非肿块型乳腺导管癌数字化乳腺X线摄影表现形式与病理类型的相关性分析

目的探讨非肿块型乳腺导管癌数字化乳腺X线摄影(DR)表现形式与病理类型的相关性。方法回顾性分析经手术、病理证实的非肿块型乳腺导管癌195例,其中导管内癌36例(1组),导管内癌伴微浸润25例(2组),浸润性导管癌58例(3组),浸润性导管癌伴导管内癌76例(4组),对DR表现形式及病灶长径进行对比和统计学处理。结果 DR表现形式与病理类型关系在总体上差异有统计学意义(P0.05),x~2分割检验显示导管内癌与浸润性导管癌组及浸润性导管癌伴导管内癌组差异均有统计学意义(P0.008),后两组之间差异有统计学意义(P0.008),病灶长径与病理类型关系在总体上差异有统计学意义(P0.05),x~2分割显示导管内癌与浸润性导管癌伴导管内癌组差异有统计学意义(P0.008),浸润性导管癌与浸润性导管癌伴导管内癌组差异有统计学意义(P0.008),其他组之间差异无统计学意义(P0.008)。结论导管内癌DR表现形式主要是单纯钙化;以片影伴钙化为表现的,病理类型多是浸润性导管癌伴导管内癌;病灶长径50 mm,浸润性导管癌伴导管内癌的可能性大。     

直接数字化X线摄影在健康体检人群胸部检查中的应用研究

目的:探讨直接数字化X线摄影在健康体检人群胸部检查中的应用价值及可行性.方法:选取自2009年1月至2010年1月期间在我院进行健康体检的受检者500例采用直接数字化X射线摄影进行胸部检查作为观察组,选取2008年1月至2009年1月期间在我院进行健康体检的受检者500例采用传统的X线胸透检查作为对照组,观察两组受检者个人受辐射剂量及病变检出率.结果:观察组受检者个人受辐射剂量为(0.43±0.09) mGy,对组为(25.03±10.28) mGy,两组差异有统计学意义(P＜0.05).观察组受检者病变检出率为10.00％,对照组为6.20％,两组差异有统计学意义(P＜0.05).结论:直接数字化摄影系统不仅操作方便、快捷,而且显著降低受检者受X射线的影响,提高了病变检出率,更加安全有效,适合健康体检人群大批量胸部检查的应用.     

45岁以上女性乳腺癌数字化X线成像筛查结果的分析

女性乳腺癌可通过人群筛查获得早期诊断，从而提高患者生存质量并明显降低死亡率。筛查的主要手段是乳腺检查及乳腺X线成像检查。在欧美定期的乳腺X线成像筛查已获得了广泛的肯定，国内近年也开始重视对乳腺癌的筛查工作。本研究报道了一个特定小样本人群的乳腺癌X线筛查结果，希望对国内开展这方面工作提供一些初步的经验。     

乳腺癌X线检查征象与分子亚型的相关性研究

目的:根据月经状态进行分层,探讨乳腺癌数字乳腺X线检查征象与不同分子亚型的相关性。方法:采用回顾性研究,序贯收集2015年2月至2020年2月入住山西白求恩医院乳腺外科病理证实为乳腺癌患者950例,采用单因素分析和多因素Logistic回归分析,以评估乳腺癌X线检查征象与其分子亚型的关联。结果:在入组乳腺癌整体人群中,...     

输尿管囊肿的X线征象分析

目的总结输尿管囊肿的X线表现,以提高对该病的认识。方法搜集1995年1月至2005年12月间经手术、病理证实的输尿管囊肿18例,回顾性分析其X线表现。结果18例输尿管囊肿中,发生在单侧者16例,双侧2例。15例出现膀胱内边界清晰的充盈缺损,16例显示“光晕征”,12例显示“蛇头征”。结论输尿管囊肿有典型的影像学表现,静脉尿路造影可明确诊断,为手术提供可靠的影像资料。     

乳腺X线摄影、局部数字化处理与立体核心活检对乳腺癌诊断的意义（附122例分析）

目的：评估立体核检在乳腺癌诊断中的意义。方法：1999年3月15日－2000年3月15日,我院外科门诊应用意大利Giotto乳腺诊断系统行高清晰乳腺X线摄影（HI－TECH mammography,HT-M)1888例,对其中符合：（1）临床Meng及乳腺肿块,性质不明：（2）X线片发现肿块;（3）X线片上有多形性、集簇性微小钙化灶;（4）双侧摄片出现局限不对称、高密度区或结构畸形等适应证者,进行数字化局部处理（digital spot image,DSI)与Bard 16G针立体核心活检（stereotactic core needle biopsy,SCNB)122例,占HT－M总数的6．46％。结果：诊断为乳腺癌（包括2例原位导管癌,1例早期导管浸润癌）59例,全部手术证实：良性病变（包括乳腺增生、纤维腺瘤、导管乳头状瘤、囊腺瘤等）63例,其中23例为手术证实,40例随诊中未发现癌变。在乳腺癌中,SCNB真阳性率为89．83％（53／59）,假阴性率为10．17％（6／59）;乳腺良性病变中SCNB无一例假阳性,故SCNB对乳腺良恶性病变的敏感性和特异性分别为89．83％和100％,全部122例SCNB者均无并发症发生。结论：为保证该项诊断技术的准确性,我们的初步经验是：（1）必须有一套包括高清晰成像、快速准确定位和活检的高质量;（2）由一个有高中级外科医师、外科护师（技师）与病理医师组成的专业小组,参与门诊临床检查→HT－M、DIS、SCNB→病理检查→手术→随1 全过程,不断提高操作的娴熟性、准确性,并在综合分析的基础上作出诊断;（3）自动弹射式Bard 16G针适用于大多数病人,但对X线片上的微小病灶采用负压切削式Mammotome针,能将SCNB正确率提高到95％－100％,想念通过克服传统旧观念,将HT－M、DIS与SCNB广泛用于医院门诊与高危人群的普查,能大大改善我国乳腺癌病人治疗的生存率与生活质量。     

数字化钼靶检查在判断乳腺癌腋窝淋巴结转移中的价值探讨

目的探讨全数字化钼靶X线摄影在判断乳腺癌有无腋窝淋巴结转移方面的价值。方法收集经术后病理证实的乳腺癌患者260例和门诊乳腺增生患者110例,全部病例均有数字化钼靶摄影。综合分析腋窝淋巴结在钼靶X线摄影上的特点。结果乳腺增生的钼靶片显示,腋窝淋巴结数目及大小不一,边界清楚,形态多样,以类圆形多见,密度大多不均质,淋巴结外腋窝组织清晰;乳腺癌钼靶片显示,腋窝淋巴结可疑阳性者,其数目和大小与乳腺增生相比无特异性,但密度多较均质,以椭圆形或圆形多见,边界不清,淋巴结周围组织紊乱;而淋巴结阴性者,其密度多不均匀,呈现中心密度低,周边密度高的壳状。结论术前通过对钼靶影像腋窝淋巴结的密度、边界、形态及周围组织结构的比较分析,可以初步了解腋窝淋巴结有无转移,有助于对乳腺癌患者的整体了解和选择治疗方案。     

踝关节X线片分析与临床应用

目的测量正常成人踝关节X线片的有关数据,提高踝关节损伤诊断的准确率,以利于早期治疗、提高疗效。方法40例正常踝关节X线片,测量踝关节间隙内侧宽度、上方胫距关节间隙宽度、距骨外侧与外踝胫侧骨重叠影宽度、侧位片距骨与胫骨之间的宽度、下胫腓联合的宽度、胫骨外侧与腓骨胫侧构成重叠的宽度共六组数据。结果踝穴内侧宽度平均(3.8±0.5)mm,正位距胫关节宽度为(3.0±0.5)mm,距骨外侧与外踝的重叠影为(4.1±2.2)mm,侧位片中距骨与胫骨的间隙为(2.8±0.5)mm,下胫腓联合宽为(3.2±0.7)mm,胫骨外侧与腓骨胫侧重叠影宽平均为(7.7±1.9)mm。结论综合分析各组正常值,结合其它骨折改变,超过正常值范围是距骨脱位移位下胫腓联合分离的依据。多组数据改变可提高早期诊断准确率。     

数字化乳腺X线立体定位真空辅助活检53例

目的:探讨数字化乳腺X线立体定位真空辅助活检(stereotactic vacuum assisted breast biopsy,SVAB)在乳腺微小病变中的临床应用价值。方法:采用全数字化乳腺X线机、三维立体定位系统以及真空负压旋切活检系统,对53例临床不可触及的可疑乳腺微小病变(BI-RADS分级为Ⅳ级及以上)行SVAB。结果:SVAB诊断的特异性为100%,敏感性为96%;阳性预测值为100%,阴性预测值为95%;假阴性率为1.9%,无假阳性病例。结论:SVAB具有定位准确,操作安全、简便,手术成功率高,损伤小等特点,是临床诊断不可触及的乳腺微小病变的理想活检方法。     

数字化乳腺X线立体定位真空辅助活检53例

目的:探讨数字化乳腺X线立体定位真空辅助活检(stereotactic vacuum assisted breast biopsy,SVAB)在乳腺微小病变中的临床应用价值.方法:采用全数字化乳腺X线机、三维立体定位系统以及真空负压旋切活检系统,对53例临床不可触及的可疑乳腺微小病变(BI-RADS分级为Ⅳ级及以上)行SVAB.结果:SVAB诊断的特异性为100%,敏感性为96%;阳性预测值为100%,阴性预测值为95%;假阴性率为1.9%,无假阳性病例.结论:SVAB具有定位准确,操作安全、简便,手术成功率高,损伤小等特点,是临床诊断不可触及的乳腺微小病变的理想活检方法.     

A comparison between ultrasonography and mammography,computed tomography and digital subtraction angiography for the detection of breast cancers

Ultrasound (US) was compared with mammography (MMG), computed tomography (CT), and digital subtraction angiography (DSA) in its effectiveness to detect breast cancer masses and metastatic axillary nodes. Forty-seven breast cancer patients who all underwent MMG, US, CT, and DSA preoperatively in our institution between 1986 and 1990 were studied. US was able to detect tumors in all cases regardless of tumor size, whereas DSA detected T1-size tumors and MMG detected T2-size tumors in 40% and 64.7% of cases, respectively, being specifically inferior to US. It was found that MMG was least likely to detect papillotubular carcinoma, although microcalcification alone without a tumor mass on MMG improved detectability from 46.2% to 76.9%, according to the histological type. CT was found to be most sensitive to axillary node metastases (81.8%), followed by US (72.7%), but DSA was significantly unfavorable (42.9%). Thus, we concluded that US was superior to MMG, CT, and DSA for detecting breast cancer masses, but that CT was more advantageous than US, while DSA was of little value for evaluating axillary nodal status.     

全数字钼靶提高同时性双侧乳腺癌检出率的临床研究

目的 评价全数字钼靶在临床上检测同时性双侧原发乳腺癌的准确率,探讨其在同时性双侧原发乳腺癌的临床诊断和治疗中的价值。方法 选取本院2006年6月～2011年12月间收治的12例同时性双侧原发乳腺癌患者,所有病例均行全数字钼靶X线摄影、彩色多普勒超声和MRI检查,并与术后病理结果对比分析;术后进行为期2年的随访。结果 总检出灵敏度：全数字钼靶诊断的灵敏度为83.3%,超声和MRI检查的灵敏度分别为54.2%、45.8%,与全数字钼靶比较差异均具有统计学意义（P<0.01,P<0.05）;第一原发癌的检出灵敏度：全数字钼靶为83.3%,超声和MRI检查分别为66.7%、50.0%,与全数字钼靶相比差异均无统计学意义（P>0.05）;第二原发癌的检出灵敏度：全数字钼靶诊断的灵敏度为83.3%,超声和MRI检查的灵敏度均41.7%,与全数字钼靶相比,差异均具有统计学意义（P<0.05）。术后随访的结果表明,未发现漏诊的对侧乳腺癌患者。结论 全数字钼靶对双侧原发癌中较早期的一侧及第二原发癌的检出率均高于超声及MRI检查,能够更早更准确地发现病灶。     

Evaluation of contrast‐enhanced digital mammography (CEDM) in the preoperative staging of breast cancer: Large‐scale single‐center experience

One of the most important indications for contrast‐enhanced breast imaging is the presurgical breast cancer (BC) staging. This is a large‐scale single‐center experience which evaluates the role of CEDM in presurgical staging and its impact on surgical planning. The aims of this retrospective study were to define the diagnostic performance of CEDM in the presurgical setting and to identify which types of patients could benefit from having CEDM. We selected 326 patients with BC who underwent CEDM as preoperative staging and had breast cancer‐related surgery at our institution. We analyzed those cases in which CEDM led to additional imaging or biopsy and those in which it changed the type of surgery that was planned according to conventional breast imaging (CI) techniques (digital mammography, tomosynthesis and bilateral handheld ultrasound). CEDM sensitivity in identifying the index lesion and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy in the correct preoperative staging of BC of the whole population and in various subgroups were calculated. CEDM sensitivity for the index lesion was 98.8% (322/326), which led to additional breast imaging in 23.6% (77/326) of patients and additional biopsies in 17.5% (57/326). CEDM changed the type of surgery in 18.4% (60/326). In the preoperative breast cancer staging, CEDM sensitivity, specificity, PPV, NPV, and accuracy produced results of 93%, 98%, 90%, 98%, and 97%, respectively. CEDM performance was better in patients with palpable lesions. CEDM has an excellent diagnostic performance in the presurgical staging of BC. Symptomatic patients with palpable lesions benefitted most from preoperative CEDM, with a statistically significant difference compared with nonpalpable.     

Survival from primary breast cancer after routine clinical use of mammography

Clinical trials indicate that mammography provides a substantial breast cancer survival benefit; however, there is a need to demonstrate that this benefit extends to clinical practice and to determine the extent that current reductions in mortality are attributable to regular screening or adjuvant systemic therapy. Mammography was used routinely at our institution across a broad age range, in an era when most patients received no adjuvant systemic therapy. We examined breast cancer survival for a cohort of 678 stage I-III primary invasive breast cancer patients accrued from 1971 to 1990, and followed to 1996; 18% received adjuvant hormonal therapy and 15% received adjuvant chemotherapy. There were 61 women less than 40 years old; 136, 40-49 years; 341, 50-69 years; 140, > or =70 years. Factors available for multivariate investigations were age (years), tumor size (cm), nodal status (N-, Nx, N+), ER (fmol/mg protein), PgR (fmol/mg protein), adjuvant radiotherapy (no, yes), adjuvant hormonal therapy (no, yes), and adjuvant chemotherapy (no, yes). Forward stepwise multivariate regression with log-normal survival analysis was used to examine the effects of these factors on disease-specific survival. Ten-year survival by tumor size was adjusted for the effects of other significant factors. For women less than 40 years of age, 10-year survival at the T1a, T1b, T1c, and T2 cut-points for tumor size is, respectively, 0.77, 0.74, 0.67, 0.44; for 40-49 years it is 0.92, 0.90, 0.85, 0.62; for 50-69 years it is 0.81, 0.79, 0.75, 0.62; for > or =70 years it is 0.84, 0.81, 0.73, 0.44. With routine use of clinical mammography and up to 26 years of follow-up, we found breast cancer survival to be significantly better (p< or = 0.05) for all women with smaller tumors and that survival indicated a change in natural disease history with early detection. The Canadian National Breast Screening Study (NBSS) controls had significantly smaller tumors (p < 0.001) than our patients, which may indicate access to mammography outside of the NBSS that reduced the apparent survival benefit for clinical trial mammography.     

Disparities in the uptake of digital breast tomosynthesis for breast cancer screening: A retrospective cohort study

We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.     

Trends in mammography and clinical breast examination: a population-based study

BACKGROUND: There are well-accepted clinical guidelines for early detection of breast cancer through mammography and clinical breast examination. The purpose of this study was to determine trends in the utilization of these techniques over the past 5 years. METHODS: The National Health Interview Survey is a population-based computer survey of noninstitutionalized civilian Americans conducted annually by the National Center for Health Statistics, Centers for Disease Control and Prevention. We evaluated the reported use of mammography and clinical breast examination in women 40 years of age and older between 2000 and 2005. Data were evaluated using SAS and SAS-callable SUDAAN software. RESULTS: Surveyed were 10,994 and 11,128 women over age 40 in 2000 and 2005, respectively. Between these years, there was a decline in women >or=40 years old who reported ever having a mammogram (80.79% versus 79.52%, P<0.0001) and in those who had a mammogram within the preceding 2 years (87.98% versus 86.30%, P=0.0040). In addition, there was a drop in women reporting ever having a clinical breast exam (82.12% versus 75.91%, P<0.0001) and in those reporting having had a clinical breast exam in the 2 years prior to the survey (89.24% versus 87.63%, P=0.0012). Similar results were found in the population aged 50-69. CONCLUSIONS: Despite well-established clinical guidelines for early detection of breast cancer, there has been a decline in the rates of annual mammography and clinical breast exam in women over the age of 40 over the past 5 years.     

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

To compare diagnostic performance of contrast‐enhanced dual‐energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast‐enhanced MRI (DCE‐MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3‐5 at imaging or clinically suspicious). CEDM, DBT, and DCE‐MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two‐dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE‐MRI. DCE‐MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE‐MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE‐MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE‐MRI. Dynamic information obtained by time‐intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.     

Calcifications in the breast and digital breast tomosynthesis

Our study was to compare the clarity with which calcifications are seen on conventional mammography (CM) with the same calcifications on digital breast tomosynthesis (DBT). We define clarity as the sharpness, contrast, and diagnostic quality by which the calcifications were depicted. In a HIPPA compliant Institutional Review Board approved study, 3,000 women volunteered to have both a screening mammogram and a DBT study. A total of 119 sequential cases with relevant calcifications (not clearly benign) were reviewed. Two board certified, dedicated, breast imaging radiologists reviewed the CM and DBT images in an unblinded paired comparison. Only the mediolateral oblique (MLO) projection was available for the DBT studies. The MLO and craniocaudal projections were reviewed using the 2D images. Window and leveling, and electronic zoom were permitted. Unlimited time was allowed to provide a subjective assessment as too how well the calcifications were seen, from a diagnostic perspective, when the two studies were evaluated side-by-side. In 41.6% of the cases, the readers felt that calcifications were seen with superior clarity on DBT. In 50.4% of the cases, the visibility of calcifications was the same for DBT and CM, and in 8% of the cases, calcifications were seen with greater clarity on CM than DBT. In 92% of the cases, the clarity with which calcifications were seen on DBT was equal to or better than for CM and in almost half, the clarity on DBT was judged to be better than for CM. Our analysis shows that calcifications can be demonstrated with equal or greater clarity on DBT as on CM, thus allowing for comparable, and, perhaps, improved interpretive analysis of detected calcifications.     

乳腺专用伽马成像、钼靶和高频超声在乳腺癌诊断中的对比研究

目的 探讨乳腺专用伽马成像（BSGI）对早期辅助诊断乳腺癌的临床应用价值.方法 对51例乳腺癌患者进行乳腺高频超声、钼靶及BSGI的检查,以病理诊断为基础,对BSGI进行敏感度和特异度分析并比较三种早期辅助诊断技术的优劣.结果 BSGI在所有患者中的敏感度为94.1％,敏感度高于钼靶,不受乳腺致密性的影响,在直径2～5 cm的肿瘤中检出率最高.但其对转移淋巴结的敏感度仅为28.6％.结论 BSGI成像技术是一种新型早期辅助诊断乳腺癌的检查技术,具有较高的敏感度,适合于致密性乳腺和原位癌的辅助诊断,对于诊断淋巴结转移情况有局限性.