超声联合钼靶X线诊断乳腺小结节病灶

目的 探讨超声联合钼靶X线对乳腺小结节病灶诊断价值.方法 回顾性分析83例女性患者微创手术切除的145个乳腺小结节病灶超声及钼靶X线检查的影像学特征,并与术后病理对比.结果 83例145个小结节病灶:增生结节125个、纤维腺瘤12个、乳头状瘤2个、黏液囊肿1个、乳腺癌5个(1例多发).超声清晰显示145个病灶,而钼靶X线只显示41个病灶;有51例患者钼靶X线可显示乳腺腺体钙化灶,其中12例(包括1例乳腺癌)呈沙砾样,3例乳腺癌超声可见钙化灶.结论 超声联合钼靶X线可提高乳腺小结节病灶的检出率及诊断准确率.     

对比增强能谱乳腺X线摄影的诊断价值分析

目的:探讨分析对比增强能谱乳腺X线摄影(contrast-enhanced spectral mammography,CESM)在乳腺病灶的检出及鉴别良恶性方面的应用。方法:前瞻性纳入临床怀疑或超声发现乳腺病变后进一步行CESM检查的患者,最终151例患者(157个病灶)纳入本次研究。阅读并评价低能图、CESM及磁共振成像(magnetic resonance imaging,MRI)表现,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析低能图、CESM及MRI的诊断效能,用Z检验比较曲线下面积(area under curve,AUC),计算灵敏度、特异度及准确率。根据患侧乳腺密度分为致密型乳腺、非致密型乳腺,作亚分组分析。结果:低能图在128例患者中检出134个病灶,其中浸润性癌39个,非浸润性癌3个,和92个良性病变。CESM在148例患者中检出154个病灶,其中44个恶性病灶,110个良性病变。CESM与低能图的AUC分别为0.97、0.89(P0.05)。致密型乳腺组CESM与低能图AUC分别为0.97、0.87(P0.05)。53例完成MRI检查的患者中,低能图、CESM及MRI三者的AUC分别为0.90、0.97、0.98(P0.05)。结论:CESM在病灶检出及诊断准确率上优于低能图,与MRI之间差异不显著,CESM在致密型乳腺中有更好的表现。     

乳腺钙化与乳腺癌的关系(三)

1乳腺钙化与乳腺想的诊断目前早期乳腺癌的诊断，尤其临床触诊不可能诊断0期癌，主要依靠X线乳腺照片诊断。X线乳腺片主要的阳性发现为腺体内砂粒样钙化。近期许多文献哟报道：切取乳腺钙化区组织行病理检查可早期发现乳腺癌。是否乳腺组织内钙化一定发生在乳腺癌内，文献报道及我们的材料均说明乳腺组织内钙化不仅在乳腺癌内发生，也在一些乳腺良性病内发生。根据我们自己的资料及文献「‘－”的复习，把乳腺钙化与乳腺癌关系讲述如下。近年来，我们对450例乳腺疾病的患者行X线乳腺照片，并行乳腺可疑肿物部位切除，从乳腺X线及病理切片…     

提高乳腺X线摄影对致密型腺体乳腺癌检出率的方法探讨

乳腺X线检查在乳腺癌的筛查及早期诊断中具有重要价值。但对于致密型乳腺,乳腺X线检查假阴性率高,早期检出病灶困难,易延误患者的最佳诊疗时机,影响患者预后。本文旨在从提高乳腺X线摄片的质量、BI-RADS分类的应用、辅助手段检查的应用等方面,对提高乳腺X线摄影对致密型腺体乳腺癌检出率的方法进行综述。     

钼靶X线下定位切除活检术对乳腺触诊阴性病灶的诊治价值

随着当代肿瘤学对乳腺癌认识的提高及乳腺高清晰度摄影技术（乳腺钼靶照相）的广泛应用，使更多的乳腺触诊阴性病灶被检出，使T0期乳腺癌的诊断成为可能。同时也使更多的乳腺癌前病变得到明确诊断和治疗。北京市通州区妇幼保健院自2002年1月至2006年7月应用乳腺钼靶摄影技术检测乳腺疾病6990例。其中发现乳腺临床触诊阴性的乳腺亚临床病灶65例，并对该65例患者行钼靶X线照相下细针定位切除和病理活检。该项技术大大提高了乳腺亚临床期病灶的检出率，使更多触诊阴性的早期乳腺癌得到明确诊断，同时也使更多乳腺癌的癌前病变得到诊断和治疗。     

全数字化乳腺X线摄影在乳腺癌诊断中的作用

目的分析经手术病理证实的乳腺病变在全数字化乳腺摄影（FFDM）中的影像学表现,提高X线在乳腺癌诊断中的准确性。方法搜集2008年1月-2010年10月313例行FFDM检查、手术和病理证实的乳腺病变患者的临床资料及乳腺X线片,由放射科医师对患者的X线片观察并分析,参照乳腺影像学报告和数据系统（BI-RADS）进行分级,以术后病理结果为金标准,评价FFDM检查诊断乳腺癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值,并分析误诊和漏诊的原因。结果病理结果显示,313例乳腺标本中,乳腺癌194例,乳腺良性病变119例。在乳腺恶性病变中,X线主要表现为单纯肿块型83例,钙化型95例,结构扭曲6例,不对称致密影8例,乳腺内弥漫性腺体结构模糊2例。X线诊断假阳性18例,假阴性20例。FFDM检查对乳腺癌诊断的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别约89.2%、84.9%、87.7%、90.6%、82.8%。误诊的主要原因是肿块的边缘形态、微小钙化等类似于恶性;漏诊的主要原因是乳腺腺体致密、不对称致密影及微小结构扭曲。结论数字化乳腺X线摄影在乳腺癌诊断中具有较高的价值。     

增强乳腺能谱摄影与常规乳腺X线摄影对乳腺良恶性疾病的诊断价值比较

目的探讨比较常规乳腺X线摄影(MG)与对比增强乳腺能谱摄影(CESM)对乳腺良恶性疾病的诊断价值。方法对2018年5月~2020年4月同时完成CESM和MG检查并最终获得病理诊断的74例患者纳入研究，均为女性，年龄22~56岁(41.02±8.24岁)。采用Stenographe Essential全数字化乳腺机，经由上肢静脉注射碘对比剂后采用头尾位(CC位)和内外斜位(MLO位)，一次压迫高低能曝光，得到低能图像和经过特定算法处理的高能减去低能的减影图像，由3名放射科乳腺专业医师对所得图像进行质量分析并做出影像学诊断，以病理为标准，比较CESM与MG对乳腺良恶性疾病诊断差异，并进一步对比两种方法诊断为同一肿瘤分级的诊断符合率差异，分析比较两种方法的诊断效。结果共40例乳腺恶性肿瘤、42例良性病变。MG在诊断良恶性病变的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为77.50%、80.95%、79.48%、70.27%及79.07%，而CESM的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为100%、90.47%、90.90%、100%及95.12%(P < 0.05)。MG在诊断乳腺肿瘤分级3~5级中的诊断符合率分别为79.00%、66.70%、86.70%、85.70%及100%，CESM为100%、92.30%、87.50%、90%及100%(P < 0.05)。结论CESM诊断乳腺良恶性疾病优于MG，尤其是在诊断3级及4A级的肿瘤中。      

常规超声与MRI对乳腺X线摄影阴性乳腺癌诊断价值的对比研究

目的:比较常规超声与MRI对乳腺X线摄影阴性乳腺癌的诊断价值。方法:收集上海交通大学医学院附属新华医院乳腺X线摄影检查阴性,并接受常规超声及MRI检查的乳腺疾病患者257例共305个病灶,以术后病理为对照,回顾性分析常规超声与MRI检查对乳腺X线摄影阴性乳腺病灶的检出率及诊断价值。结果:常规超声和MRI对乳腺X线摄影阴性乳腺病灶的总检出率分别为97.38%和90.49%。MRI对导管内病灶的检出率高于常规超声(98.21%和75.00%,P0.05),两种方法对肿块型病灶的检出率无统计学差异(97.19%和93.98%,P0.05)。常规超声和MRI对乳腺X线摄影阴性乳腺癌诊断的灵敏度、特异度、准确率分别为85.37%、74.62%、76.07%,90.24%、58.71%、62.95%,常规超声对乳腺X线摄影阴性乳腺癌的诊断特异度和准确率高于MRI(P0.001)。常规超声和MRI诊断乳腺X线摄影阴性乳腺癌的受试者工作特征(receive operating characteristic,ROC)曲线下面积分别为0.800和0.745,无统计学差异(P0.05)。结论:常规超声和MRI对乳腺X线摄影阴性乳腺病灶均具有较高的检出率,其中MRI对导管内病灶的检出率优于常规超声,但常规超声与MRI对乳腺X线摄影阴性乳腺癌的诊断效能相仿,因此常规超声可作为乳腺X线摄影阴性患者的首选检查方法。     

多量腺体型及致密型乳腺癌的X线分析

目的 总结多量腺体型及致密型乳腺患者乳腺癌易漏诊的钼靶X线征象,提高这类乳腺癌术前诊断符合率.方法 回顾分析手术病理证实的40例多量腺体型或致密型乳腺乳腺癌患者的X线表现.结果 40例患者,钼靶片8例显示乳腺内肿块影;32例仅表现为非对称性改变,包括局限性致密6例、结构扭曲8例,两者伴随出现18例,其中有3例行导管造影后导管可见相应改变.结论 对多量腺体型及致密型乳腺的乳腺检查时尤其要注意对比同一投照位置的双侧乳腺,仔细观察非对称性改变,结合临床及其它检查有助于提高此类病患乳腺癌的诊断符合率.     

钼靶X线影像诊断乳腺疾病的临床分析

目的:研究钼靶X线影像诊断乳腺疾病的临床效果。方法:选取我院2018年9月至2019年9月期间入院接受治疗的乳腺疾病患者84例,对所有患者均进行钼靶X线影像诊断,判断其中的相应指标,对其鉴别诊断结果进行分析对比,并依照相应的信息评定结果来进行综合评定。结果:经诊断,患者中,发现乳腺癌18例(21.43%),其中12例为乳腺癌早期,乳腺良性疾病66例(78.57%),且经过手术治疗后,证实患者基本病情,均得到控制。结论:在临床影像科检测中,通过执行钼靶X线进行诊断检测,能够及时的定位疾病并病灶,并为后续治疗提供有效的临床依据,与此同时,对于患者的乳腺癌治疗执行问题等,提供有效的治疗保障,其执行的治疗标准以及控制调节等,可结合实际的使用规格,进行适当的位置调整,从而保证检测的精确度。在临床中,钼靶X线影响诊断技术,可在诊断乳腺疾病中进行普及推广。     

Breast ultrasound image enhancement using fuzzy logic

Breast cancer is still a serious disease in the world. Early detection is very essential for breast cancer prevention and diagnosis. Breast ultrasound (US) imaging has been proven to be a valuable adjunct to mammography in the detection and classification of breast lesions. Because of the fuzzy and noisy nature of the US images and the low contrast between the breast cancer and tissue, it is difficult to provide an accurate and effective diagnosis. This paper presents a novel algorithm based on fuzzy logic that uses both the global and local information and has the ability to enhance the fine details of the US images while avoiding noise amplification and overenhancement. We normalize the images and then fuzzify the normalized images based on the maximum entropy principle. Edge and textural information are extracted to describe the lesion features and the scattering phenomenon of US images and the contrast ratio measuring the degree of enhancement is computed and modified. The defuzzification process is used to obtain the enhanced US images. To demonstrate the performance of the proposed approach, the algorithm was tested on 86 breast US images. Experimental results confirm that the proposed method can effectively enhance the details of the breast lesions without overenhancement or underenhancement.     

乳腺疑难肿块的超声图像与病理

目的通过对乳腺疑难肿块超声图像的分析,提高乳腺癌的诊断水平。方法经超声检查手术病理证实乳腺肿块共203例其中38例声像图难以确认其良恶性,对照手术病理进行分析。结果恶性肿块声像图误诊为良性病变的原因是在肿块的边界、形态、后方回声及血流方面有交叉重叠性;良性肿块误诊为恶性的病理结果往往不是单一的良性病变,故导致声像图错综复杂,易出现错误。乳腺导管内癌超声易漏诊;乳腺病则由于病理类型不同而和癌肿难于鉴别。结论非典型乳腺肿块超声图像易混淆,采用提高仪器分辨率、局部放大技术、结合临床触诊、推动肿块等检查手法,有助于提高肿块良恶性鉴别诊断。但仍有部分病例难以明确诊断,需进一步结合三维超声等其他检查方法,以提高诊断正确率。     

Screening for breast cancer with MRI

Breast MRI has emerged as an extremely powerful tool in breast imaging. The use of breast MRI for cancer detection has the potential to change our current algorithms in the detection of breast cancer. By being able to detect cancer that is occult on conventional imaging, such as mammography and sonography, MRI can detect early breast cancer that was previously unseen by conventional imaging. This article reviews the experience of screening breast MRI in the high-risk population. It also reviews the limitations associated with its use. Before breast MRI can be used in the clinical setting, an ability to localize or biopsy MRI detected lesions that are occult on mammography and ultrasound is needed and must be available for these patients. Although the robustness of this technique has generated considerable enthusiasm, our perspective should be tempered by the fact that many questions remain unanswered regarding the use of breast MRI for screening in the nonhigh risk population as well as integration of breast MRI into clinical practice.     

乳腺DCE-MRI环形强化病变的研究现状及展望

乳腺疾病是女性的常见病,乳腺磁共振动态对比增强检查在临床诊断中占有举足轻重的地位.在乳腺动态对比增强磁共振成像检查中,环形强化作为一种常见的强化方式,既可见于良性病变,又可见于恶性病变,其病理类型广泛,临床上容易误诊.目前,国内外对乳腺MRI上环形强化病变的诊断及鉴别诊断缺乏系统性认识.本文从形态学、血流动力学及扩散加...     

扩散加权成像表观扩散系数在乳腺癌中的应用进展

Breast cancer has become the most common cancer in Chinese women, and breast magnetic resonance imaging (MRI) has become increasingly important in the diagnosis of breast diseases. MRI has high sensitivity in the diagnosis of breast cancer, but lack specificity. As an important supplementary technique for breast MRI, diffusion weighted imaging (DWI) can improve the specificity and has been widely used in clinic. Apparent diffusion coefficient (ADC) is a measure of the diffusion of water molecules in tissues, which can be calculated using diffusion-weighted images. DWI-ADC value becomes a hot topic in the differentiating benign and malignant breast lesions and evaluating the prognosis, metastasis risk and chemotherapy efficacy of breast cancer. Building upon recent surveys of this field, this article reviews the basic principle, application progress, limitation and prospect of DWI-ADC.      

7532例乳腺超声体检分析

目的 用高频超声对正常女性乳腺健康体检,探讨其在临床及乳腺普查方面的应用价值.方法 对2006年1月-2009年12月间7 532例健康女性乳腺体检声像图进行分析,并对各年龄段的乳腺病变超声结果分布情况进行统计.结果 共检出乳腺病变2 861例(37.98%),正常者4 671例(62.02%).所有受检者中,囊性病变...     

Knowledge, practice, and risk of breast cancer among rural women in Korea

Abstract Breast cancer is the third leading cause of death among Korean women after stomach and cervical cancer. Furthermore, the incidence of breast cancer is increasing in contrast to decreasing trends of those two cancers described above. According to the Korean Ministry of Health and Welfare, in 1998, 6.1% of all cancers and 14.1% of cancers in women were breast cancers. Early detection of breast cancer can be achieved by performing periodic breast self-examinations (BSE), clinical breast examinations, and/or mammography. Women should perform early detection procedures such as BSE or mammography on a regular basis to detect breast cancer earlier. For the cost effectiveness of the program, the identification of high-risk groups should be conducted, and the provision of community programs for the early detection of breast cancers should be focused on high-risk groups. The present study was designed to classify the high-risk groups of breast cancer among rural women in Korea, to provide early detection of breast cancer programs. Breast cancer risk of each participant, aged 35–65 years and who reside in the Korean rural community including Kyungki-Do and Chungchongbuk-Do, was assessed utilizing the breast cancer risk appraisal instruments. The tool estimates the six risk factors including age, family history, personal breast disease history, breast-feeding experience, number of children, and frequency of fat intakes. Breast cancer-related knowledge and practices were also assessed. The study results identified a 1.5% high-risk group, 3.8% moderate-risk group, and 24.0% borderline-risk group. Approximately 30% of the respondents were above the borderline-risk groups, which indicate the need for systematic approach for breast cancer prevention and early detection in the community.     

影像组学在乳腺癌淋巴结转移中的研究进展

乳腺癌是全世界女性中最为常见的恶性肿瘤之一,发病率正逐年递增,严重威胁女性健康。淋巴结转移是乳腺癌预后的重要指标,传统影像学检查方法在乳腺癌患者淋巴结转移状态的术前评估方面仍存在很大挑战,影像组学作为一种高通量提取特征的新技术,可提取图像深层次信息并用于建立临床诊断、预后和预测模型,在临床诊疗中得到了广泛应用和研究。目前,基于MRI、超声和钼靶的影像组学技术已逐步开始应用于乳腺癌淋巴结转移的预测,成为学术研究的一大热点。本文介绍了影像组学的定义、工作流程,并对影像组学在乳腺癌淋巴结转移的研究进展进行综述,分别从基于MRI的和非MRI影像的影像组学两方面展开分析,影像组学有望为乳腺癌患者的个体化精准诊疗提供可靠依据。      

Enhancing Your Acoustics: Ultrasound Image Optimization of Breast Lesions

A general understanding of ultrasound physics relative to image optimization is essential when performing breast ultrasound examinations and in accurately interpreting images of the breast. Appropriate technique is crucial to achieve accurate lesion characterization and is emphasized in the second edition of the American College of Radiology Breast Imaging Reporting and Data System for ultrasound (2013). This pictorial essay reviews clinically relevant ultrasound physics to best characterize breast lesions for guiding the clinician to the proper diagnosis. Differences in chosen parameters on ultrasound imaging can create variability in the appearance of breast lesions.