对比增强乳腺X线摄影强化特征对乳腺癌的诊断价值

目的 探讨对比增强乳腺X线摄影(CESM)强化特征对乳腺癌的诊断价值.方法 将临床怀疑乳腺异常病变的69例患者纳入研究.所有患者均完成CESM检查.由3位有经验的乳腺影像诊断医师对所有图像进行分析,分析乳腺病变的强化类型及强化程度,肿块强化观察病变形态、密度及边缘,非肿块强化观察病变分布类型.对照病理结果分析强化特征与...     

乳腺密度评估:使用全自动软件一对一比较数字乳腺X线摄影和数字乳腺体层摄影

正摘要目的使用全自动化软件比较数字乳腺X线摄影和数字乳腺体层摄影(DBT)的乳腺密度。方法该研究获得机构批准并得到全部参与者的知情同意,每位参与者均进行DBT和全视野乳腺X线摄影(FFDM)。通过软件计算两种检查的乳腺密度百分比。结果50例连续病人(平均51岁,35~83岁)接     

屏胶乳腺X线摄影和数字化乳腺X线摄影的对比研究

数字乳腺X线摄影（DM）较屏胶乳腺X线摄影（SFM）具有更多的优势,其对于图像的获取、储存和显示都是相互分离的,每个系统都能优化产生最佳效果,而且数字图像能够由计算机处理并显示为多种形式。因此,DM系统正逐渐替代SFM系统并成为筛查及诊断乳腺癌的常规手段。就DM和SFM的成像原理、图像质量、图像处理以及临床应用进行比较。     

屏胶乳腺X线摄影和数字化乳腺X线摄影的对比研究

数字乳腺X线摄影(DM)较屏胶乳腺X线摄影(SFM)具有更多的优势,其对于图像的获取、储存和显示都是相互分离的,每个系统都能优化产生最佳效果,而且数字图像能够由计算机处理并显示为多种形式。因此,DM系统正逐渐替代SFM系统并成为筛查及诊断乳腺癌的常规手段。就DM和SFM的成像原理、图像质量、图像处理以及临床应用进行比较。     

乳腺锥光束CT平扫与数字乳腺X线摄影对乳腺病灶检出及定性比较

目的 探讨锥光束乳腺CT(CBBCT)平扫与数字乳腺X线摄影(DM)对乳腺病灶的检出情况及定性情况,研究CBBCT平扫是否较DM更适于临床诊断需要.方法 回顾性分析2020年10月至2021年1月同时接受CBBCT平扫和DM检查的患者,患者均为女性且行病理检查.结果 CBBCT平扫共检出83个病灶,DM共检出67个病灶...     

数字钼靶X线乳腺摄影技术研讨

乳腺检查有较多方法，有超声，红外线等，但钼靶X线乳腺摄影仍是目前诊断乳腺疾病的一种较为精确的重要手段，对于观察乳腺肿瘤，钙化以及血管分布等具有不可替代的重要的诊断价值，为了进一提高钼靶X线摄影技术，我们对钼靶X线乳房摄影技术问题进行研讨。     

数字乳腺X线机与传统乳腺X线机的临床应用对比研究

目的　初步探讨数字乳腺X线机与传统乳腺X线机的临床应用效果。方法　系统回顾 2 0 0 0年 6～ 12月连续 80 0例使用传统乳腺X线机和 2 0 0 1年 1～ 8月连续 812例使用数字乳腺X线机的临床及影像资料 ,分别统计各组的摄影体位、曝光次数及检查时间 ,并将术前诊断与病理对照。结果　传统乳腺机组平均摄影体位 4 87个 /人 ,平均曝光时间 5 16次 /人 ,平均检查时间15 2min/人。数字乳腺机组平均摄影体位 4 14个 /人 ,平均曝光次数 4 3 8次 /人 ,平均检查时间5 4min/人。差异均有显著意义 (t值分别为 2 147、2 149、16 2 5 ,P均 <0 0 5 )。病理结果显示传统乳腺机组恶性病变 74例 ,良性病变 83例 ,数字乳腺机组恶性病变 71例 ,良性病变 44例。传统乳腺机与数字乳腺机诊断乳腺癌的敏感度、特异度、准确度分别为 82 4%、87 3 % ;80 7%、84 1% ;81 5 %、86 1%。结论　虽然数字乳腺机对乳腺癌诊断的敏感度、特异度和准确度的提高尚不显著 ,但与传统乳腺机对比 ,数字乳腺机减少了摄影体位和曝光次数 ,缩短了检查时间     

乳腺钼靶X线摄影技术的临床应用

乳腺铝靶X线摄影,是针对乳腺本身的组织结构以腺体和脂肪为主,密度对比小的特点,以金属钼为靶面,在管电压40KV以下,产生低能X线.是一种专门应用于乳腺检查的特殊X摄影技术.     

数字化乳腺摄影与普通钼靶摄影在小乳癌诊断中的对比分析

目的：探讨数字化乳腺摄影在小乳癌诊断中的优越性。方法：经手术病理证实的小乳癌57例，采用数字化乳腺摄影及普通钼靶摄影方法。结果：数字化乳腺摄影诊断51例，其敏感性、特异性、准确性分别为89．4％、95．O％、90.9％；普通钼靶摄影术前诊断46例，其敏感性、特异性、准确性分别为80．7％、85．O％、81．8％。结论：在小乳癌诊断中。数字化乳腺摄影在敏感性、特异性、准确性方面均优于普通钼靶摄影。     

数字乳腺断层摄影及其合成二维影像技术在乳腺癌筛查中的研究进展

目前乳腺X线检查仍是乳腺癌早期诊断的有效检查方法之一,主要包括全视野数字化乳腺摄影（FFDM）、数字乳腺断层摄影（DBT）、合成乳腺X线摄影（SM）以及3种技术的联合应用（FFDM联合DBT、SM联合DBT）。对DBT、SM和SM联合DBT在乳腺筛查中诊断效能、影像质量及辐射剂量等进行比较。SM联合DBT可有效平衡辐射剂量和诊断效能,但仍然在判读时间、信息的存储与传输和检查成本方面存在局限性。就以上3种检查技术在乳腺癌筛查中的研究进展予以综述。     

Digital versus screen-film mammography: a retrospective comparison in a population-based screening program

Background

Digital radiography has several advantages over screen-film radiography in data storage and retrieval, making it an attractive alternative to screen-film radiography in screening mammography programs, if it performs as well.

Methods

We retrospectively compared screen-film mammography, photon-counting direct radiography, and computed radiography with population-based screening data from the Breast Unit at Helsingborg Hospital, Sweden, collected between January 2000 and February 2005. Outcomes were cancer detection rates, recall rates, and positive predictive values for breast cancer detection in women reappearing for screening.

Results

Data were available for 52,172 two-view mammography examinations of 24,875 women. No initial screening (prevalence) examinations were included. Cancer detection rates based on mammographic findings were 0.31% (81/25,901) for film, 0.49% (48/9841) for photon-counting, and 0.38% (63/16,430) for computed radiography. The recall rate for film was 1.4%, which was significantly higher than that for PC-DR (1.0%; P < 0.001) and computed radiography (1.0%; P < 0.001). The positive predictive value was lower for film (22%) than for photon-counting (47%; P < 0.001) and computed radiography (39%; P < 0.001). In addition, the average glandular dose was 1.1 mGy for film, 0.28 mGy for photon-counting and 0.92 mGy for computed radiography. Thus, photon-counting provided a 75% dose reduction, and computed radiography a 16% dose reduction, over film.

Conclusions

Digital radiography, especially photon-counting, performs as well as or better than screen-film radiography. Given the advantages related to improved data storage and communication, digital radiography seems to be a valid alternative to screen-film radiography.     

Image quality, lesion detection, and diagnostic efficacy in digital mammography: full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

OBJECTIVE: To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. MATERIALS AND METHODS: In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. RESULTS: For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p<0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. CONCLUSION: Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.     

Tomosynthesis and contrast-enhanced digital mammography: recent advances in digital mammography

Digital mammography is more and more replacing conventional mammography. Initial concerns about an inferior image quality of digital mammography have been largely overcome and recent studies even show digital mammography to be superior in women with dense breasts, while at the same time reducing radiation exposure. Nevertheless, an important limitation of digital mammography remains: namely, the fact that summation may obscure lesions in dense breast tissue. However, digital mammography offers the option of so-called advanced applications, and two of these, contrast-enhanced mammography and tomosynthesis, are promising candidates for improving the detection of breast lesions otherwise obscured by the summation of dense tissue. Two techniques of contrast-enhanced mammography are available: temporal subtraction of images acquired before and after contrast administration and the so-called dual-energy technique, which means that pairs of low/high-energy images acquired after contrast administration are subtracted. Tomosynthesis on the other hand provides three-dimensional information on the breast. The images are acquired with different angulations of the X-ray tube while the object or detector is static. Various reconstruction algorithms can then be applied to the set of typically nine to 28 source images to reconstruct 1-mm slices with a reduced risk of obscuring pathology. Combinations of both advanced applications have only been investigated in individual experimental studies; more advanced software algorithms and CAD systems are still in their infancy and have only undergone preliminary clinical evaluation.     

Breast cancer detection: Comparison of digital mammography and digital breast tomosynthesis across non-dense and dense breasts

IntroductionBreast density is associated with an increase in breast cancer risk and limits early detection of the disease. This study assesses the diagnostic performance of mammogram readers in digital mammography (DM) and digital breast tomosynthesis (DBT).MethodsEleven breast readers with 1–39 years of experience reading mammograms and 0–4 years of experience reading DBT participated in the study. All readers independently interpreted 60 DM cases (40 normal/20 abnormal) and 35 DBT cases (20 normal/15 abnormal). Sensitivity, specificity, ROC AUC, and diagnostic confidence were calculated and compared between DM and DBT.ResultsDBT significantly improved diagnostic confidence in both dense breasts (p = 0.03) and non-dense breasts (p = 0.003) but not in other diagnostic performance metrics. Specificity was higher in DM for readers with >7 years' experience (p = 0.03) in reading mammography, non-radiologists (p = 0.04), readers who had completed a 3–6 months training fellowship in breast imaging (p = 0.04), and those with ≤2 years’ experience in reading DBT (p = 0.02), particularly in non-dense breasts.ConclusionDiagnostic confidence was higher in DBT when compared to DM. In contrast, other performance metrics appeared to be similar or better with DM and may be influenced by the lack of experience of the reader cohort in reading DBT.Implications for practiceThe benefits of DBT may not be entirely accrued until radiologists attain expertise in DBT interpretation. Specificity of DBT varied according to reader characteristics, and these characteristics may be useful for optimising pairing strategies in independent double reading of DBT as practiced in Australia to reduce false positive diagnostic errors.     

Follow-up and final results of the Oslo I Study comparing screen-film mammography and full-field digital mammography with soft-copy reading

Purpose: To compare cancer detection rates of screen-film (SFM) and full-field digital mammography (FFDM) with soft-copy reading in a screening program including the initial positive scores for interval cancers and cancers in the subsequent screening round, and to analyze the false-negative FFDM interpretations.

Material and Methods: Using a paired study design, 3683 women underwent SFM and FFDM in a population-based screening program. Two standard views of each breast were acquired. The images were interpreted without previous films for comparison. Independent double reading using a 5-point rating scale for probability of cancer was used for each modality. An examination was defined as positive if at least one of the two independent readers scored 2 or higher on the 5-point rating scale. SFM-positive cases were discussed in a SFM consensus meeting and FFDM-positive cases in a separate FFDM consensus meeting before recall. The study population was followed for more than 2 years so that interval cancers and screen-detected cancers in the subsequent screening round could be included. Cancer detection rates were compared using the McNemar test for paired proportions. The kappa statistic and Wilcoxon signed-rank test for matched pairs were used for comparing rating scores. The reading time was recorded for all FFDM interpretations.

Results: A total of 31 cancers (detection rate 0.84%) were diagnosed initially, of which SFM detected 28 and FFDM 23 (McNemar test P = 0.23, discordant pair 8 and 3). Two cancers with a positive score at initial SFM reading and three with a positive score at initial FFDM reading were dismissed at SFM and FFDM consensus meetings, respectively. The difference in cancer detection after recall (discordant pair 11 and 5) was not significant (McNemar test, P = 0.21). Of the 10 interval cancers and 16 screen-detected cancers in the subsequent round, 3 had true-positive SFM scores while 4 had true-positive FFDM scores in the initial reading session. A total of 38 cancers therefore had a positive result at double reading at one or both modalities, 31 at SFM and 27 at FFDM (McNemar test, P = 0.48). Comparison of SFM and FFDM interpretations using the mean score for each case revealed no statistically significant difference between the two modalities (Wilcoxon signed-rank test for matched pairs; P-value = 0.228). Two initial round cancers (one tumor found incidentally at work-up for a mass proved to be a simple cyst with a positive score at FFDM but a negative score at SFM, and one tumor with positive score at SFM but negative score at FFDM due to positioning failure) were excluded from the further analysis. Excluding these two cancers from comparison, there were 31% (22 of 72) false-negative SFM and 47% (34 of 72) false-negative FFDM individual interpretations. The overall mean interpretation time for normal FFDM examinations was 45 s. For most false-negative FFDM results, the reading time was shorter or longer than for normal examinations. The recorded FFDM interpretation time was noticeably short for several overlooked cancers manifesting as microcalcifications (ductal carcinoma in situ).

Conclusion: There is no statistically significant difference in cancer detection rate between SFM and FFDM with soft-copy reading in a mammography screening program. Analysis of cancers missed at FFDM with soft-copy reading indicates that close attention has to be paid to systematic use of image display protocols.     

Full-field digital mammography compared to screen film mammography in the prevalent round of a population-based screening programme: the Vestfold County Study

The purpose of the study was to compare the performance of full-field digital mammography (FFDM) with soft-copy reading to screen film mammography (SFM) used during the first prevalent 2-year round of population-based screening. A total of 18,239 women aged 50–69 years were screened with FFDM as part of the Norwegian Breast Cancer Screening Programme (NBCSP). Process indicators were compared to data from 324,763 women screened with SFM using the common national database of the NBCSP. The cancer detection rates were 0.77% (140/18,239) for FFDM and 0.65% (2,105/324,763) for SFM (p = 0.058). For ductal carcinoma in situ (DCIS) alone, the results were: FFDM 0.21% (38/18,239) compared to SFM 0.11% (343/324,763) (p < 0.001). Recall rates due to positive mammography were for FFDM 4.09% (746/18,239), while for SFM 4.16% (13,520/324,764) (p = 0.645), due to technically insufficient imaging: FFDM 0.22% (40/18,239) versus SFM 0.61% (1,993/324,763) (p < 0.001). The positive predictive value (PPV) in the FFDM group was 16.6% (140/843), while 13.5% (2,105/15,537) for SFM (p = 0.014). No statistically significant differences were recorded concerning histological morphology, tumour size, or lymph node involvement. In conclusion FFDM had a significantly higher detection rate for DCIS than SFM. For invasive cancers no difference was seen. FFDM also had a significantly higher PPV and a significantly lower technical recall rate.     

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women

IntroductionDigital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening.Materials and methodsAsymptomatic women aged 40–49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre.Results1227 women were recruited. 1221 first screens (604 2D, 617 2D + DBT) and 1124 second screens (558 2D + DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D + DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D + DBT (p = 0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D + DBT than 2D (p = 0.023).ConclusionThe addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.     

Breast tomosynthesis: A diagnostic addition to screening digital mammography

Objectives

Comparison between digital mammography alone and with adding digital breast tomosynthesis in breast cancer screening.