高频二维 三维彩超与X线钼靶联合应用对乳腺癌的诊断价值探讨

目的探讨高频二维、三维彩色多普勒超声与X线钼靶联合应用对乳腺癌的临床诊断价值。方法随机选取2014-01~2016-06在无锡惠山区人民医院和苏州市立医院东区均有钼靶和超声影像资料,并经手术和临床病理确诊为乳腺癌的患者59例,回顾性分析其临床资料,总结高频彩色多普勒超声联合X线钼靶临床诊断符合率。结果高频彩色多普勒超声和X线钼靶单独诊断乳腺癌的阳性符合率分别为84.74%和76.27%,均显著低于联合诊断93.22%的阳性符合率,组间比较差异有统计学意义(P0.05)。结论高频彩色多普勒超声与X线钼靶联合诊断乳腺癌阳性符合率得到显著提高,值得临床推广。     

彩色多普勒超声与钼靶X线检查在乳腺疾病诊断中的应用

目的探讨彩色多普勒超声检查（CDFI）和钼靶X线检查以及联合两种检查方法在乳腺疾病诊断及鉴别诊断中的应用价值。方法对245例乳腺疾病患者进行CDFI及钼靶X线的检查,并与术后病理结果对比分析。结果CDFI和钼靶x线对乳腺疾病的术前诊断率无明显差异,二者联合检测增加了恶性肿瘤的检出率。结论CDFI和钼靶X线检查各有其优缺点,联合应用对乳腺疾病的鉴别诊断具有重要价值。     

乳腺超声联合X线摄影在社区高危妇女乳腺癌筛查中的应用

目的探讨乳腺超声和X线两种检查在乳腺癌筛查中的应用价值。方法对2014年2月至2015年12月陕西省咸阳市35个社区的37 294名年龄30~65岁的女性进行乳腺癌临床和影像学筛查工作,利用受试者工作特征(ROC)曲线分析方法评价钼靶X线、超声及联合检查在乳腺癌筛查中的灵敏度和特异度。结果共筛查10 843名高危女性,检出乳腺癌患者43名,乳腺癌检出率为396.57/10万,其中X线检查出13例;乳腺超声检查出15例;乳腺超声联合X线检查出15例,钼靶X线、乳腺超声及联合检查的ROC曲线下面积分别为0.764、0.793、0.920;经Z检验,联合检查的准确性高于单线检查(P0.05),超声的诊断的准确性高于钼靶X线,但差异无统计学意义(P0.05)。结论在中国女性乳腺癌高危人群的乳腺癌筛查中,超声优于X线,二者联合可最大限度地提高乳腺癌筛查的准确性。     

多种影像学联合检查诊断早期乳腺癌的临床价值

目的探讨多种影像学联合检查诊断早期乳腺癌的临床价值。方法分析126例早期乳腺癌患者的彩色多普勒超声（彩超）、X线钼靶、CT、MRI检查结果 ,统计其与手术或穿刺活检病理诊断的符合率。结果与病理诊断乳腺癌的符合率为彩超88.9%、X线钼靶82.5%、CT80.9%、MRI 81.8%。结论彩超及X线钼靶诊断早期乳腺癌的敏感性较高,两者联用可提高其诊断率;CT及MRI检查可作为彩超及X线钼靶检查的重要补充。     

X线钼靶联合超声检查在乳腺肿块鉴别诊断中的价值

目的探讨X线钼靶联合超声检查在乳腺肿块鉴别诊断中的价值。方法选择女性BI-RADSⅣ级病变乳腺肿块患者100例。所有病例均经临床常规查体、X线钼靶检查、超声影像学检查,并与病理分析结果对比。回顾性分析X线钼钯检查、超声影像检查表现,总结两种检查方式的诊断特点,比较两者检查的准确率、漏诊率、误诊率。结果在肿块检出方面,X射线钼靶检查影像学特征主要为片状致密影、结节状影及钙化影等影像学表现,诊断阳性率为70.73%;超声检查表现多为内部呈现低回声的圆形、椭圆形肿块、中央部存在或不存在沙砾样的钙化结节影,边缘清晰或不清,诊断阳性率为83.73%,超声检出乳腺肿块的结果优于X线钼靶(P<0.05);两者联合检查时,阳性诊断结果提升至95.12%,与X线钼靶、超声单项检查相比,差异均具有统计学意义(P<0.05)。在钙化点的检出中,X线钼靶单独检查的诊断阳性率明显高于超声检查(P<0.05),两者联合应用诊断阳性率显著高于单独检查(P<0.05)。X线钼靶检查的诊断准确率为79.00%,误诊率为13.00%,漏诊率为8.00%;超声检查准确率为70.00%,误诊率为16.00%,漏诊率14.00%;两者联合应用诊断准确率明显高于单一检查,误诊率与漏诊率均明显低于单一检查(P<0.05)。结论超声影像与X线钼靶对乳腺BI-RADSⅣ级病变的检查均有部分的漏诊及误诊,对于一些诊断难点的鉴别诊断存在盲区,二者联合则可优势互补,减少乳腺BI-RADSⅣ级病变漏诊、误诊的发生,协助准确诊断乳腺良、恶性肿块。     

超声与X线钼靶联合应用对乳腺疾病定性诊断的价值

目的评价超声与X线钼靶检查对乳腺疾病定性诊断的价值。方法对128例女性术前乳腺触及肿块,均经超声与X线钼靶两者检查行定性诊断,与术后病理对照分析。结果超声对乳腺恶性肿块定性诊断准确性为94.4%,X线钼靶为91.6%,两者结合诊断准确率为97.2%,超声对良性病变定性高于X线摄影。结论两者结合能提高乳腺良恶性病变诊断的准确率,及早发现早期乳腺癌。     

数字化钼靶、超声、MRI及MR扩散加权在老年乳腺肿瘤中的临床诊断价值

目的 探讨临床乳腺肿瘤常规影像检查方法的准确率.方法 收集330例患者,均经手术病理证实并与病理结果对照.行数字化钼靶检查患者300例,超声检查330例,MRI检查110例,MR扩散加权检查80例.结果 数字化钼靶、超声、MRI及MR扩散加权的准确率分别为73.67%,79.09%,85.45%.91.25%.钼靶X线结合超声诊断准确率为91%,钼靶X线结合MRI诊断准确率为94.54%,再结合MR扩散加权诊断准确率为97.5%,超声结合MRI诊断准确率为93.63%,再结合MR扩散加权诊断准确率为96.25%.结论 初级乳腺检查方法钼靶x线或者超声检查结合MRI和MR扩散加权将大大提高诊断准确率.     

宜昌市2011～2015年乳腺癌流行趋势及不同筛查方案检出情况

目的了解宜昌市2011~2015年乳腺癌流行趋势及不同筛查方案检出情况。方法采用乳腺超声和钼靶X线检查宜昌市30岁以上妇女中乳腺癌发病情况,分析其流行趋势,并比较不同筛检方案的检出率。结果 2011~2015年乳腺癌检出率依次为49.39/万、48.01/万、51.98/万、54.05/万和52.50/万,乳腺癌检出率基本成上升趋势;2011~2015年乳腺癌检出率在30岁组和60岁以上组上升趋势明显;筛查检出肿瘤中以Ⅰ期、Ⅱ期为主;乳腺超声联合钼靶X线对乳腺癌的检出率为51.27/万,乳腺超声检出率为46.52/万、钼靶X线检出率为42.41/万,有统计学意义(P<0.05)。结论宜昌市2011~2015年乳腺癌呈上升趋势,30岁组妇女检出率上升明显,乳腺超声联合钼靶X线对乳腺癌的检出效果较优。     

乳腺癌的非典型钼靶X线表现及诊断策略

目的探讨乳腺癌的非典型钼靶X线表现,提高对该病的诊断率。方法搜集有病理结果的98例乳腺癌患者的非典型钼靶X线图像,分析归纳其特征,并结合病理、年龄、乳腺背景等进行综合分析。结果98例乳腺癌的非典型钼靶X线征象可分为5种类型:小肿块(直径≤10 mm)、细小钙化、局灶性非对称性致密影、结构扭曲、星芒征。结论钼靶X线检查对乳腺癌的非典型表现具有重要诊断价值,是对以钙化为主要表现的乳腺癌的可靠影像学检查方法,结合不同技术手段可进一步提高诊断符合率。     

多普勒超声及钼靶X线检查在老年不可触及乳腺病灶诊断中价值

目的探讨多普勒超声及钼靶X线检查在老年不可触及乳腺病灶早期诊断中的临床应用价值。方法收集78例超声检查结果存在不可触及乳腺病灶的老年患者,查体结果均为阴性,所有患者均接受多普勒超声和钼靶X线两种检查,检查结果病灶阳性患者接受外科切除手术及病灶组织活检,对比两种检查方法的早期诊断价值。结果 78例患者中,平均病灶的大小为(1.03±0.84)cm~2,组织活检结果中59例患者为良性病灶;7例为交界性病灶,癌变风险较高;12例患者为恶性,其中9例为导管内癌,3例为浸润性导管癌。超声与X线钼靶两种检查对不可触及乳腺病灶的早期诊断无统计学意义(P>0.05),而两种检查方法与活检结果存在统计学意义(P<0.05)。结论超声检查与钼靶X线检查对老年不可触及乳腺病灶早期诊断效果无明显差异,联合两种检查方法可对老年不可触及乳腺病灶的早期诊断更有诊断价值。     

Diagnostic tests in breast cancer. Clinical strategies based on diagnostic probabilities

Optimal diagnostic strategies used in screening for breast cancer and evaluating breast masses depend on the likelihood of malignancy, findings at physical examination, and the accuracy of tests and procedures. Results from published series, in conjunction with calculations of the probability of malignancy based on test results, indicate that only mammography is needed for screening. A clinical sequence for evaluating palpable breast masses should include a combination of mammography, ultrasound examination, and needle aspiration. In patients with negative findings, the probability of cancer will be sufficiently low to obviate the need for immediate surgical biopsy. However, if there are positive findings, or the initial clinical likelihood of malignancy is high, excision of the mass is indicated.     

Usefulness of mammoscintigraphy with thallium-201 single photon emission computed tomography to differentiate palpable breast masses of young Taiwanese women when comparing with mammography

Sixty young Taiwanese women with palpable breast masses detected by mammography and/or physical examinations underwent mammoscintigraphy with thallium-201 (Tl-201) single photon emission computed tomography (SPECT) to assess its value for differentiating breast masses. The results showed that 42 of the 45 cases of breast carcinoma were detected by Tl-201 SPECT mammoscintigraphy. Fourteen of the 15 of benign breast lesions were differentiated by Tl-201 SPECT mammoscintigraphy. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tl-201 SPECT mammoscintigraphy were 93%, 93%, 98%, 82%, and 93%, respectively. Thirty-eight of the 45 cases of breast carcinoma were detected by mammography. Twelve of the 15 of benign breast lesions were differentiated by mammography. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mammography were 84%, 80%, 93%, 63%, and 83%, respectively. We concluded that Tl-201 SPECT mammoscintigraphy significantly improves the accuracy when comparing with mammography for the differentiating breast cancer in Taiwanese women.     

Comparative Effectiveness of Digital Breast Tomosynthesis and Mammography in Older Women

BackgroundDigital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women.ObjectiveTo assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D) mammography among women 67–74 and women 75 and older.DesignCohort study.ParticipantsMedicare fee-for-service beneficiaries aged 67 years and older with no history of prior cancer who received a screening mammogram in 2015.Main MeasuresUse of subsequent imaging (ultrasound and diagnostic mammography) as an indication of recall, breast cancer detection, and characteristics of breast cancer at the time of diagnosis. Analyses used weighted logistic regression to adjust for potential confounders.Key ResultsOur study included 26,406 women aged 67–74 and 17,001 women 75 and older who were screened for breast cancer. Among women 75 and older, the rate of subsequent imaging among women screened with DBT did not differ significantly from 2-D mammography (91.8 versus 97.0 per 1,000 screening mammograms, p=0.37). In this age group, DBT was associated with 2.1 additional cancers detected per 1,000 screening mammograms compared to 2D (11.5 versus 9.4, p=0.003), though these additional cancers were almost exclusively in situ and stage I invasive cancers. For women 67–74 years old, DBT was associated with a higher rate of subsequent imaging than 2-D mammography (113.9 versus 100.3, p=0.004) and a higher rate of stage I invasive cancer detection (4.7 versus 3.7, p=0.002), but not other stages.ConclusionsBreast cancer screening with DBT was not associated with lower rates of subsequent imaging among older women. Most additional cancers detected with DBT were early stage. Whether detecting these additional early-stage cancers among older women improves health outcomes remains uncertain.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07132-6.KEY WORDS: comparative effectiveness, digital breast tomosynthesis, mammography, breast cancer, older women     

False-negative tests in breast cancer management

We review the sensitivity of different diagnostic tests for breast cancer management based on recent experience in a 34-year-old patient. False-negative tests at diagnosis of early disease and of relapse resulted in diagnostic and therapeutic delays. Initial mammography and breast ultrasonography were falsely negative despite a palpable breast lump. Clinical examination and axillary ultrasound missed macroscopically involved lymph nodes. At relapse, metastatic lesions were missed despite symptoms, three years after primary treatment. CA 15-3 was normal; bone and liver metastases were missed by standard and more advanced imaging techniques including liver ultrasonography, nuclear bone scan and PET -CT scan. Worsening of clinical symptoms, lab results and abnormal tissue biopsies finally led to the diagnosis of extensive metastatic disease. Genetic screening showed an abnormality within the BRCA-1 region of unknown clinical importance. This review highlights 1) that diagnostic tests managing symptomatic breast cancer patients may have a low sensitivity, 2) the importance of clinical findings and other markers for disease, such as lactate dehydrogenase and 3) the need for diagnostic biopsies for clinically suspect symptoms despite normal imaging and biochemistry.     

Breast cancer: evaluating mammography in early diagnosis

The high incidence of breast cancer among American women has made early diagnosis the focus of large scale research efforts. X-ray mammography plays a key role in achieving the goal of early diagnosis inasmuch as mammography is currently the best proven imaging modality for the diagnosis of breast cancer. Data demonstrating the efficacy and safety of mammography are summarized and radiographic features of breast cancer are outlined. Newer, more invasive methods used in conjunction with mammography are also discussed. It is hoped that the emphasis on practical considerations will enhance the understanding of the primary physician caring for women in order to increase the current under-utilization of mammography.     

超声与钼靶检查对乳腺疾病良恶性诊断的对比分析

目的系统、定量地评价超声及钼靶成像技术对乳腺疾病的诊断准确性及诊断特点,为乳腺疾病选择影像学检查提供有价值的指导。方法分析228例患者237个乳腺结节彩色多普勒超声及钼靶声像学特征,以病理组织结果为金标准,评价多普勒超声、钼靶以及两者联合对乳腺疾病良恶性诊断价值。结果本组病理检查结果良性188例（194个结节）,恶性40例（43个结节）;彩色多普勒超声诊断恶性病变灵敏度为46.5%,特异度为80.4%,正确率为74.2%;X线钼靶诊断乳腺恶性肿瘤的灵敏度为55.8%,特异度为75.2%,正确率为71.7%;两者结合诊断乳腺恶性肿瘤灵敏度为90.6%,特异度为89.6%,正确率为89.8%。结论多普勒超声及钼靶检查对乳腺肿块定性诊断均有较高价值,两者结合可提高鉴别乳腺肿瘤良恶性正确率,在临床诊断及制定治疗方案上有重要的指导价值。     

超声联合钼靶对早期浸润性乳腺癌豁免前哨淋巴结活检的价值分析

目的 分析超声联合钼靶检查对肿瘤直径≤2 cm早期浸润性乳腺癌患者豁免前哨淋巴结活检(SLNB)的价值.方法 选取重庆医科大学附属第一医院2018-01～2019-06肿瘤直径≤2 cm且术中行SLNB的122例早期浸润性乳腺癌患者,对其临床资料进行回顾性分析,收集超声、钼靶、MRI及SLNB的结果,分别与术后腋窝淋巴...     

Estrogen plus progestin and breast cancer detection by means of mammography and breast biopsy

BACKGROUND: The effect of combined hormone therapy on breast cancer detection is not established. METHODS: We examined the effect of combined hormone therapy on breast cancer detection in the Women's Health Initiative trial, which randomized 16,608 postmenopausal women to receive conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo. Mammography and breast examinations were performed at baseline and annually per protocol, with breast biopsies based on clinical findings. The effects of conjugated equine estrogens plus medroxyprogesterone acetate on breast cancer detection was determined throughout 5.6 years of intervention using receiver operating characteristic analyses to evaluate mammography results. RESULTS: Conjugated equine estrogens plus medroxyprogesterone acetate increased the cumulative frequency of mammograms with abnormalities vs placebo (35.0% vs 23.0%; P < .001), which had less sensitivity for cancer detection and increased cumulative breast biopsy frequency (10.0% vs 6.1%; P < .001). Although breast cancers were significantly increased and were diagnosed at higher stages in the combined hormone group, biopsies in that group less frequently diagnosed cancer (14.8% vs 19.6%; P = .006). After discontinuation of combined hormone therapy, its adverse effect on mammograms modulated but remained significantly different from that of placebo for at least 12 months (P < .001). CONCLUSIONS: Use of conjugated equine estrogens plus medroxyprogesterone acetate for approximately 5 years resulted in more than 1 in 10 and 1 in 25 women having otherwise avoidable mammogram abnormalities and breast biopsies, respectively, and compromised the diagnostic performance of both. This adverse effect on breast cancer detection should be incorporated into risk-benefit discussions with women considering even short-term combined hormone therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000611.     

Incidence of latent breast cancer in Japanese women

Detection of small or early neoplastic lesions is essential for the secondary prevention of cancer, and for this purpose information concerning their incidence and characteristics is required. Although data for latent or early cancers are available for various organs, details are limited in the case of the breast. The present investigation was carried out to cast light on the incidence of latent cancers, considered as lesions, in women with no symptoms and no palpable mass of the breast. Out of 2126 women visiting our hospital for initial breast examination during July to December in 1987, 542 (25.5%) had no complaint and neither a detectable mass on careful palpation nor a tumor shadow on mammography. However, 21 (3.9%) demonstrated microcalcification, 7 giving the impression of a possible malignancy. Subsequent biopsy of the 7 cases revealed 3 carcinomas. The detection rate of breast cancer in this population was thus 0.6% (3/542). Adopting the frequency (36%) of microcalcification detectable on mammography in 185 breast cancers diagnosed in this period as a base, the incidence of latent breast cancer among women visiting our hospital was calculated to be 1.5%.     

Downstream Breast Imaging Following Screening Mammography in Medicare Patients with Advanced Cancer: A Population-Based Study

Background

Screening tests are generally not recommended in patients with advanced cancer and limited life expectancy. Nonetheless, screening mammography still occurs and may lead to follow-up testing.

Objective

We assessed the frequency of downstream breast imaging following screening mammography in patients with advanced colorectal or lung cancer.

Design

Population-based study.

Participants

The study included continuously enrolled female fee-for-service Medicare beneficiaries ≥65 years of age with advanced colorectal (stage IV) or lung (stage IIIB-IV) cancer reported to a Surveillance, Epidemiology, and End Results (SEER) registry between 2000 and 2011.

Main Measures

We assessed the utilization of diagnostic mammography, breast ultrasound, and breast MRI following screening mammography. Logistic regression models were used to explore independent predictors of utilization of downstream tests while controlling for cancer type and patient sociodemographic and regional characteristics.

Key Results

Among 34,127 women with advanced cancer (23% colorectal; 77% lung cancer; mean age at diagnosis 75 years), 9% (n = 3159) underwent a total of 5750 screening mammograms. Of these, 11% (n = 639) resulted in at least one subsequent diagnostic breast imaging examination within 9 months. Diagnostic mammography was most common (9%; n = 532), followed by ultrasound (6%; n = 334) and MRI (0.2%; n = 14). Diagnostic mammography rates were higher in whites than African Americans (OR, 1.6; p <0.05). Higher ultrasound utilization was associated with more favorable economic status (OR, 1.8; p <0.05).

Conclusions

Among women with advanced colorectal and lung cancer, 9% continued screening mammography, and 11% of these screening studies led to at least one additional downstream test, resulting in costs with little likelihood of meaningful benefit.