彩色多普勒超声介入乳腺疾病诊断的临床观察

目的：分析彩色多普勒超声介入乳腺疾病诊断的临床效果。方法：采用彩色多普勒超声进行对乳腺增生、乳腺炎、乳腺纤维瘤、乳腺囊肿和乳腺癌进行诊断,分析在人群中的病发率。结果：88例患有乳腺疾病患者中,乳腺增生有57例（64.7%）,乳腺炎15例（17.0%）,乳腺纤维瘤7例（7.9%）,乳腺囊肿6例（6.8%）,乳腺癌3例（3.4%）。乳腺增生的发生率显著高于其他四种类型（P〈0.05）,乳腺炎和乳腺囊肿的发生率无显著性差异（P〉0.05）,乳腺纤维瘤和乳腺癌的发生率无显著性差异（P〉0.05）。结论：彩色多普勒超声可应用于诊断和区分不同类型的乳腺疾病,具有很大的临床应用价值。     

妇女乳腺癌筛查结果及干预对策

目的：对我卫生所辖区的妇女乳腺疾病的发病情况进行了解,并制定有效的干预对策。方法：对我卫生所辖区自愿接受筛查的妇女按照我所乳腺癌检查项目实施方案进行检查,主要运用乳腺临床检查法与超声检查法互相结合筛查的方法,如对患者给予乳腺临床检查后,确诊为阳性体征,则对其给予乳腺钼钯检查,如钼钯x线检查结果显示为可疑人员或者阳性,则给予组织病理学检查,直到获得病理诊断。结果：我所2013年乳腺癌年筛查总人数4329人,彩超筛查4249人,可疑人数80,乳腺钼钯x线检查人数80,阳性2人。乳腺良性病变人数1944人（乳腺增生1840人,乳腺纤维腺瘤52人,其他52人）,病理检查人数2人,乳腺癌确诊人数2个（导管原位癌1个、浸润癌一个）。结论：采取有效的筛查措施对妇女乳腺癌进行筛查,不但能够早期对乳腺癌进行干预和诊断,还能适时发现妇女各类乳腺疾病,为尽早治疗争取了时间,进而有效保障妇女身体健康。     

54例早期乳腺癌的诊治体会

目的：探讨早期乳腺癌的诊治体会。方法：对2010年7月份至2011年7月份年我院收治的108例乳腺癌中的54例早期乳腺癌，进行回顾性分析研究。结果：54例早期乳腺癌患者中，乳腺局限性增厚为27．8％，可触及结节为31．4％，有乳腺增生病史并伴有增生的为40．7％。钼靶X线单纯增生改变的为53．7％，伴不规则造成密影的为33．3％，肿块结节影为31．4％。活检诊断均诊断出54例早期乳腺癌。结论：临床上，应提高患者对早期乳腺癌的认识，全面了解乳腺癌以及乳腺肿块等相关知识；应格外重视对早期乳腺癌相关临床特点的了解；应加强多种诊断方法的联合应用，以此来进行综合分析，做好乳腺癌的早期诊断就治疗。     

重庆市南川区宫颈癌、乳腺癌筛查结果分析

目的：为进一步提高南川区妇女宫颈癌和乳腺癌的早治率,降低死亡率,对10000例宫颈癌筛查适龄妇女及1000例乳腺癌筛查适龄妇女进行筛查结果分析,为提高广大妇女健康水平。方法 ＂两癌＂筛查对象以全区35～59岁妇女,宫颈癌将妇科检查和宫颈脱落细胞巴氏涂片、阴道镜检查相结合,宫颈脱落细胞学诊断标准采用TBS系统。乳腺癌以乳腺视诊、触诊、乳腺彩超检查,确诊钼钯X线检查。结果宫颈癌筛查妇科疾病2954例,患病率为29.54%,发现宫颈CIN（I-Ⅲ期）29例,确诊宫颈癌2例。乳腺癌筛查疾病患病率为17.80%,乳腺增生乳为156例,乳腺可疑病例21例,乳腺癌1名。结论早发现、早诊断、早治疗是预防和控制宫颈癌和乳腺癌发生、发展,降低死亡率的最有效措施。     

B超在乳腺疾病诊断中的价值分析

目的：探讨B超在乳腺疾病诊断中的应用价值。方法：对70例怀疑为乳腺占位疾病的患者分别采用B超和钼靶X线检查,将检查结果与病理检查结果作对比分析。结果：使用B超对乳腺纤维瘤和乳腺囊肿诊断的准确率高于钼靶x线（均P〈0．05）;乳腺增生、乳腺癌的诊断准确率两组间无明显差异（P〉0．05）。结论：B超诊断乳腺疾病准确率高,且对人体无放射伤害,具有较高的临床应用价值。     

有乳腺增生性疾病妇女的雌激素替代治疗

为观察有乳腺增生性疾病患者能否使用雌激素替代治疗(ERT)以及应用ERT的危险性,对患乳腺增生性疾病应用和未用ERT者的乳腺癌发生危险性进行长期随访。 结果:随访乳腺增生性疾病2911例,其中非典增生287例,发生恶变39例,相对危险(RI)3.58,增生性病变2624例,发生恶变137例,RI为1.42。比较绝经前曾患乳腺良性疾病患者应用ERT时间和发生乳腺癌的关系,共3383例患者,其中ERT治疗1～12个月707例,发现乳腺癌26例,RI为     

应用高频彩超对女性乳腺健康普查的价值

目的：探讨高频彩超在女性乳腺健康普查中的应用价值。方法：对2013年1月至2013年6月在我科就诊及健康体检的500名妇女的乳腺彩超结果进行回顾性分析。结果：在500名受检者中，超声提示乳腺增生320例，乳腺囊肿20例，急性乳腺炎2例，乳腺实质性病灶62例，其中乳腺纤维瘤32例，乳腺癌8例。结论：高频彩超对女性乳腺进行健康普查具有很高的应用价值，是女性乳腺疾病普查的首选方法。     

超声对乳腺癌诊断价值的评价

目的：探讨超声检查对乳腺癌的诊断价值。方法回顾性分析我院近年来经术后病理证实的56例乳腺癌病人的超声检查结果。结果超声诊断和术后临床诊断的符合率为92.9%（52/56）。结论超声对乳腺癌的诊断有较高的敏感性和准确性。     

广东省东莞市沙田镇妇女宫颈癌和乳腺癌筛查结果分析

目的了解广东省东莞市沙田镇35~59岁户籍妇女生殖健康状况,筛查子宫颈癌和乳腺癌,为其制定切实有效的防治措施提供依据。方法 2012年8月至2014年12月对广东省东莞市沙田镇35~59岁的妇女进行宫颈细胞学检查及乳腺癌筛查,并记录个人基本信息及病史进行分析。结果参加宫颈癌筛查的妇女共5 027例,筛查率为99.36%;妇科良性疾病患病率为31.25%,宫颈癌前病变患病率为17.90/万,宫颈癌患病率为3.98/万;参加乳腺癌筛查的妇女共5 050例,筛查率为99.82%;乳腺良性疾病患病率为30.18%,乳腺癌患病率为5.94/万。结论开展妇女癌筛查工作对降低宫颈癌和乳腺癌的发病率、普及预防知识和提高妇女自我保护意识具有重要的意义。应总结经验,完善筛查制度,逐步扩大筛查年龄范围,提高妇女癌筛查率,建立长效机制,保障妇女的生殖健康。     

超声及超声引导下粗针穿刺活检对妊娠期乳腺癌的诊断价值

目的:评价超声及超声引导下粗针穿刺活检对妊娠期乳腺癌的诊断价值。方法:回顾性分析2012年6月至2015年8月四川省人民医院手术病理确诊的12例妊娠期乳腺癌患者术前超声检查结果和超声引导下粗针穿刺活检的组织病理学结果。结果:10例妊娠期乳腺癌具有非妊娠期乳腺癌典型的超声声像特征,其余2例妊娠期乳腺癌超声表现为以囊性成分为主的囊实混合性团块,并伴后方回声增强,误诊为炎性肿块或乳腺脓肿。12例患者行超声引导下粗针穿刺均成功,取材满意,穿刺后无大出血、血肿、感染及气胸等并发症发生,活检结果示11例为浸润性导管癌,1例为原发性肿瘤炎性乳腺癌。与手术病理诊断结果对照,术前超声诊断妊娠期乳腺癌与病理诊断符合10例,诊断符合率83.3%(10/12),超声引导下粗针穿刺活检病理诊断结果符合率100.0%(12/12)。结论:超声诊断妊娠期乳腺癌具有一定的误诊率,联合超声引导下粗针穿刺活检操作简单、安全、诊断率高,对妊娠期乳腺癌的诊断有重要的临床价值。     

他莫昔芬对乳腺癌患者子宫内膜影响的前瞻性临床病理研究

目的:前瞻性研究他莫昔芬对乳腺癌患者子宫内膜的影响。方法:对2005年1月~2008年10月于温州医学院附属第二医院乳腺外科手术的155例乳腺癌患者进行随访,以阴道B超、宫腔镜及子宫内膜活检评价服用他莫昔芬前后子宫内膜情况。结果:可评价患者共135例,其中绝经前46例,绝经后89例。服用他莫昔芬后,未绝经组36例(78.26%)出现异常阴道流血,9例(19.56%)出现子宫内膜病变,绝经组22例(24.72%)发生异常阴道流血,出现子宫内膜病变29例(32.60%),其中术前绝经组18例(18/59,30.51%),化疗后绝经组11例(11/30,36.67%)。阴道B超对绝经后子宫内膜病变诊断的灵敏度为52.3%,特异度为90.2%,宫腔镜诊断相应的灵敏度为81.8%,特异度为100%。结论:他莫昔芬导致绝经后妇女子宫内膜病变发生增加,对绝经前妇女的影响还不确定。阴道B超可作为初步检测手段,宫腔镜检查可提高诊断的准确率。     

Significance of endovaginal ultrasonography in assessing tamoxifen-associated changes of the endometrium. A prospective study

BACKGROUND: A prospective study was conducted investigating the value of endovaginal ultrasound in the assessment of tamoxifen-associated changes of the endometrium in patients with breast cancer. METHODS: Seventy postmenopausal patients with breast cancer treated with anti-estrogens for at least 6 months were entered. Those with bleeding disorders and/or an endometrial thickness of > or =10 mm found on ultrasonography underwent hysteroscopy and dilatation and curettage (D&C) for further histological evaluation. In 22 patients, positive ultrasound findings could be compared with histopathology. RESULTS: 82% of the 22 patients with positive sonographic findings had a glandular-cystic hyperplasia or a glandular-cystic polyp. No adenomatous hyperplasia or endometrial cancer was observed in our series. CONCLUSION: Vaginal ultrasound represents a useful diagnostic tool to detect tamoxifen-associated changes of the endometrium. A threshold of 10 mm endometrial thickness appears suitable to identify endometrial abnormalities while reducing the rate of false-positive findings to an acceptable level. However, the role of vaginal ultrasound in screening for endometrial cancer or premalignant lesions remains uncertain.     

高血压性心脏病心脏彩超与心电图的对比分析

目的探究高血压性心脏病心脏彩超与心电图的对比，分析两种诊断方法的临床应用价值。方法：选择我院自2013年1月到2014年1月间接收治疗的40例高血压性心脏病患者。医师分别采用传统心电图检测仪器对40例患者进行诊断，然后采用彩色多普勒超声对40例患者进行检查，其中心电图组为参照组，彩色多普勒超声诊断组为研究组，观察两组患者的影像学表现，分析两组诊断符合率。结果：研究组患者采用彩色多普勒超声诊断后，诊断结果显著优于参照组患者（P〈O．05）。结论：高血压性心脏病患者在进行病情检测时，借助彩色多普勒超声仪进行诊断，可以提高检测准确性，这样做安全且易操作，值得在临床医学中推广使用。     

Mastopatía fibroquística. Aspectos controvertidos

ObjectivesTo elucidate the most controversial features of fibrocystic breast disease, which is highly prevalent.MethodsWe reviewed the literature on the topic.ResultsIn fibrocystic breast disease, the diagnostic method of choice is ultrasound, which shows similar characteristics to those in cystic tumors but with differences in number and maximum diameter. With dominant, or separate, nodules, ultrasound can be used to determine whether the lesion is cystic or solid. In cystic lesions, fine-needle aspiration can be used; in solid lesions, core needle biopsy can be employed. No active treatment is required if there is mastalgia and nodularity without a dominant nodule, or if diffusely nodular breasts are painless.Conclusions1. There is no risk of malignancy in simple fibrocystic breast disease but proliferative mastopathy with atypical cells has a relative risk of 4-5. 2. The diagnostic technique of choice for differentiating simple from complex cysts is ultrasound, which can also be used for monitoring and as a guide when aspirating the cyst. 3. When there are clinical and radiologic signs suspicious for malignancy (BI-RADS 3) or suggestive of malignancy (BI-RADS 4 and 5), the first step is fine-needle aspiration or core needle biopsy, or both. 4. Asymptomatic fibrocystic breast disease does not require follow-up, while symptomatic disease can be monitored with ultrasound and/or mammography.     

宫腔镜诊治宫内占位性疾病1065例临床分析

目的:探讨宫腔镜检查与阴道彩色超声(TVB)对宫内占位性疾病的诊治价值。方法:回顾性分析因不孕、绝经后出血、阴道彩色超声提示宫腔占位等不同原因行宫腔镜检查的1 065例患者,根据宫腔镜检查结果,了解TVB诊断的准确率及宫腔占位性疾病的病理性质。结果:1 065例宫腔镜检查的患者术前TVB提示有宫内占位的为800例,经宫腔镜检查,术中见宫内占位900例,2种检查方法相比,差异无统计学意义(P0.05)。术前TVB提示有宫内占位的800例患者中,经宫腔镜检查证实有宫内占位750例,TVB与宫腔镜检查的阳性符合率为93.8%(750/800),假阳性率为6.2%(50/800)。术前TVB未提示宫内占位的265例患者中,经宫腔镜检查存在宫内占位的有150例,TVB的假阴性率为10.8%(115/1 065)。宫腔镜术后病理诊断提示,宫腔内膜息肉670例,占62.9%(670/1 065),子宫黏膜下肌瘤121例,占11.4%(121/1065),内膜简单性增生153例,占14.4%(153/1 065),内膜功能性增生93例,占8.7%(93/1 065),复杂性增生9例,占0.8%(9/1 065),不典型增生8例,占0.8%(8/1 065),子宫内膜癌11例,占1.0%(11/1 065)。结论:准确诊断宫内占位性疾病性质,须在宫腔镜直视下检查并取材进行病理诊断,此是宫内占位性疾病的最终诊断结果。     

聚焦超声治疗外阴上皮内非瘤样病变900例临床疗效分析

目的 探讨聚焦超声治疗外阴上皮内非瘤样病变的临床疗效,评价聚焦超声治疗的有效性、安全性及可行性。方法 对2003年6月至2005年8月,采用聚焦超声治疗的941例外阴上皮内非瘤样病变患者的临床资料进行回顾性分析,其中鳞状上皮增生型498例（占52．9％）,硬化性苔癣型342例（占36．4％）,硬化性苔癣伴增生（混合）型101例（占10．7％）。患者年龄18～70岁,平均年龄40．8岁。平均病程为6．2年（3个月～45年）,于治疗后6、12个月评价其疗效（分为治愈、有效、无效,以治愈及有效例数计算有效率）。结果 941例患者中900例患者随访资料完整,治疗后6个月,临床治愈434例（占48．2％）,有效420例（占46．7％）,无效46例（占5．1％）,治疗后6个月的有效率为94．9％。治疗后12个月的有效率为83．7％。治疗后12个月有101例患者再次出现明显的外阴瘙痒症状（占11．2％）,再次给予聚焦超声治疗,其中90例达到临床有效。900例患者中,无一例出现阴道周围组织（尿道或直肠）损伤等并发症,但有50例患者（5．6％）在治疗中及1周后出现皮肤水泡及局部浅表溃疡,经对症治疗后全部愈合。结论 聚焦超声是当前治疗外阴上皮内非瘤样病变行之有效的新方法,值得在临床上进一步推广应用。     

CT、超声在卵巢癌诊断中的价值及影像特征分析

目的 观察分析CT、超声在卵巢癌诊断中的价值及影像特征.方法 选取60例疑似卵巢癌患者,患者均实施CT、超声检查,以术后病理检查结果为金标准,对比两种不同检查方法的诊断结果、诊断敏感性、特异性、准确性、卵巢癌临床分期、典型影像学表现及影像特征.结果 60例患者病理检查结果示阳性48例,阴性12例;CT检查中,阳性47例...     

Saline sonohysterography for monitoring asymptomatic postmenopausal breast cancer patients taking tamoxifen.

OBJECTIVES: To evaluate the effectiveness of sonohysterography for monitoring asymptomatic postmenopausal breast cancer patients on long-term tamoxifen therapy. METHODS: Thirty-eight asymptomatic postmenopausal patients receiving tamoxifen for breast cancer were enrolled into the study. The endometrium of study subjects was measured by transvaginal ultrasound. If a distinct echo measured < or = 5 mm, no further procedure was performed. For thickened or inadequately visualized endometrium by transvaginal ultrasound (TVS), sonohysterography was performed. Endometrial biopsies were performed for patients with generalized symmetrical changes on sonohysterography. In cases with focal changes, or inadequate SHG, hysteroscopy/dilatation and curettage (D&C) were performed. RESULTS: Transvaginal ultrasound examination showed 12 (31.6%) patients with thin endometrium < or = 5 mm, 18 (47.4%) cases with thickened endometrium while eight (21%) cases were not adequately visualized by TVS. Sonohysterography was satisfactorily performed in 22 of 26 (84.6%) cases. Of these, three cases showed thin endometrium, 10 patients had endometrial polyps (45.5%) and nine patients showed abnormal endometrial-myometrial junction. Histology revealed hyperplasia in three cases and well differentiated adenocarcinoma associated with one polyp. Endometrial curettage for cases with abnormal endometrial-myometrial junction showed endometrial hyperplasia in two cases. Hysteroscopy and D&C were performed for four (15.4%) patients where SHG was unsuccessful, histopathology revealed inactive endometrium in three cases and one was hyperplastic. CONCLUSIONS: Sonohysterography is superior to unenhanced transvaginal sonography in specifying the abnormal ultrasonographic appearance induced by prolonged tamoxifen therapy, it is easily performed, cost-effective and very well tolerated by the patients with no complications. Sonohysterography is recommended as a minimally invasive diagnostic tool for the assessment of endometrial changes in asymptomatic postmenopausal breast cancer patients on long-term tamoxifen therapy with thickened endometrium or inadequately visualized endometrial echo on transvaginal sonography.     

Mammasonographie

In gynecological practice ultrasound has achieved a high significance for preventive breast diagnosis and in follow-up after breast cancer treatment. This is also represented in the new German S3 guidelines for early detection and for diagnosis and treatment of breast cancer. However, the use of this widespread and highly efficient method continuously gives rise to controversial discussions. Besides different medical political interests these discussions are also largely influenced by different standards and questions of quality control. Within the German mammography screening program ultrasound is only considered for evaluating suspect mammographic lesions. Apart from screening ultrasound is widely used in cases of diffuse benign disease, unclear clinical findings, unclear palpation findings, dense breast tissue and in general when mammography is problematic and for ultrasound-guided interventional diagnosis. Within the framework of gynecological tumor prevention ultrasound is also widely established for early cancer detection in non-symptomatic women.     

FNAC: its role, limitations and perspective in the preoperative diagnosis of breast cancer

Fine-needle aspiration cytology (FNAC) was first described and performed in 1930. Thirty years later, it gained acceptance first in Europe and about a decade later in North America. The method is generally considered as a rapid, reliable, safe diagnostic tool to distinguish non-neoplastic from neoplastic breast lesions. In developed countries, in the last 20 years, mammographic screening programmes, which have been used extensively, are designed to detect the earliest possible breast cancer. The FNAC report is extremely important because it gives the necessary information for the management of patients, in order to proceed with more invasive diagnostic methods or surgical treatment, and to decide what kind of operation to perform. In the preoperative phase, FNAC has taken a fundamental role of both palpable and nonpalpable lesions, using ultrasound or stereotactic guidance. New developed techniques, breast biopsy instrumentation (ABBI) and mammotome have the advantage of complete removal of breast lesions, but this is not possible in all the examined cases. In developing countries, economical restrictions, low budget for health care and screening programmes put the patients at a disadvantage because of the high cost of sophisticated diagnostic methods, thus we recommend that FNAC be used as a routine diagnostic method because of its low cost compared with the others and this policy maximizes the availability of health care to women with breast cancer. We conclude that FNAC plays an important and essential role in the management of patients with breast lesions and also offers a great potential for prediction of patient outcome, disease response to therapy and assessment of risk of developing breast cancer. The reliability and efficiency of the method depends on the quality of the samples and the experience of the medical staff that performs the aspiration.