MRI对乳腺癌术前评估的价值:与X线摄影、超声比较

目的 探讨MRI对乳腺癌术前评估的价值,并与X线摄影、超声比较. 方法 35例经手术病理证实的乳腺癌患者,术前均接受乳腺动态增强MRI、X线摄影及彩色多普勒超声检查.病理类型包括浸润性导管癌28例,导管内癌伴局灶浸润3例,导管内癌2例,黏液腺癌合并广泛高级别导管内癌1例,浸润性小叶癌1例.其中病理报告局部多灶5例,导管内播散10例.将三种影像学方法 对乳腺癌的检出、病变大小及范围与病理结果进行对照. 结果 MRI、X线摄影和超声检查对乳腺癌的检出率分别为100%、74.29%和82.86%.MRI对乳腺癌患者的检出率明显高于X线和超声(P＜0.05).MRI、X线和超声检查对病灶大小评价与病理结果进行相关性分析,相关系数r分别为0.94、0.87、0.70,均具有显著性统计学意义(P＜0.01).MRI、X线摄影和超声检查对局部多灶及导管内播散诊断的灵敏度、特异度、准确率分别为100%、80.00%、88.57%;66.67%、95.00%、82.86%;33.33%、95.00%、68.57%;其中MRI灵敏度明显高于X线摄影(P=0.042)和超声检查(P=0.000). 结论 MRI在乳腺癌术前检出、病变大小及范围评估方面优于X线摄影和超声检查.     

超声成像与钼靶X线摄影对乳腺癌肿瘤大小术前评价的对比研究

目的对比分析超声成像及钼靶X线摄影对原发性乳腺癌肿瘤大小的术前诊断价值。方法对我院2006年7月至2009年7月手术病理证实的原发性乳腺癌术前同时完成超声及钼靶X线成像检查患者影像资料进行回顾性分析,以手术病理证实的病灶大小为诊断标准,分别对超声成像、钼靶X线摄影术前测量肿瘤的大小与手术病理结果进行Pearson相关分析。结果术前完成超声、钼靶X线摄影检查的57例经手术病理证实乳腺癌患者,包括51例浸润导管癌、4例浸润型小叶癌、2例原位导管癌。手术病理证实肿瘤大小范围是0.6～12.6cm,平均(3.4±2.9)cm,超声成像测量肿瘤大小范围0.6～11.8cm,平均(2.3±2.1)cm,钼靶X线摄影测量肿瘤大小范围0.7～10.2cm,平均(2.4±1.8)cm。超声成像测量肿瘤大小与手术病理结果相关系数r=0.749(P0.05)。钼靶X线摄影测量肿瘤大小与手术病理结果相关系数r=0.544(P0.05)。结论超声成像对原发乳腺癌肿瘤大小的术前评价较钼靶X线摄影更为准确。     

对比超声"萤火虫"成像与X线钼靶摄影对乳腺肿瘤微钙化的检出率

目的比较超声"萤火虫"成像与X线钼靶摄影对乳腺病灶微小钙化的检出率。方法经手术病理证实的112例乳腺肿瘤患者接受X线钼靶摄影与超声"萤火虫"成像检查。计数两种方法检出的结节内微钙化及结节外簇状微钙化,并进行统计学分析。结果 112例中,X线钼靶摄影检出钙化61个,良性15个,恶性46个,其中结节外簇状钙化6个(均为恶性);超声"萤火虫"成像检出钙化97个,良性33个,恶性64个,其中结节外簇状钙化2个(均为恶性)。X线钼靶摄影未检出而超声"萤火虫"成像显示的钙化36个,其中良性22个,恶性14个。超声"萤火虫"成像检出微钙化灶及恶性病灶优于X线钼靶摄影(P<0.05)。结论与X线钼靶摄影相比,超声"萤火虫"成像可显著提高乳腺恶性肿瘤及微小钙化灶的检出率,提高超声对乳腺恶性病灶的诊断准确率。     

乳腺X射线摄影及MRI评估伴微钙化乳腺癌新辅助治疗后残余病灶

目的 观察乳腺X射线摄影（MG）及MRI评估伴微钙化乳腺癌新辅助治疗（NAT）后残余病灶的效能。方法 回顾性分析145例经手术病理证实伴微钙化的乳腺癌患者,均接受NAT及NAT前、后MG及乳腺MR检查,测量X线片中钙化最大径及增强MRI所示病灶强化最大径,评估NAT后X线片所示钙化范围变化,并记录病理所见残余肿瘤大小及完全缓解（pCR）等。观察NAT后X线片所见残余钙化范围最大径及增强MRI残余肿瘤强化灶大小与病理残余肿瘤大小的相关性,分析X线片钙化范围变化与pCR的相关性。以病理结果为标准,计算MRI评估残余肿瘤pCR的敏感度、特异度、假阳性率及假阴性率。结果 145例中,144例浸润性癌,1例导管原位癌;NAT后67例达pCR。NAT后X线片所示钙化范围最大径与病理残余肿瘤大小无明显相关（P=0.49）,增强MRI残余肿瘤强化灶大小与病理残余肿瘤大小呈中等相关（r=0.69,P<0.01）。NAT后钙化范围52例不变、65例缩小、28例增加,其间pCR差异无统计学意义（χ²=1.79,P=0.44）。MRI评估残余肿瘤pCR的敏感度为93.59%（73/78）,特异度为62.69%（42/67）,假阳性率37.31%（25/67）,假阴性6.41%（5/78）。结论 NAT后X线片所示乳腺癌残余钙化最大径与病理残余肿瘤大小之间无明显相关;MRI残余病灶大小与病理残余肿瘤大小呈中度相关,且以之评估残余肿瘤达pCR与否的效能较佳。     

高频彩色多普勒超声在乳腺癌钼靶X线摄影阴性诊断中的应用价值

目的评价高频彩色多普勒超声在乳腺癌钼靶X线摄影阴性诊断中的应用价值。方法将2936例女性乳腺检查中发现病变并经手术或超声引导下穿刺活检病理证实的56例乳腺癌病灶的术前钼靶X线摄影结果与超声检查结果进行对比分析,采用双盲法,检查结果依照BI-RADS标准评判分级,并与病理结果作对照。结果56例中,术前超声诊断乳腺癌53例(53/56),超声表现为不规则的低回声肿物图像,部分肿物可见穿入性血流信号及高阻血流频谱;超声呈假阴性3例,超声声像图未见肿物图像,在钼靶X线摄影则表现为恶性钙化,无明确肿块。乳腺钼靶X线摄影诊断乳腺癌47例(47/56),主要影像表现为毛刺样肿块及恶性钙化,呈假阴性9例,肿块最大直径范围约1.5~0.4cm。结论超声诊断肿块型乳腺癌有较高的准确性,尤其可检出钼靶X线不能检出的较小的乳腺癌肿块。     

高频超声对乳腺肿瘤内部微钙化灶的敏感度和特异度的研究

目的通过高频超声显像对乳腺肿瘤中微钙化灶的敏感度和特异度进行研究,探讨高频超声显像检出乳腺肿瘤内部微钙化灶对乳腺癌的诊断价值。方法对130例乳腺肿瘤患者进行高频超声检查,观察肿瘤大小、形态、边界、回声,并重点进行钙化灶的形态特点研究;所有乳腺肿瘤均经病理证实。结果在130例乳腺肿瘤中,病理证实恶性肿瘤（乳腺癌）102例,良性肿瘤28例;98例乳腺癌中出现微钙化灶,4例乳腺癌未出现微钙化灶;5例良性肿瘤中出现微钙化灶,23例良性肿瘤未出现微钙化灶;乳腺恶性肿瘤中微钙化灶检测的敏感度为96．1％,特异度为82．1％,正确指数为0．78。结论乳腺肿瘤中出现微钙化灶是高频超声诊断乳腺癌的重要指标。     

彩色多普勒超声诊断微钙化乳腺癌的临床价值

目的:探讨彩色多普勒超声诊断微钙化乳腺癌的临床价值。方法:选取2010年1月—2014年1月于山东省单县东大医院接受治疗的19例微钙化乳腺病变患者,对所有患者实施彩色多普勒超声及钼靶X线摄影检查,比较两种方法。结果:X线摄影诊断结果与病理结果相比差异无统计学意义(χ~2=0.684,P0.05),彩色多普勒超声的诊断准确率低于病理结果(χ~2=4.75,P0.05)。此外,两种方法联合提高了诊断的特异度和阳性预测值,但降低了灵敏度和阴性预测值,即漏诊率提高,误诊率降低。结论:随着高频超声技术的不断发展,其能检测出乳腺肿块的内部钙化,但对无肿块微钙化的识别还存在一定困难,而钼靶X线摄影对微钙化乳腺癌的诊断有一定优势,将两种方法联合使用能显著提高微钙化乳腺癌的诊断准确率,从而有效提高早期乳腺癌的诊断率。     

超声斑点抑制成像检出乳腺癌微钙化

目的 探讨超声斑点抑制成像(SRI)在乳腺癌微钙化检出中的应用价值。方法 经手术病理证实的乳腺癌患者92例,术前均接受高频超声和SRI检查。首先行常规高频超声检查,观察乳腺病变的大小、形态、边界、回声、有无微钙化(直径<1 mm)、血流信号以及腋窝淋巴结有无转移;然后加行SRI,观察肿瘤内、外有无微钙化,并分析不同大小、不同病理类型的乳腺肿瘤内存在微钙化情况。结果 92例乳腺癌患者,术前SRI发现42例存在微钙化,其中6例常规高频超声不能确定是否存在微钙化,应用SRI则显示清晰。直径>1.0 cm且≤2.0 cm的肿瘤微钙化的检出率最高(25/35,71.43%),直径>2.0 cm的肿瘤微钙化的检出率最低(17/54,31.48%),二者差异有统计学意义(P<0.05)。术后病理证实导管内原位癌3例,存在微钙化者1例;导管内癌11例,存在微钙化者4例;浸润性导管癌64例,存在微钙化者36例;浸润性小叶癌14例,未见微钙化。结论 乳腺癌中大部分存在微钙化,其病理类型主要为浸润性导管癌和导管内癌。应用超声SRI技术可提高乳腺肿瘤微钙化检出率。     

乳腺占位性病变80例的钼靶X线特征分析

目的:分析良性乳腺肿块与乳腺癌X线钙化特征。材料与方法:对33例乳腺癌及47例乳腺良性肿块患者的钼靶X线特征及乳腺癌钙化的特点,探讨钙化Le Gal分型与良性乳腺肿瘤及乳腺癌的相关性。结果:1.钙化数量≥10个/cm2病例、短杆状钙化、分支状钙化、等密度的钙化、节段性及线性的钙化中,乳腺癌比例均显著高于乳腺良性肿瘤(P<0.05)。2.良性乳腺肿瘤Le Gal分型Ⅱ型、Ⅲ型钙化的比例高于乳腺癌,Ⅴ型钙化低于乳腺癌,差异均具有显著性(P<0.01)。结论:钼靶X线摄影可以清晰显示乳腺肿瘤钙化征象,具有很高的应用价值。     

乳腺X线摄影及超声表现为多发肿块患者的临床、病理学及影像学特征分析

目的:探索乳腺多发肿块患者的乳腺X线摄影、超声、病理学及临床特征。方法:回顾并分析2005年1月—2019年11月乳腺X线摄影及超声表现为多发肿块的患者(双侧乳腺肿块数目至少3个),记录患者年龄、绝经状态、病理学类型及影像学特征[腺体组织构成、肿块形态、密度、边缘、肿块最大径、钙化及乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类]。将BI-RADS 2～3类归为良性,BI-RADS 4～5类归为恶性,首先分析表现为多发肿块患者的病理学特征,然后比较良性及恶性多发肿块患者临床及影像学特征的差异性;最后比较乳腺X线摄影及超声诊断乳腺多发肿块良恶性的准确率。结果:105例乳腺多发肿块中,良性99例,占94.29%(纤维腺瘤52例,纤维囊性腺病24例,乳腺腺病13例,导管内乳头状瘤7例,囊肿2例,良性叶状肿瘤1例),恶性6例(三阴性乳腺癌4例,黏液癌2例)。良恶性多发肿块患者发病年龄、绝经状态、肿块形态、边缘及BI-RADS分类差异有统计学意义(P0.05)。良性多发肿块患者的发病年龄[(43.25±6.69)岁]低于恶性多发肿块患者[(50.00±9.19)岁],以非绝经状态为主(88.89%)。乳腺X线摄影及超声评价为BI-RADS 2类及5类病变与病理学结果相符;乳腺X线摄影诊断为BI-RADS 3类中的恶性病变1.49%(1/67)及诊断为BI-RADS 4类的良性病变96.00%(24/25)均因肿块边缘存在遮蔽现象,但超声诊断结果与病理学基本相符。超声诊断BI-RADS 3类病理学结果均为良性;诊断为BI-RADS 4类的良性患者占90.00%(9/10),这些患者均因肿块内含有钙化导致诊断升级,而乳腺X线摄影均显示为良性钙化。乳腺超声诊断多发肿块的灵敏度为100.00%、特异度为90.91%,曲线下面积为0.96;乳腺X线摄影灵敏度为83.33%、特异度为75.76%,曲线下面积为0.80。结论:①乳腺X线摄影及超声表现为多发肿块患者的病理学结果多为良性,恶性多发肿块患者年龄较良性患者大;②超声诊断乳腺多发肿块良恶性的准确率高于乳腺X线摄影,两者结合可以进一步提高诊断准确率,但并非所有多发肿块患者均需要进行2种影像学检查;③当乳腺X线摄影表现为肿块边缘遮蔽时,应考虑采用超声做进一步检查;④当超声因肿块内钙化特征判断为恶性肿块时,建议行乳腺X线摄影进一步分析钙化形态及分布特征。     

Microcalcifications of non-palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology.

OBJECTIVES: Microcalcifications are generally not demonstrated well on ultrasonography. In this study, we attempted to demonstrate the usefulness of high-resolution ultrasonography in the detection of microcalcifications associated with non-palpable breast cancers. DESIGN: Fourteen patients with non-palpable breast lesions in whom microcalcifications were detected or suspected by ultrasonography and one patient in whom microcalcifications were detected on mammography only were included in the study. Mammography and analysis of biopsy specimens were performed in each patient and the findings were correlated with the ultrasonographic findings. Ultrasonography and mammography were performed independently by different physicians at different times. RESULTS: In three patients < or = 30 years of age, who were not at high risk of breast cancer and who had no evidence of cancer on palpation, high-resolution ultrasonography clearly showed microcalcifications but no mass. Two of these patients had ductal carcinoma in situ and one had small invasive carcinoma with extensive comedocarcinoma. Among the other 12 patients with non-palpable breast lesions, ultrasonography detected microcalcifications accurately in six and suggested possible microcalcifications in a further four. Microcalcifications in all of these ten patients were confirmed by mammography thereafter. Four of these ten patients had ductal carcinoma in situ, with or without invasive carcinoma. Of the remaining two patients, one demonstrated false-positive findings and one false-negative findings on ultrasound. On high-resolution ultrasonography, microcalcifications produced the appearance of twinkling stars (bright dots in different planes) in a dark sky (contrasted against ill-defined hypoechoic patches), corresponding on histopathology to groups of expanded ducts with increased cell density with or without necrosis. CONCLUSION: High-resolution ultrasonography may be used for detection of microcalcifications in non-palpable breast lesions. Ultrasonography is helpful in screening for early breast cancers, especially in young patients who are at risk for breast cancer and in whom mammography is not usually carried out.     

Advances in Ultrasound-Guided Vacuum-Assisted Biopsy of Breast Microcalcifications

Microcalcification is one of the significant indications for or can even be the sole mammographic feature of breast cancer, especially occult breast cancer. Biopsy and pathologic examination are the most important methods used to identify the nature of suspicious microcalcifications. Stereotactic vacuum-assisted breast biopsy (S-VAB) is the most commonly used biopsy method for microcalcifications currently because of the high detection rate of mammography for microcalcifications. However, in recent years, several clinical studies have gradually found that ultrasound-guided vacuum-assisted breast biopsy (US-VAB) could be an alternative to S-VAB for microcalcifications to some extent, and has its own advantages of flexibility, real-time performance, comfort and high accessibility compared with mammography. An overview of US-VAB of microcalcifications is provided with respect to success rate, diagnostic accuracy, advantages and limitations. On the basis of numerous studies and clinical experience, US-VAB proved to be a valid alternative to S-VAB, with comparable diagnostic accuracy if the microcalcification foci could be detected by ultrasound. And for patients with ultrasound-invisible microcalcifications who are not suitable for or tolerable of S-VAB, US-VAB combined with mammography localization of microcalcifications can also be considered.     

乳腺癌微小钙化X线表现与病理对照研究

目的探讨乳腺癌微小钙化X线表现特征及病理基础,加深对乳腺癌x线特征的认识。方法对186例x线显示微小钙化乳腺癌进行研究。根据x线显示钙化部位指导病理取材,将X线表现与病理表现一一对照。进行病理分型,观察各型的微小钙化大小、密度、形态、分布及腺体改变,对其间的差别进行）（2检验。结果非浸润癌、早期浸润癌、浸润性非特殊性癌微小钙化的病理基础为多个癌性腺体内细胞坏死、退变,钙化“沙粒体”聚集。浸润性非特殊性癌间质内及癌组织腺管壁也见钙化。各型X线表现以小针尖状、条状低密度钙化为主,钙化合并腺体异常非浸润癌与早期浸润性癌低于浸润性非特殊性癌,具有统计学差异（P〈0．05）。钙化的分布为细线状、簇状、不规则状,各类型的分布无显著性差异（P〉0．05）。结论乳腺癌微小钙化灶对诊断具有特征性,与病理改变密切相关,理解微小钙化的病理特点,对准确诊断具有重要的意义。     

超声及乳腺X线摄影对乳腺硬化性腺病的诊断价值与病理对照研究

目的：评价超声及乳腺X线摄影对乳腺硬化性腺病的诊断价值,并与病理对照。方法：收集2007年8月-2012年11月29个硬化性腺病的影像病理资料．回顾性分析其超声、乳腺X线摄影及病理表现。结果：超声检查肿块27个,主要表现为≤2cm,形态不规则、无血流、无后方声影,其中10个病灶边缘模糊或成角或伴后方声影．误诊为恶性,病理见纤维增生及间质硬化;超声表现正常1个。乳腺X线摄影肿块10个,主要表现为〈2cm、形态规则、边缘清楚或部分被遮蔽、等密度,病理组织成分多样,纤维组织透明变性为主,边界清楚;微钙化1个,为小圆形簇状分布;X线表现正常5个。结合超声及乳腺X线检查,诊断的准确率为75．86％（22／29）,无漏诊病例。结论：结合超声及乳腺X线检查,可以提高硬化性腺病的诊断准确率。     

钼钯X线微钙化对乳腺触诊阴性的乳腺癌诊断价值

目的 探讨钼靶X线检查发现微小钙化对乳腺触诊阴性乳腺癌的诊断价值.方法 回顾性分析106例临床检查阴性且乳腺X线摄片发现微小钙化的患者,所有患者均接受穿刺活检或手术.根据病理组织学结果 ,对各影像学和临床指标进行单因素和多因素分析.结果 106例微小钙化患者中96例(90.57%)表现为成簇状钙化,10例(9.43%)表现为散在钙化.乳腺癌发生率分别为32.29%(31/96)和 20.00%(2/10).2例表现为散在钙化的乳腺癌患者,均为双侧乳腺出现的散在钙化,且形状不规则.结论 乳腺内成簇钙化的数目、钙化颗粒的总数、密度均匀性及分布形态等钼靶X线特征,有助于诊断临床检查阴性的早期乳腺癌.散在钙化通常出现在良性乳腺疾病中,但当双侧乳腺内均出现散在钙化,且形状不规则时应警惕乳腺癌可能.     

Metaplastic carcinoma of the breast: mammographic and sonographic findings

PURPOSE: We investigated the mammographic, sonographic, and pathologic findings in metaplastic carcinoma of the breast. METHODS: The mammographic (n = 16) and sonographic (n = 11) findings in 16 patients with metaplastic carcinoma of the breast were analyzed retrospectively along with pathologic findings. Whenever possible, results of preoperative fine-needle aspiration biopsy and immunohistochemical studies were obtained. RESULTS: All patients presented with a palpable breast mass. The mean size of the lesions at pathologic examination was 4.2 cm. On mammography, 15 patients had a mass (1 patient had 2 masses), and 1 patient had only clustered microcalcifications without an associated mass. The mean longest diameter of the 16 masses on mammography was 4.6 cm. Eleven lesions (69%) were round to ovoid in shape, 13 lesions (81%) showed ill-defined or obscured margins, and 10 lesions (63%) showed associated architectural distortion. On sonography, 6 (55%) of 11 lesions were round to ovoid, 9 lesions (82%) had well-defined margins, and 6 lesions (55%) showed complex echogenicity with solid and cystic components. At pathologic examination, 4 of these 6 lesions showed hemorrhagic or cystic necrosis. Axillary lymph nodes were positive in 6 (40%) of 15 patients in whom axillary node dissection was performed. CONCLUSIONS: Metaplastic carcinoma of the breast manifests as a rapidly growing, mammographically ill-defined round mass with associated architectural distortion on mammograms. Complex echogenicity with solid and cystic components may be seen sonographically and is related to hemorrhagic or cystic necrosis seen pathologically.     

Needle-localized biopsy of occult breast lesions

Over a 3 1/2-year period, we did 121 needle-localized breast biopsies for nonpalpable, mammographically suggestive lesions. The presence of a mass lesion on mammography with or without microcalcifications was associated with malignancy more frequently than microcalcifications alone. In 15 cases (12.4%), biopsy showed malignancy; 13 patients had modified radical mastectomy, with 11 (85%) having no histologic evidence of axillary metastases. Evaluation of risk factors associated with breast cancer in those patients with positive biopsy results showed that advanced age and a past history of a breast cancer were present in a significant number of patients. Four patients (3.5%) had complications; a hematoma developed in one (0.8%), and three (2.7%) required a second biopsy to remove the suggestive mammographic lesion. We conclude that needle-localized breast biopsy is a reliable tool in detecting early breast carcinoma. The procedure causes only minimal morbidity and we believe it should be done in all patients with mammographically suggestive, nonpalpable breast lesions.     

钼靶和MR诊断乳腺纯黏液腺癌

目的 探讨乳腺纯黏液腺癌钼靶及MRI影像学特征。方法 回顾性分析25例经手术病理证实为乳腺纯黏液腺癌患者的资料,11例接受MR检查,17例接受钼靶检查,其中3例同时接受MR及钼靶检查。结果 17例纯黏液腺癌钼靶表现包括：肿块10例,肿块伴微钙化3例,不对称影1例,不对称影伴微钙化2例,钼靶阴性1例。13例以肿块（或伴钙化）为表现的病灶中,6例为高密度,7例为等密度。11例纯黏液腺癌MRI表现包括：9例病灶呈肿块样强化,其中8例呈边缘环形强化,1例早期不均匀强化、晚期均匀强化;2例呈非肿块样强化,均呈段样分布;所有病灶动态增强曲线均为流入型,TIRM及T2-FS序列均为高信号或等高混杂信号。结论 乳腺纯黏液腺癌钼靶多表现为等密度肿块,MRI长TE序列高信号及动态增强序列边缘环形强化较具特征性。