MR动态增强扫描结合T2WI首过灌注成像诊断乳腺肿瘤的价值

目的评价乳腺MR T1WI动态增强扫描结合T2＊WI首过灌注成像对乳腺良恶性肿瘤的鉴别诊断价值。材料与方法对39例乳腺良、恶性肿瘤均行T2＊WI首过灌注成像及T1WI动态增强扫描,计算T2＊WI首过灌注成像的最大信号强度下降率及动态增强扫描的早期强化率,绘制T2＊WI首过灌注TIC及动态增强TIC。结果乳腺良恶性肿瘤的T2＊WI首过灌注最大信号强度下降率的差异有统计学意义,以最大信号强度下降率20%作为诊断恶性肿瘤的阈值,敏感度为91.7%,特异度为93.3%,准确度为92.3%。乳腺良恶性肿瘤T1WI动态增强早期强化率的差异无统计学意义,但动态增强曲线类型差异有统计学意义,以流出型作为诊断恶性的标准,诊断的敏感度为62.5%,特异度为93.3%,准确度为74.4%。T1WI动态增强TIC表现为平台型（Ⅱ型）的乳腺肿瘤,其T2＊WI灌注TIC类型的差异有统计学意义。结论 T1WI 动态增强扫描结合T2＊WI首过灌注成像有助于乳腺良恶性肿瘤的鉴别诊断,T2＊WI首过灌注成像能提高动态增强Ⅱ型曲线病灶定性诊断的准确率。     

乳腺动态增强MRI参数与肿瘤血管的相关性及其鉴别诊断价值

目的探讨乳腺动态增强（DCE）MRI的各项参数：时间-信号强度曲线（TIC）、早期增强率（EER）、最大线性斜率（slope）、最大强化率（Slmax）、达峰时间（Tpeak）、MIP图血管计数（NTV）与微血管密度（MVD）、血管内皮生长因子（VEGF）之间的相关性及其对乳腺良、恶性病变的鉴别价值。方法对52例确定一周内手术治疗的乳腺疾病患者行术前DCE-MRI扫描,记录上述参数。对切除病变行常规病理和免疫组化检查,观察边缘MVD（mMVD）、中心MVD（cMVD）和VEGF的表达。将DCE-MRI各项参数与免疫组化结果进行相关性分析。结果乳腺病变的mMVD、VEGF表达与TIC类型、Tpeak、及NTV育相关性;其中TIC类型与mMVD关系最为密切,Tpeak与VEGF之间的关系最密切;cMVD与各参数间无明显线性关系。52例患者中乳腺癌22例,良性病变30例。恶性病变的TIC呈Ⅲ或Ⅱ型,EER、NTV和DMVD、VEGF的表达明显高于良性病变,而Tpeak及SImax显著低于良性病变（P〈0．005）。Slope在良、恶性病变中无显著性差异。结论乳腺DCE—MRI多项参数中,TIC类型、NTV、Tpeak与MVD和VEGF有相关性,反映了良、恶性病变的血管生长差异,具有很大的鉴别诊断价值。     

血管内皮生长因子在乳腺浸润性导管癌中的表达及意义

目的 检测乳腺浸润性导管癌中血管内皮生长因子（VEGF）的表达水平及肿瘤微血管密度（MVD）值，探讨VEGF、MVD水平及与临床病理学特征之间的相关性。方法 采用免疫组化染色法（SP法）分别检测88例乳腺癌患者术后标本中VEGF的表达水平、MVD值以及C-erbB-2表达情况。结果 88例标本中VEGF阳性62例，阳性率为70．45％；淋巴结转移组中VEGF表达水平高于未转移组（P〈0．05）；相对中晚期组（Ⅱb-Ⅲ）中VEGF表达水平高于相对早期组（Ⅰ-Ⅱa）（P〈0．05）；C-erbB-2阳性组中VEGF表达水平高于阴性组（P〈0．05）；随着癌组织学分级的升高，VEGF表达水平也有逐渐升高趋势（P〈0，05）。随着癌组织学分级的升高，MVD值也呈现出逐渐增高趋势（P〈0．01）；MVD值随着VEGF表达水平增高而增高（P〈0．01）。结论 VEGF在乳腺浸润性导管癌的肿瘤血管生成及转移过程中可能发挥重要的调控作用。VEGF和MVD值可作为反映乳腺癌生物学行为的指标之一。以VEGF为靶点的抗血管生成治疗策略有望成为治疗C-erbB-2阳性患者的一条新的途径。     

超声造影微血管成像评估乳腺肿瘤血管形态及分布特征

目的探讨超声造影微血管成像在鉴别乳腺肿瘤良、恶性中的临床应用价值。方法对61例乳腺肿瘤患者行超声造影微血管成像检查，评价乳腺肿瘤血管的形态及分布特征，并与病理结果进行对照。利用ROC曲线评估其诊断价值。结果超声造影微血管成像显示乳腺良恶性肿瘤内部及周边血管的分布、形态特征差异有统计学意义（P〈0．05）。以乳腺肿瘤内微血管的分布情况为诊断乳腺肿瘤良恶性的标准，具有较高的敏感性（93．8％），ROC曲线下面积为0．836，诊断价值中等。而通过病灶周围血管情况鉴别则具有较高的特异性（96．6％），ROC曲线下面积为0．913，诊断价值较高。以病灶血管形态及分布整体特征为标准，具有较高的准确性（91．8％），ROC曲线下面积最大为0．961，诊断价值高。结论超声造影微血管成像技术可以评估乳腺肿瘤微血管的灌注情况、肿块内部及周边血管形态及分布特征，显著提高对乳腺肿瘤良恶性的鉴别诊断能力。     

二维与三维能量多普勒血流成像评价乳腺肿瘤血管的比较

目的探讨三维能量多普勒血流成像评价乳腺肿瘤血管的应用价值。方法对手术病理证实的213个乳腺病灶进行二维及三维能量多普勒血流成像检查，记录各自声像图表现。结果同一病灶的二维及三维能量多普勒血流成像血流分级差异有统计学意义（P〈0．05），良恶性病灶的三维能量多普勒血流成像血流分级差异有统计学意义（P〈0．01）。结论三维能量多普勒血流成像能更好的评价乳腺肿瘤血管，有助于乳腺肿瘤良恶性的鉴别。     

磁共振邻近血管征对乳腺良恶性肿瘤的鉴别诊断价值

目的：分析63个乳腺肿瘤的磁共振表现,探讨病灶邻近血管征（AVS）在乳腺良恶性肿瘤鉴别诊断中的价值。材料与方法：回顾性分析经病理证实的60例63个乳腺肿瘤的MR动态增强图像,在工作站获得剪影图像及3DMIP图像,分析病灶邻近血管征与病灶良恶性、病灶大小的关系。结果：血管征在恶性肿瘤出现率（55％）明显高于良性肿瘤出现率（26．09％）,差异有统计学意义（χ2=4．944,P〈0．05）。病灶平均直径与血管征有关,病灶直径〉2cm的出现率（65．52％）明显高于直径≤2cm的出现率（26．47％）,差异具有统计学意义（χ2=9．664,P〈0．05）。血管征分3型,单支血管型17例,其中恶性12例,良性5例;多支血管型7例,其中恶性6例,良性1例;血管扩张型4例,均为恶性。血管征诊断乳腺癌的敏感性为55．0％,特异性73．91％,阳性预测值78．57％,准确度61．90％。结论：血管征在鉴别诊断中有较高价值,表现为多支血管及扩张血管征时高度提示恶性;血管征可以作为乳腺癌多因子评估的有力补充。     

VEGF、PCNA、MVD、flk-1在(人脑显形细胞瘤)中的表达及临床意义

目的 研究血管内皮细胞生长因子（vascular endothelial growth factor，VEGF）及其受体flk-1（fetal liver kinase-1）在人脑显形细胞瘤中的表达与肿瘤增殖及血管再生的相互关系。方法 应用免疫组化技术和形态定量分析法，检测69例手术切除脑胶质瘤中VEGF表达、PCNA标记指数（PCNAta）、微血管密度（Mierovessel density，MVD）及部分病例flk-1表达。结果（1）肿瘤细胞及血管内皮细胞均可以表达VEGF及flk-1，阳性颗粒分布于肿瘤胞浆中。（2）高级别肿瘤PCNALI、MVD显著高于低级别肿瘤（P〈0．05）；VEGF表达阳性肿瘤的PCNALI、MVD显著高于VEGF表达阴性肿瘤（P〈0．05）；（3）VEGF与其受体flk-1在肿瘤细胞中表达呈正相关；肿瘤组织VEGF及其受体flk-1表达与肿瘤的恶性程度呈正相关；（4）在星形细胞肿瘤中，随着MVD的增大，VEGF及flk-1在肿瘤血管内皮的染色率逐渐增加，分别与肿瘤的MVD存在正相关关系（r分别为0．40，0．44，P〈0．01）。结论 人脑显形细胞瘤可以合成VEGF，VEGF在肿瘤细胞增殖及血管再生过程中起重要作用。     

VEGF与膀胱尿路上皮癌微血管密度及预后的相关性研究

目的探讨血管内皮生长因子（vascular endothelial growth factor,VEGF）表达与膀胱尿路上皮癌微血管密度（microvessel density,MVD）及预后的关系。方法采用免疫组化的方法对50例原发性膀胱尿路上皮癌组织中VEGF进行染色,记数肿瘤内MVD,并观察VEGF的表达同MVD的关系。结果膀胱尿路上皮癌VEGF阳性表达率为62％（31／50）,在正常膀胱黏膜组织中未见表达。VEGF阳性表达组MVD显著高于阴性表达组（P〈0．05）。VEGF表达与肿瘤的分级分期明显相关（P〈0．05）,提示VEGF阳性表达者的预后较阴性者差。结论VEGF的异常表达是膀胱癌微血管形成能力增高的重要因素。VEGF表达与膀胱癌MVD增加及恶性进程和不良预后有关,是判断膀胱癌预后有价值的指标。     

MR T2W与T1W灌注对良恶性肌骨病变鉴别诊断的价值

目的对比MRT2W与T1W灌注对良恶性肌骨病变鉴别诊断的效果，评价MRT2W灌注的临床应用价值。方法94例良恶性肌骨病变先后进行MRT1、T2W灌注，分别记录灌注曲线的形态、造影剂首过（FP）期信号最大增／降幅、信号强度一时间（SI-T）曲线最大斜率和造影剂首过时间。将两种灌注的曲线各分4型，并分别对良、恶性病灶SI-T曲线的形态、FP期信号增／降幅、SI-T曲线最大斜率和首过时间进行统计学比较；采用ROC曲线法确定恶性诊断的阈值，并计算其敏感性、特异性和准确率。观察两种灌注方法显示的最高灌注区一致性程度。结果（1）T，w：Ⅰ型和Ⅳ型SI-T曲线在良恶性病变FP期信号最大降幅和SI-T曲线最大斜率及首过时间无统计学差异（P〉0．05）。（2）T1W：Ⅰ型SI-T曲线多见于恶性病灶，Ⅲ型、Ⅳ型SI-T曲线多见于良性病灶；良性病变的FP期信号增幅均值为29．20％，恶性病变均值为73．92％（P〈0.001）；良性病变的SI-T曲线最大斜率均值为3，49，恶性病变均值为9.57（P〈0．001）。（3）ROC曲线分析发现，当以首过增幅44．50％作为诊断恶性的界值时，其敏感性为98.50％，特异性为86．70％，准确率为88．30％；当以SI-T曲线最大斜率5．09作为恶性的界值时，诊断敏感性为96．20％，特异性为85，60％，准确率为86．17％。两种研究方法显示最高灌注区位于同一区域的14例（14．90％），不同区域的80例（85．10％）。结论T2W灌注扫描在鉴别良恶性肌骨病变中的价值不如T1W灌注。MRT1W和T2w灌注扫描FP期信号变化可能是Gd-DTPA在血管内和血管外间隙共同作用的结果。     

3．0T磁共振动态增强曲线与早期强化率对乳腺病变良恶性的鉴别诊断价值

目的探讨3．0T磁共振动态增强曲线类型与早期强化率对乳腺病变良恶性的鉴别诊断价值。方法对40例乳腺病变患者（均经病理证实）的MRI平扫及动态增强扫描影像学资料进行回顾分析。观察分析病变增强后血流动力学特点,包括时间一信号强度曲线（TIC）及96s、144S早期强化率。结果对乳腺病变良恶性的诊断：时间信号强度曲线的灵敏度为0．842,特异度为0．762,AUC值（ROC工作曲线下面积）为0．8083;96S早期强化率（％）的灵敏度为0．526,特异度为0．857,舯C值为0．7193;144S早期强化率（％）的灵敏度为0．737,特异度为0．857,AUC值为0．8534。结论在诊断乳腺病变的良恶性方面,96S、144s早期强化率与时间一信号强度曲线类型三者相比：96S、144S早期强化率的特异度较高;时间一信号强度曲线类型的灵敏度较高;144S早期强化率的AUC最大,即144S早期强化率的诊断价值最佳。     

Spectrum of sonographic findings in superficial breast masses.

OBJECTIVE: The purpose of this presentation is to show the sonographic findings of breast masses, which can occur in subcutaneous fat or in the cutaneous layer of the breast. METHODS: We reviewed the sonographic findings of superficial breast masses, including the epidermal inclusion cyst, steatocystoma multiplex, fat necrosis, accessory breast, Mondor disease, sparganosis, neurofibroma, tuberculosis, mastitis, and breast malignancy. RESULTS: Specific sonographic features of superficial breast masses have been illustrated. CONCLUSIONS: Radiologists must be familiar with the sonographic findings of various diseases involving the superficial layer of the breast to avoid further patient workup.     

Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast.

OBJECTIVE: To evaluate the value of combined negative sonographic and mammographic findings in patients with palpable breast abnormalities. METHODS: One hundred seventy-two patients with 186 palpable abnormalities who had combined negative sonographic and mammographic findings were prospectively studied. Patients who did not undergo biopsy had imaging and clinical follow-up; the mean follow-up period was 28.9 months (range, 24-33 months). RESULTS: Twelve patients underwent biopsy; benign histologic diagnoses were reported in all 12 (12 [6.9%] of 172). In the remaining 160 patients who were followed, there was no interval development of breast cancer at the site of the palpable abnormality. The negative predictive value of combined negative mammographic and sonographic findings in a patient with a palpable abnormality of the breast was 100%. CONCLUSIONS: Our findings suggest that in a patient with a palpable abnormality of the breast, the negative predictive value of combined normal sonographic and mammographic findings is very high and is therefore reassuring to the patient.     

乳腺癌患者不同乳房重建术后乳房感觉恢复情况研究进展

随着外科手术技术的进步、患者对生存质量要求的不断提高,乳腺癌外科治疗的目标从最初的根除肿瘤、解除病痛发展为修复局部缺损、还原乳房外形,并进一步发展至目前美学与功能学并重的乳房重建。作为功能学的重要组成部分,乳房感觉对乳腺癌患者术后生活质量的影响不容忽视。乳房重建术后乳房感觉的恢复已成为乳腺癌外科治疗的重要目标之一。本文就乳腺癌患者不同乳房重建术后乳房感觉恢复情况的研究进展作一综述。     

Breast hemangiomas: Correlation between imaging and pathologic findings

Hemangiomas are benign vascular tumors that are rare in the breast. A high percentage of hemangiomas are diagnosed incidentally during imaging examinations. They have mammographic, sonographic, and pathologic characteristics that allow radiologists and pathologists to diagnose them. We present four different cases of breast hemangiomas showing their mammographic and sonographic features. Two were diagnosed with an 18‐gauge core needle biopsy and they underwent surgical excision. The other two cases were diagnosed with a 14‐gauge core needle biopsy and their radiologic and pathologic appearances were concordant with breast hemangiomas, so they did not need surgical excision and are being followed. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:512–517, 2012     

Galactoceles mimicking suspicious solid masses on sonography.

OBJECTIVE: The purpose of this study was to evaluate the sonographic appearance of a galactocele that can sonographically mimic a suspicious solid mass and to differentiate between a galactocele and a solid mass. METHODS: From September 2002 to February 2004, 33 galactoceles classified as Breast Imaging Reporting and Data System category 4 were included. They were all confirmed by sonographically guided core biopsies. Their sonographic imaging and clinical findings were reviewed retrospectively. RESULTS: The lesions had a round or irregular shape in 26 patients (78.8%), a noncircumscribed margin in 31 (93.9%), a nonparallel orientation in 22 (66%), and posterior shadowing in 13 (39.4%). Twenty-five nodules (75.8%) had internal hypoechogenicity or mixed echogenicity. Twenty-nine (87.9%) of 33 lesions showed a relatively sharp convex echogenic rim on the anterior or posterior wall. CONCLUSIONS: Galactoceles have various sonographic findings, many of which are similar to those of suspicious solid breast masses. However, there is a tendency for a galactocele to appear as a small, round hypoechoic nodule with an indistinct or microlobulated margin and mild posterior shadowing. It is helpful to search for a partial anterior or posterior echogenic rim to identify a galactocele.     

Characterization of Breast Masses With Sonography

OBJECTIVE: To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred. METHODS: We prospectively characterized 844 sonographically visible solid breast masses referred for biopsy. Mammographic and sonographic features of the masses were recorded, and all masses were categorized by American College of Radiology Breast Imaging Reporting and Data System classification before biopsy. Of the 844 masses, 148 were categorized as probably benign (Breast Imaging Reporting and Data System category 3). Sonographically guided biopsy (n = 804) or fine-needle aspiration (n = 40) was performed for pathologic correlation. RESULTS: Of the 148 masses that met the sonographic criteria for probably benign masses, there was 1 malignancy, for a negative predictive value of 99.3%. CONCLUSIONS: Follow-up can be an acceptable alternative to biopsy for sonographically probably benign solid masses.     

Preferential use of sonographically guided biopsy to minimize patient discomfort and procedure time in a percutaneous image-guided breast biopsy program.

OBJECTIVE: To determine whether preferential use of sonographic guidance for percutaneous biopsy of breast masses results in a subset of patients with a shorter procedure time and less discomfort compared with patients undergoing stereotactic biopsy. METHODS: A prospective observational study was performed on 193 women undergoing percutaneous image-guided breast biopsy between 1997 and 1999. Data were collected on room time, physician time, and patient comfort levels for 122 stereotactic and 71 sonographically guided biopsies. Differences between stereotactic and sonographically guided biopsy for all lesions and for masses were analyzed for statistical significance. RESULTS: Mean room times were 62.2 minutes for stereotactic biopsy and 39.4 minutes for sonographically guided biopsy (P < .0001). Mean physician times were 23.0 minutes for stereotactic biopsy and 15.8 minutes for sonographically guided biopsy (P < .0001). When we limited our analyses to women undergoing biopsy for masses, the difference in physician time largely disappeared, but the difference in room time remained (P < .0001). Women undergoing stereotactic biopsy were more likely to report discomfort due to body positioning than were women undergoing sonographically guided biopsy (P < .001). These differences existed whether we included all lesions or restricted our analyses to masses. CONCLUSIONS: Preferential use of sonographically guided breast biopsy for masses results in shorter procedure times and less patient discomfort compared with prone stereotactic biopsy.     

Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings.

OBJECTIVE: To evaluate the mammographic and sonographic findings of pregnancy-associated breast cancer. METHODS: A total of 22 consecutive patients with breast cancer pathologically diagnosed during pregnancy (n = 10) or lactation (n = 12) were included in this study. The ages of the patients ranged from 26 to 49 years. Both mammography and sonography were performed on 12 patients; sonography only was performed on 7 patients; and mammography only was performed on 3 patients. Mammographic and sonographic findings were evaluated retrospectively. RESULTS: Mammography revealed positive findings in 13 (86.7%) of 15 patients, even though all 15 patients had dense breasts. Mammographic findings included masses (n = 5), masses with calcifications (n = 2), calcifications with axillary lymphadenopathy (n = 2), a mass with axillary lymphadenopathy (n = 1), calcifications alone (n = 1), asymmetric density alone (n = 1), and diffuse skin and trabecular thickening alone (n = 1). Sonographic findings were positive and showed masses for all 19 patients (100%). The common sonographic findings of masses were irregular shapes (n = 15), irregular margins (n = 16), parallel orientation (n = 11), complex echo patterns (n = 14, including marked cystic [anechoic] components [n = 4]), and posterior acoustic enhancement (n = 12). Surrounding tissue effects could be seen in 5 patients, including ductal changes (n = 2), Cooper ligament thickening (n = 1), edema (n = 3), and skin thickening (n = 3). Calcifications within or outside a mass (n = 7) and axillary lymphadenopathy (n = 8) were also detected. CONCLUSIONS: Although a mass could not be discernible by mammography because of increased radiodensity during pregnancy or lactation, calcification, asymmetric density, axillary lymphadenopathy, and skin and trabecular thickening were helpful for diagnosis of pregnancy-associated breast cancer. Sonographic findings of a solid mass with posterior acoustic enhancement and a marked cystic component were somewhat different from the appearance of breast cancer in nonpregnant women, possibly because of the physiologic changes of pregnancy and lactation.     

A Systematic Review of Phantom Breast Pain/Sensation in Breast Cancer Patients Postmastectomy

ObjectiveTo identify the prevalence/incidence of, associations with, and treatments for phantom breast pain/sensation in breast cancer patients after mastectomy as reported in the literature within the past decade.Data SourcesPubMed, CINAHL, Embase, and Scopus databases.Study SelectionEligible articles met the following criteria: (a) English language full-text article, (b) published in the past 10 years (2012–2022), (c) peer-reviewed quantitative and qualitative study designs, and (d) specifically assessed for the presence of or factors related to phantom breast pain/sensation in the context of breast cancer treatment in humans. Eighteen studies were found to be eligible.Data ExtractionData extracted included citation; study country of origin; study design; study focus; number of participants; age range and mean age of participants; percentage of participants who reported phantom breast pain/sensation; and other findings about phantom breast pain/sensation, including relevant effect sizes. Gender identity, racial and ethnic identity, and sexual orientation were also noted.Data SynthesisThe following were obtained from the data: (a) phantom breast pain/sensation has been investigated in numerous countries worldwide in the past decade; (b) most studies lacked information on certain identity characteristics (e.g., race and ethnicity); (c) diversity of methodology and quality and risk of bias varied among the studies; (d) prevalence/incidence rates vary among studies and over time, but the more recent literature suggests that rates of the phenomenon are 0% to 19% in women; (e) a number of significant associations have been identified with the experience of the phenomenon; (f) most women have reported that pain or discomfort with the phenomenon are minimal; and (g) there has been limited research on potential treatment options.ConclusionThe recent literature suggests that a small percentage of individuals postmastectomy may experience phantom breast pain/sensation. This condition can be bothersome to some patients, and further research is necessary.