钼靶X线引导下定位FNAC或CNB及其对乳腺微小病变的诊断价值

目的探讨钼靶X线引导下定位细针穿刺抽吸细胞学检查(fineneedleaspirationcytology,FNAC)或针芯组织学活检术(coreneedlebiopsy,CNB)及其对乳腺微小病变的诊断价值。方法经病理证实的34例35个乳腺微小病变均先行常规钼靶X线摄片,再在钼靶X线引导下定位FNAC或CNB。以手术病理为金标准回顾性分析35个乳腺微小病变的初期钼靶X线诊断率和中期钼靶X线诊断率。随机抽取经手术病理证实的30例30个未行钼靶X线引导下定位FNAC或CNB的乳腺微小病变作为对照。结果钼靶X线引导下35个病变FNAC或CNB均定位成功。2组初步钼靶X线的正确诊断率分别为60%和53.3%(P>0.5),无明显差异。研究组中期钼靶X线的正确诊断率与对照组初步钼靶X线的正确诊断率分别为82.9%和53.3%(P<0.05),有明显差异。结论钼靶X线引导下定位FNAC或CNB操作过程简便、经济、安全,定位准确率高。中期钼靶X线正确诊断率明显提高。     

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。     

全数字化乳腺X线立体定位活检技术对早期乳腺癌诊断及治疗的指导意义

目的 探讨全数字化乳腺X 线立体定位活检技术对早期乳腺癌的诊断及治疗价值.方法回顾性总结40 例临床未触及病变,仅通过X线摄影发现乳腺微小病变的患者,应用全数字化X 线立体定位导丝导向切除活检术及核心针穿刺活检术. 结果 28 例导丝定位患者中,27例一次性成功,成功率达96.4%.12例乳腺核心针穿刺活检,1例乳腺癌漏诊,无乳腺癌误诊病例.结论 应用全数字化乳腺X线机及配套的立体定位活检系统,可有效提高对早期乳腺癌的诊断能力,并为其微创手术治疗提供精确的导向作用.     

乳腺少见肿瘤影像分析

目的　评价乳腺少见肿瘤的影像学特点。方法　回顾分析经手术及病理证实 11例少见乳腺肿瘤影像学表现。结果　11例乳腺肿瘤中 ,非何杰金氏淋巴瘤 1例 ,恶性多形性腺瘤 1例 ,乳腺原发性鳞癌 1例 ,骨肉瘤 1例 ,叶状囊肉瘤 2例 ,错构瘤 5例。骨肉瘤特征表现为 :肿块中有象牙骨组织 ,恶性多形性腺瘤表现为较大肿块 ,边界清楚 ,周边血管增粗。叶状囊肉瘤为低度恶性肿瘤 ,病程长 ,肿块大 ,边界清楚 ,内有粗大钙化 ,周围有宽窄不一透亮带 ,通常无腋下淋巴结转移。错构瘤的特征表现是 :瘤体密度高度不均 ,高密度区域呈岛屿状分布 ,包膜完整。原发性乳腺鳞癌及非何杰金氏淋巴瘤无特征性表现。结论　乳腺少见肿瘤影像无明显特征性 ,需综合分析才有可能作出定性诊断     

Imaging Tips to Recognize Primary Breast Angiosarcoma

Teaching Point: Primary breast angiosarcoma should be in the differential of a breast mass with rapid growth. It typically appears intensely vascularized and non-calcified, predominantly hyperechoic, and hyperintense on T2-weighted MRI.     

超声引导下乳腺隐匿性病灶的穿刺定位

目的：探讨超声引导下乳腺隐匿性病灶的穿刺定位术的价值。材料和方法：对131处乳腺隐匿性病灶施行穿刺定位术。重点讨论适应证、方法学等，并与钼钯摄片立体定位术进行比较。结果：乳癌2个，乳腺良性病变129个，最小病灶直径4mm，所有定位均成功，无并发症。结论：超声引导下穿刺定位术是一个准确而易耐受的有效方法，目前，我院已取代了钼钯摄片立体定位术。     

动态光学乳腺成像技术诊断乳腺癌指标初探

目的：动态光学乳腺成像技术（dynamic optical breast imaging,DOBI）对乳腺癌诊断指标进行初步探讨。材料和方法：接受DOBI及乳腺活检的患者共52例,均为女性。乳腺癌组19例,非乳腺癌组33例。结果：非乳腺癌感兴趣区内的“蓝色病灶”85．42％为漂移或发散,而乳腺癌68．42％为聚焦;非乳腺癌的“蓝色病灶”代谢曲线86．46％为平缓下降或呈波浪状,而乳腺癌以直线下降为多,达57．37％;64．58％非乳腺癌感兴趣区内的“蓝色病灶”代谢曲线与非蓝区代谢曲线相同,78．95％乳腺癌患者的代谢曲线与非蓝区代谢曲线不同;乳腺癌患者“蓝色病灶”代谢值（平均值为-5．77&#177;2．13）的绝对值明显高于非乳腺癌患者（平均值为-3．34&#177;0．87;P〈0．05）。结论：DOBI空间特征的局限、聚焦且稳定、代谢曲线呈陡直下降对恶性或可疑恶性病变诊断价值更大,其次为代谢值的绝对值较大（多大于｜-5｜）。     

Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database

PurposeThe aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic.MethodsScreening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods.ResultsIn total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers.ConclusionsCOVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.     

Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging

Breast cancer remains the most common nonskin cancer, the second leading cause of cancer deaths, and the leading cause of premature death in US women. Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older. A mortality reduction of 40% is possible with regular screening. Treatment advances cannot overcome the disadvantage of being diagnosed with an advanced-stage tumor. The ACR and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy. Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals. Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women. Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular. Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy. Benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis. Although recall and biopsy recommendations are higher with more frequent screening, so are life-years gained and breast cancer deaths averted. Women who wish to maximize benefit will choose annual screening starting at age 40 years and will not stop screening prematurely.