乳腺钼靶X线立体定位穿刺活检和手术

1992年7月～1993年9月间,对56例乳腺疾病患者进行钼靶摄片,发现56例57处病灶,对其中54例55处病灶进行了立体定位细针穿刺细胞学检查。结果显示其敏感性为92.5％,特异性为100％,诊断符合率为96.3％。若将细胞学检查结果与钼靶摄片相结合,联合敏感性与特异性均可达100％。上述病灶中有12处为临床所不能扪及的隐匿性病灶,6处在立体定位引导下完成了切除术。     

X线立体定位活检对乳腺微小病变的诊断价值

目的:探讨乳腺摄片结合立体定位穿刺活检对临床触诊阴性的乳腺微小病变的诊断价值。方法:回顾性分析80例临床触诊阴性而乳腺摄片发现微小病变并进行立体定位穿刺活检患者的病例资料。结果:80例中乳腺癌30例(37.5%),原位癌8例、临床Ⅰ期22例,不典型增生10例;良性病变40例,包括纤维腺病10例,纤维瘤8例,乳腺增生病伴显微囊肿8例,乳腺增生病伴部分纤维腺瘤变10例,导管内乳头状瘤3例,错构瘤1例。结论:对临床触诊阴性的乳腺微小病变应积极活检,X线立体定位活检术是提高早期乳腺癌检出率的有效方法。     

立体定位核芯针活检在乳腺疾病诊断中的应用研究

目的探讨乳腺微小病变行立体定位核芯针活检（SCNB）的临床应用价值。方法采用计算机辅助乳腺三维立体定位系统、弹射式活检枪和16G核芯针，对47例乳腺X线发现的可疑恶性病变直接行穿刺活检，记录每例的临床和X线表现（钙化、结节、结构紊乱等）、穿刺活检诊断、外科术后病理诊断或随访观察资料。比较SCNB与外科手术二者的病理诊断结果，统计其诊断符合率。对照分析SCNB准确性与病灶X线表现的关系，分析SCNB成败、误诊原因。结果欲行SCNB47例，成功完成44例，未能完成3例。31例患者随后行外科手术，SCNB诊断与术后病理符合27例，4例SCNB与术后病理不符。结论SCNB具有准确、快速、微创等优势，可减少手术活检数量，及早确诊乳腺疾病，具有良好的临床应用前景。     

乳腺导管内肿瘤钼靶X线诊断

乳腺导管造影检查是诊断乳腺导管内肿瘤的主要方法，现将近几年我们所见的32例经手术病理证实的导管内肿瘤报告如下。     

钼靶X线定位穿刺留置导丝活检对乳腺微小病灶的诊断价值

目的探讨乳腺X线定位穿刺留置导丝活检术对乳腺微小病灶的诊断价值。方法回顾分析临床触诊阴性而乳腺钼靶X线片显示的微小病灶28例,采用乳腺钼靶X线定位下穿刺,留置导丝于微小病灶区,引导手术将病灶切除活检。结果28例微小病灶均一次性定位成功,定位满意率93%,手术切除完整。病理检查:恶性病变9例,其中浸润性导管癌5例,导管内癌伴早期浸润1例,导管内癌2例,髓样癌1例;良性病变19例。结论乳腺钼靶X线定位穿刺留置导丝活检术,定位准确,诊断明确,能确定乳腺微小病灶的性质,是目前诊断早期乳腺癌的有效方法。     

乳腺肿瘤的钼靶X线诊断

目的　明确乳腺肿瘤的钼靶摄影 (mammography)征象 ,评价钼靶在早期乳腺癌诊断中的价值。 方法　总结分析我院从1 760例乳腺疾病钼靶X线摄影中检出并经手术和病理证实为乳腺肿瘤 1 67例 ,其中乳腺良性肿瘤 1 2 4例 ,乳腺癌 43例。结果　①43例乳腺癌的钼靶X线征象 ,圆形 ,不规则形肿块 2 6例 ,占 60 .46 % ,X线测量肿块比值小于临床 ;微小钙化 1 5例 ,占 34 .88% ;局部浸润 2例 ,占 4 .65 %。②良性乳腺肿瘤钼靶X线征象 ,多为圆形、椭圆形肿块 ,周边透明晕征。X线测量肿块比值大于临床。结论　乳腺钼靶X线在乳腺肿瘤检查中 ,特别对早期乳腺癌的诊断很有价值。乳腺癌的主要直接征象和间接征象在乳腺癌的早期诊断中具有重要意义     

乳腺X线立体定位细针引导切检术的临床应用

目的 重点阐述乳腺X线立体定位细针引导切检术在临床不可触及的乳腺病变应用中的操作技术要点.方法 127例临床触诊阴性、乳腺X线片显示可疑病变的患者,在X线立体定位引导下,将导丝滞留在病变处.外科医生将带有导丝的病变切除并送病理检查.结果 良性病变43例,其中腺纤维瘤12例,囊性增生9例,间质纤维组织增生8例,导管内乳头状瘤8例,慢性炎症4例,错构瘤1例,囊肿1例;恶性病变84例,其中浸润性导管癌48例,导管内癌31例,浸润性小叶癌5例.127例患者中116例定位满意,满意率为91.3%.同时与直接手术的48例患者比较病变切除的准确性,差异具有统计学意义(χ2=28.998,P<0.005).结论 行乳腺X线立体定位细针引导切检术的临床触诊阴性患者手术切除病变的准确性明显优于直接手术的患者.     

全数字化乳腺摄影技术的临床应用

目前，乳腺癌发病率呈逐年增多之势，严重威胁着妇女健康．在我国各大城市占女性恶性肿瘤发病率的首位。早期发现、早期诊断、早期治疗是提高乳腺癌患者生存率，提高生存质量的关键。据资料统计早期乳腺癌生存率可达95％，而晚期仅为6％。因此，及时准确地检出和早期治疗是极为重要的。随着数字化信息技术和网络技术的迅猛发展，医学影像技术也发生了日新月异的变化。越来越多的医院开始使用数字化设备，乳腺摄影技术也实现了数字化成像，并开始逐渐替代传统屏-片乳腺摄影。本文就数字化乳腺摄影与传统屏-片乳腺摄影进行对比分析，以探讨数字化乳腺摄影的临床应用价值。     

数字化三维立体导丝定位穿刺技术在乳腺微小病灶中的应用

目的:探讨数字化三维立体导丝定位穿刺术对乳腺微小病灶的诊断价值。方法:回顾性分析临床触诊阴性而影像学表现异常的患者41例(乳腺微小病灶43处),41例均行乳腺数字化三维立体导丝定位穿刺切除并进行病理学检查。结果:43处微小病灶均定位成功,病变完全切除。病理检查:恶性病变8处,其中原位癌3处,浸润性导管癌Ⅰ～Ⅱ级3处,导管内癌伴早期浸润1处,浸润性导管癌伴腋下淋巴结转移1处;良性病变35处。结论:乳腺数字化三维立体导丝定位穿刺技术定位准确、损伤小、诊断符合率高,是治疗乳腺微小病变的重要手段,也是发现早期乳腺癌的重要方法。     

Screen-film mammographic technique for breast cancer screening

The values of dose and signal-to-noise ratio (SNR) for many techniques and breast thicknesses were computed and compared with a reference technique and breast thickness to provide a valid basis upon which to select a screening technique for screen-film mammography. The reference consisted of a Min-R/OM1 combination (or its equivalent) exposed through a 4.5-cm thick breast via 28 kV and a molybdenum target-beryllium window tube with a 0.03-mm Mo filter. Radiographs of an improved breast phantom were used to relate computed relative SNR values of techniques to diameters of the smallest calcific and soft-tissue objects demonstrated in mammograms. Without use of a grid, four Mo target/filtration combinations yielded similar computed dose and SNR levels, as did a tungsten target tube operated at 23 kV without a filter. Operation of the latter tube at 27.5 kV with a 0.051-mm rhodium filter should reduce dose by half but also SNR by 22%. However, such operation with a grid should greatly improve imaging moderate to large breasts without increasing dose over reference values.     

Preoperative localization using a bidimensional mammographic technique of non-palpable lesions of the breast

It is widely known how the early diagnosis and treatment of breast cancer may lead to better prognosis. When a non-palpable breast lesion detected with mammography is correctly localized with fine-needle biopsy under X-ray guidance, the surgeon can easily remove the lesion while preserving normal breast tissue. In such cases, histology is also possible. The authors describe an easy bidimensional technique for the preoperative localization of occult nonpalpable breast lesions with a fine-needle. The procedure is feasible also with out-of-date equipment and does not cause any discomfort to the patients. It should be performed on all women with mammographic suspicion of non-palpable breast lesion. From January through December 1989 the authors performed 64 preoperative fine-needle biopsies of clinically-occult breast lesions. The presence of a lesion associated with microcalcifications was found to be indicative of malignancy more often than in the case of microcalcifications or lesions alone. Of 64 cases, histology demonstrated malignancy in 31 patients.     

32层螺旋CT三维重组在急性阑尾炎诊断及鉴别诊断中的价值

目的：探讨32层螺旋CT三维重组诊断急性阑尾炎的临床应用。方法：搜集60例临床拟诊急性阑尾炎的病例,采用32层螺旋CT进行扫描,以1.25mm层厚行薄层多平面容积重组图像后处理,总结分析其CT表现,并将诊断结果与手术及病理结果进行对照。结果：60例患者中,诊断为急性阑尾炎54例,右侧腹股沟疝1例,右侧输尿管下段结石1例,胆囊炎1例,结肠肿瘤1例,假阴性2例。其中CT表现为阑尾水肿、增粗、管壁增厚者52例,阑尾腔内肠石10例,阑尾周围炎45例,回盲部壁增厚12例,阑尾脓肿2例,阑尾穿孔2例,其中1例并发腹膜炎及麻痹性小肠梗阻。结论：急性阑尾炎有典型的CT表现,32层螺旋CT三维重组及图像后处理技术能从不同角度显示阑尾及其周围情况,在急性阑尾炎的诊断和鉴别诊断中,有较高的临床应用价值。     

Nonpalpable breast lesions: accuracy of prebiopsy mammographic diagnosis

Mammograms of 220 patients who underwent spot localization for removal of nonpalpable breast lesions were reviewed for accuracy of interpretation. Results of subsequent biopsy indicated malignancy in 77 cases. The interpretations of mammograms obtained before biopsy were incorrect in 71 cases (27 false-negative and 44 false-positive studies). Among the false-negative cases, 70% of the abnormalities were determined histologically to be noninfiltrative cancers. An aggressive screening program with preoperative localization and biopsy is needed in questionable cases, since mammographic signs of early or nonpalpable malignancy are often subtle and nonspecific.     

磁共振扩散加权成像在乳腺病变诊断中的应用

目的：探讨单纯磁共振扩散加权成像对诊断乳腺病变的临床应用价值。方法：对临床拟诊为乳腺肿块的37例患者行磁共振扩散加权成像检查,并获得病理证实,其中良性病灶18个,恶性病灶19个。描记扩散图像上病变的兴趣区,由软件计算获得表观扩散系数（ADC）值。对获取数据进行统计分析,采用t检验对良性和恶性病变的ADC值进行比较。结果：12例良性病变在DWI上呈等信号或高信号,但ADC值升高或下降不明显,6例良性病变DWI上呈高信号,ADC值明显下降;19例恶性肿瘤DWI上呈高信号,ADC值明显下降。良性病变组ADC值为（1.474±0.441）×10^-3mm^2/s,恶性病变组ADC值为（1.082±0.160）×10^-3mm^2/s,两者间差异有显著性意义（P=0.002）。结论：MR扩散加权成像ADC值测量在乳腺病变定性诊断中有一定的辅助诊断价值。     

Clinical, mammographic and ultrasonographic features of blunt breast trauma

Evaluation of acute breast injury depends largely on the findings at physical examination. Patients may not initially remember the traumatic event to the breast, and mammography may be the first radiographic study to suggest this history, particularly if it shows findings of fat necrosis. Clinical, mammographic and sonographic findings resulting from non-iatrogenic trauma to the breast can be mistaken for signs of malignancy, especially because trauma often is not considered as a cause for such findings. In this paper some of the manifestations of blunt traumatic injury to the breast are presented. Familiarity with mammographic and sonographic findings of breast trauma is essential for the radiologist to avoid unnecessary biopsy and to avoid overlooking breast cancer.