数字乳腺断层摄影定性诊断乳腺肿块

目的观察数字乳腺断层摄影(DBT)定性诊断乳腺肿块的效能。方法回顾性分析85例女性乳腺肿块患者,以组织病理学结果为诊断金标准,采用受试者工作特征(ROC)曲线分析全数字化乳腺X线摄影(FFDM)、DBT及FFDM+DBT的定性诊断效能。结果于85例共检出89个乳腺肿块,病理诊断良性病变56个、恶性病变33个。FFDM、DBT及FFDM+DBT定性诊断乳腺肿块的敏感度分别为69.64%、87.50%、和87.50%,特异度分别为69.70%、78.79%和84.85%,准确率分别为69.66%、84.27%和86.52%,AUC分别为0.75[95%CI(0.65,0.84)]、0.92[95%CI(0.84,0.97)]和0.93[95%CI(0.86,0.98)];DBT、FFDM+DBT的敏感度、特异度、准确率及AUC均大于FFDM(P均0.05),DBT与FFDM+DBT差异均无统计学意义(P均0.05)。结论 DBT可定性诊断乳腺肿块,且其诊断效能高于FFDM。     

弹性应变率比值对乳腺肿块良恶性的诊断价值

目的：探讨弹性应变率比值对乳腺肿块诊断的临床应用价值。 方法：对随机检查的103例患者的109个乳腺肿块分别进行二维超声和弹性成像检查, 测量肿块组织与周围组织弹性应变率比值, 结果与病理对照。 结果：109个肿块中, 良性71个, 恶性38个, 良、恶性乳腺肿块弹性应变率比值分别为（2.26±1.39）和（6.95±4.08）, 两者差异有统计学意义（P<0.05）。二维超声、弹性应变率比值诊断恶性病变的敏感性、特异性和准确性分别为81.58%, 80.28%, 80.73%和86.84%, 88.73%, 88.07%（P>0.05）; 联合应用则诊断的敏感性、准确性提高至97.37%和93.58%（P<0.05）。 结论：以二维超声为基础, 结合弹性成像技术, 可提高乳腺肿块的术前诊断符合率。     

超声造影对乳腺良恶性肿块鉴别诊断的价值

目的 探讨超声造影在乳腺良、恶性肿块鉴别诊断中的应用价值.方法 采用普通超声及SonoVue(声诺维,注射用六氟化硫微泡)超声造影分别对65例(70个肿块)乳腺肿块进行检查,通过增强程度、增强模式、增强时病灶边界是否清晰、消退模式等指标来判定包块的良、恶性,并与术后病理结果进行比较.结果 病理学诊断系良性病变37例,恶性病变28例,超声造影检查的敏感性、准确性、阳性预测值及阴性预测值均明显高于普通超声检查(P<0.05),而在特异性及误诊率的差异无统计学意义(P>0.05).超声造影显示70个病灶均有不同程度增强,其中78.6%(22/28)恶性肿瘤表现为明显增强,75.0%(21/28)为结节状不均匀增强85.7%(24/28)病灶边界不清楚、不规则,周边呈放射状增强;而良性肿块增强较弱,均匀增强,病灶边界较清晰,成团状,仅有18.9%(7/37)病灶边界不清楚,与恶性肿块比较差异有统计学意义(P=0.000).消退期,良、恶性病灶均呈现均匀或不均匀消退,两者差异无统计学意义(P=0.791).结论 与普通超声相比,超声造影对鉴别诊断乳腺良、恶性肿块的价值更高.     

UE联合CDFI鉴别诊断乳腺良恶性疾病的价值分析

探讨超声弹性成像(UE)联合彩色多普勒超声(CDFI)鉴别诊断乳腺疾病良恶性的价值。病理学确诊的乳腺癌患者80例(恶性组)、乳腺良性疾病患者80例(良性组),两组患者均接受UE、CDFI检查,对比两组患者乳腺肿块超声特征、UE硬度评分,以病理学检查结果作为准计算两种方法单独及联合应用诊断乳腺癌良恶性疾病的价值。结果显示,恶性组和良性组的肿块形态规则情况、边缘完整性、微钙化灶检出率、后方回声衰竭情况、肿块内血流分级、RI≥0.7的占比比较,差异均具有统计学意义(P0.05);恶性组UE评分≥4分的患者检出率83.8%显著的高于良性组患者的12.5%(P0.05);UE、CDFI联合应用鉴别诊断乳腺肿块性质的灵敏度为96.3%、特异度为90.00%、漏诊率为3.75%、误诊率为10.00%。结果表明,UE联合CDFI对临床鉴别诊断乳腺良恶性疾病具有较高的价值。     

钼靶X线对乳腺良恶性病变诊断的临床意义

目的 评价钼靶X线检查对乳腺良恶性病变诊断的临床意义.方法 对100例临床可触及乳腺肿块患者进行钼靶X线检查,分析病变的X线征象,并与病理结果 进行对照.结果 100例患者中钼靶X线诊断为乳腺癌40例,良性病变60例.术后病理证实乳腺癌46例,良性病变54例.钼靶X线诊断正确率为87%.结论 乳腺钼靶X线检查是诊断和鉴别乳腺良恶性肿瘤首选有效的影像学方法.     

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。     

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。     

多模态“第二眼”超声联合全数字乳腺X线摄影对额外可疑高危病灶的再评价

探讨多模式“第二眼”超声联合全数字化乳腺X线（FFDM）对额外可疑高危病灶的再评价价值。选取2022年5月至2023年7月在我院行FFDM筛查检出的有可疑高危病灶患者80例,所有患者给予“第二眼”超声检查,分析良恶性病灶超声、FFDM征象差异以及“第二眼”超声联合FFDM诊断良恶性病灶的价值。病理结果确诊恶性病灶68例,良性病灶12例。恶性病灶形态不规则、边界不清晰,有包膜,内部回声不均匀、有钙化,深度与宽度比>1,血流信号Ⅱ～Ⅲ级比例明显高于良性病灶（P<0.05）。恶性病灶FFDM征象：有钙化、结构扭曲和非对称致密影比例明显高于良性病灶（P<0.05）。“第二眼”超声联合FFDM诊断良恶性病灶结果与病理结果有较高的一致性,“第二眼”超声联合FFDM诊断恶性病灶的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为94.12%、100.00%、95.00%、100.00%和75.00%。“第二眼”超声联合FFDM在额外可疑高危病灶诊断中有较好应用价值,值得临床使用。     

钼靶X线和MRI对乳腺肿块良恶性诊断效能及术前评估研究

目的 探讨钼靶X线和MRI对乳腺肿块良恶性的诊断效能及术前评估。方法 回顾性选取2019年1月至2022年12月本院就诊的82例女性乳腺肿块患者作为研究对象。所有患者均行钼靶X线和MRI检查，以病理结果为金标准，评估乳腺肿块良恶性的诊断效能及术前评估。结果 总计患者82例，病灶94个；其中良性病变患者47例，病灶56个；恶性病变患者35例，病灶38个。钼靶X线检查诊断乳腺肿块良恶性的灵敏度、准确度、特异度为78.95%、82.98%、85.71%,Kappa值为0.598;MRI检查诊断乳腺肿块良恶性的灵敏度、准确度、特异度为87.50%、91.49%、94.44%,Kappa值为0.796，良性病灶时间信号曲线（TIC）类型主要是Ⅲ型，恶性病变TIC类型多为Ⅰ型或Ⅱ型；联合检查诊断乳腺肿块良恶性的灵敏度、准确度、特异度为97.37%、97.87%、98.21%,Kappa值为0.908。MRI、联合诊断的灵敏度、准确度、特异度均高于钼靶X线（P均<0.05），且联合检查曲线下面积明显大于钼靶X线、MRI检查（Z=6.568、5.1113,P均<0.05）。钼靶X线评估的肿...     

超声弹性成像对乳腺良恶性肿块的鉴别诊断价值

目的探讨超声弹性成像新评分标准(7分法)在诊断乳腺良、恶性病变的诊断价值及其最佳诊断界点。方法对手术病理结果证实的475个乳腺病灶的超声弹性成像图进行回顾性分析,用ROC曲线法探讨用7分法超声弹性成像评分标准的最佳诊断界点。结果7分法弹性成像评分标准对乳腺病灶的最佳诊断界点为5分,其ROC曲线下面积为0.959,其敏感性、特异性、准确性、阳性预测值、阴性预测值、Youden指数分别为:81.60%、99.14%、94.53%、97.14%、93.78%和0.81。结论7分法超声弹性成像评分标准使用简便,有助于鉴别乳腺良恶性肿块。     

DCE-MRI 在乳腺肿瘤保乳术中的应用价值

目的 分析并讨论DCE-MRI在乳腺肿瘤保乳术中的应用价值。方法 随机选取我院2021年 5月-2023年5月收治的70例乳腺肿瘤患者，所有患者均采取保乳术治疗。依据临床诊断方式差异将其分为 FFDM组与DCE-MRI组，FFDM组采取FFDM进行检查，DCE-MRI组采取DCE-MRI进行检查，在病理检测 结果的基础上比较两组乳腺肿瘤良恶鉴别率以及两种检查方式的临床灵敏度及特异度。结果 DCE-MRI组 良、恶性鉴别准确率高于FFDM组（P＜0.05）；DCE-MRI组临床灵敏度及特异度高于FFDM组（P＜0.05）。 结论 在乳腺肿瘤保乳术中采取DCE-MRI具有很高的诊断率、临床灵敏度及特异度，能够有效评估患者 的治疗效果，因此具有很高的临床应用价值。     

壶腹周围病所致梗阻性黄疸术前诊断的评价

目的 评价彩色多谱勒超声，CT，ERCP对壶腹周围病变所致梗阻性黄疸的诊断价值。方法 86例患者全部经彩色多谱勒超声检查，CT检查34例，ERCP检查24例。结果 彩超、CT、ERCP对胰头癌诊断的准确性分别为92．6％，88．2％和33．3％；对胆总末端及壶腹诊断的准确性分别为58．3％，66．7％和100％；对十二指肠乳头癌的准确性分别为62．5％，20％和100％；对良性病变所致狭窄诊断的准确性分别为27．3％50％和50％。结论 多数壶腹周围病变所致梗阻性黄疸患者，彩,,CT检查足以可以明确病因诊断；ERCP对胰头癌和胆道末端炎性狭窄所致梗阻性黄疸准确率不高，应根据超声、CT检查结果和治疗需要而选择。     

Systematic review of 3D mammography for breast cancer screening

This review investigated the relative performance of digital breast tomosynthesis (DBT) (alone or with full field digital mammography (FFDM) or synthetic digital mammography) compared with FFDM alone for detecting breast cancer lesions in asymptomatic women. A systematic review was carried out according to systematic reviewing principles provided in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A protocol was developed a priori. The review was registered with PROSPERO (number CRD42014013949). Searches were undertaken in October 2014. Following selection, five studies were eligible. Higher cancer detection rates were observed when comparing DBT + FFDM with FFDM in two European studies: the summary difference per 1000 screens was 2.43 (95% CI: 1.8 to 3.1). Both European studies found lower false positive rates for individual readers. One found a lower recall rate based on conditional recall. The second study was not designed to compare post-arbitration recall rates between FFDM and DBT + FFDM. One European study presented data on interval cancer rates; sensitivity and specificity for DBT + FFDM were both higher compared to FFDM. One large multicentre US study showed a higher cancer detection rate for DBT + FFDM, while two smaller US studies did not find statistically significant differences. Reductions in recall and false positive rates were observed in the US studies in favour of DBT + FFDM. In comparison to FFDM, DBT, as an adjunct to FFDM, has a higher cancer detection rate, increasing the effectiveness of breast cancer screening. Additional benefits of DBT may also include reduced recalls and, consequently, reduced costs and distress caused to women who would have been recalled.     

Ultrasound-guided, vacuum-assisted excision in the diagnosis and treatment of clinically benign breast lesions

INTRODUCTION

Ultrasound-guided, vacuum-assisted biopsy has a definitive role in the diagnosis of breast lesions. Its role in the treatment of benign breast lesions like fibroadenomas has not been established.

PATIENTS AND METHODS

This is a retrospective review of patients undergoing ultrasound-guided, vacuum-assisted biopsy for clinically benign breast lesions. The procedures were performed in all cases by two consultant radiologists with special interest in breast radiology between February 2002 and January 2004. Patients were followed up in the clinic 6 weeks after the procedure.

RESULTS

Seventy-six patients had ultrasound-guided, vacuum-assisted excision of clinically benign breast lesions during this 2-year period. Mean age of the patients was 31 years. Altogether, 86 procedures were performed. Six patients with larger lesions (> 2 cm) had two procedures on separate sitting and 4 patients had separate lesions excised on a later date. Fifty-six patients were identified to have fibroadenomas and had complete excisions as evidenced on scan. Three out of nine patients identified with equivocal disease on fine needle aspiration cytology (FNAC) were found to have cancer following ultrasound-guided, vacuum-assisted excision. One patient who was diagnosed with cancer on FNAC, proved to be fibroadenoma on final histopathology. Four patients developed haematomas following ultrasound-guided, vacuum-assisted excision and all were managed conservatively.

CONCLUSIONS

Our study shows that ultrasound-guided, vacuum-assisted excision can play an efficient role in the diagnosis of benign breast lesions and is a safe and successful alternative in treatment of fibroadenomas.     

Benign breast diseases associated with cyclosporine therapy in renal transplant recipients

PURPOSE: Our aim was to correlate the radiologic characteristics of cyclosporine-induced benign breast diseases with clinical and pathologic findings. MATERIALS AND METHODS: The clinical, mammographic, and ultrasonographic records of 33 female renal transplant recipients who received cyclosporine were retrospectively reviewed. Eleven patients had 46 breast masses on ultrasonography. We performed core needle biopsies on 20 masses and reviewed the pathologic findings. RESULTS: Among 33 female renal transplant recipients, 11 (33%) had 46 benign breast lesions detected on ultrasonography. We performed core needle biopsies on 20 of the 46 masses. On pathologic examination, 12 were fibroadenomas, 6 showed fibrocystic changes, and 2 revealed dense fibrosis. Regardless of the final pathologic diagnosis, more than half of the lesions revealed severe lymphatic and venular swellings. Among 11 patients with breast lesions on ultrasonography, 10/11 (91%) showed multiplicity, and 7/11 (64%) bilaterality. Mammographically, patients with breast lesions revealed heterogeneous or extremely dense breast patterns, and 8 of 11 patients, circumscribed masses. Twenty-two patients without breast lesions showed scattered fibroglandular densities (n = 7), or heterogeneously dense (n = 11) or extremely dense (n = 4) breast patterns, and 3 of 22 patients showed vague or asymmetric densities that needed further evaluation. CONCLUSION: The development of new breast lesions in patients after renal transplantation should suggest a diagnosis of cyclosporine-induced benign breast disease including fibroadenoma, fibrocystic changes, and dense fibrosis.     

超声评分对乳腺良、恶性结节的诊断价值

目的探讨超声评分对乳腺结节的诊断价值。方法对乳腺良、恶性结节进行超声评分,并与术后病理结果对比分析。结果良性乳腺结节的二维评分及总评分与恶性乳腺结节相比差异有统计学意义（P〈0.01）,恶性结节超声评分高于良性结节（P〈0.01）;根据ROC曲线和Youden指数,可将超声评分≥11分作为二维超声诊断恶性占位的临界点,超声评分≥12分作为总评分诊断恶性占位的临界点。结论通过对乳腺占位的超声评分有助于提高乳腺良、恶性结节超声诊断的准确率。     

超声引导下乳腺癌细针穿刺标本中癌胚抗原和雌激素受体检测的临床意义

目的 探讨癌胚抗原（carcinoembryonic antigen,CEA)和雌激素受体（estrogen receptor,ER)的检测在乳腺癌早期、晚期辅助诊断中的临床意义。方法 采用放射免疫技术检测118例乳腺细针穿刺标本（69例乳腺癌，49例乳腺良性病变）中的CEA。并用免疫组化技术检测69例乳腺癌穿刺标本及相应组织切片的ER表达。结果 乳腺癌与乳腺良性病变组织中的CEA活性差异有显著意义（P＜0.01)，前者明显升高。乳腺癌细针穿刺标本和组织切片中ER表达有极显著的一致性（P＜0.01)，两者一致率为90％。结论 细针穿刺取材检测其CEA水平和ER表达，有助于早、晚期乳腺癌的诊断和制定合理的治疗方案。     

Clinical significance of 99mTc-MIBI breast imaging in the diagnosis of early breast cancer

OBJECTIVE: To find an effective, sensitive, specific and noninvasive diagnostic method for cancer. METHODS: 109 masses from 102 patients with breast lesions smaller than 2 cm in diameter were divided into three groups to undergo 99mtechnetium-methoxyisobutylisonitrile (99mTc-MIBI) imaging. The results were compared with their pathology. Twenty cases without breast lesions were selected as a control group. Abnormal density of 99mTc-MIBI in the breast and a threshold level 10% higher than that in the counterpart of the healthy breast was regarded as positive. RESULTS: Of 32 breast cancers, positive imaging appeared in 25. Negative imaging was found in 31 of 38 benign breast lesions. Of 39 nonpalpable breast lesions, five cases were breast cancers and 34 cases benign. Positive MIBI imaging appeared in all of the breast cancers, while in the benign lesions, four were positive and 30 negative. No positive imaging was found in the control group. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 99mTc-MIBI were 88.4%, 89.2%, 88.0%, 75.0% and 95.3%, respectively.CONCLUSIONS: 99mTc-MIBI imaging had high sensitivity and accuracy in the diagnosis of breast cancer, as well as in the differentiation between benign and malignant breast lesions. It could provide reliable information in confirming the diagnosis in patients with clinically suspected breast cancer.     

乳腺不典型病灶超声引导下粗针活检的价值

目的评价超声引导下粗针活检术（US-CNB）对不典型乳腺病变的诊断意义。方法对女性患者的61个不典型病灶行US-CNB和手术切除活检,以切除活检病理结果为诊断标准。结果在US-CNB标本中,33个为良性,15个为可疑恶性,10个为恶性,3处取材不当。在手术切除标本中,26个病灶为恶性,32个为良性,US-CNB取材不当的3个均为良性。超声引导下粗针活检术诊断恶性肿瘤的诊断阳性率为96.15%（25/26）,特异性为100%（32/32）,正确率为98.28%（57/58）。结论US-CNB诊断不典型病灶安全、创伤小、准确率高。