesion. Although image quality was sufficient, automated US is not good enough to replace manual US at this time.     

乳腺高危病变的乳腺X线诊断及技术进展

乳腺高危病变包括良性病变及原位癌,具有发生乳腺癌的风险。高危病变首诊主要依赖于穿刺活检,但首诊后存在一定的病变升级率。对于不同的高危病变,如不典型导管增生（ADH）、乳头状瘤伴不典型增生、放射状瘢痕、小叶原位癌（LCIS）、不典型小叶增生（ALH）、黏液囊肿样病变、平坦上皮非典型增生等,乳腺X线检查的诊断及处理原则并不完全相同。就乳腺X线检查对高危病变的诊断、处理、预后评估的研究进展予以综述。     

群集钙化对鉴别乳腺良恶性病变的意义

目的评价乳腺钼靶片群集钙化对鉴别乳腺良恶性病变的意义。方法分析76例乳腺X线钼靶片群集钙化病例,全部经手术病理证实,其中,乳腺恶性病变52例,良性病变24例。采用下列4项指标分析上述76例群集钙化的特征并进行良恶性对照研究:a)病灶钙化总数;b)每平方厘米钙化数目(N/S);c)钙化灶的大小、形态;d)钙化灶合并肿块。结果76例群集钙化病例中钙化总数大于30个、N/S大于等于10个、钙化灶大小形态不一致、钙化合并肿块,这4项指标诊断恶性钙化的特异性和敏感性分别为83.3%和69.2%,79.2%和76.9%,62.5%和92.3%,62.5%和53.8%。结论N/S大于等于10个、钙化总数大于30个及钙化灶大小、形态不一致这3个特征对恶性钙化最具有诊断价值。