乳腺钼靶摄影及立体定位活检对不典型乳腺癌的诊断价值

  目的 探讨应用乳腺钼靶摄影并结合X线立体定位活检对不典型乳腺癌的诊断价值。方法 经定位活检、手术及病理证实的不典型乳腺癌21例，对其X线表现进行回顾性分析。结果 21例患者X线表现为局部结构紊乱8例，钙化灶6例，局灶性非对称性致密影3例，结构扭曲3例，结节状肿块影1例。结论 不典型乳腺癌大多为早期乳腺癌，缺乏乳腺癌特有的X线征象，表现相对不典型，临床常不能扪及，故结合X线立体定位活检对乳腺病灶的定位、定性有重要的指导意义。     

年轻女性乳腺包块的X线及MRI征象分析

目的:分析年轻女性乳腺包块X线、MRI特点,提高影像诊断准确率。方法:回顾研究33例临床、病理证实的年轻女性乳腺单发包块患者的临床及术前X线、MRI资料。结果:全组包括原发血管肉瘤2例,浸润性导管癌17例,导管内癌微浸润7例,纤维腺瘤7例;X线征象包括肿块或结节13 例,结构扭曲 2例,局灶性不对称致密影7例,大片泥沙样钙化1 例,细小多形性钙化2例,簇状泥沙样钙化2例,无阳性征象6例;MRI平扫+增强征象包括:结节或肿块样强化22例,局灶性片状强化3例,沿导管走行分布多发强化4例,段样强化1例,多发导管样强化2例,多发线样强化1例,曲线平台型12例,流出型15例,流入型6例。结论:X线对年轻女性乳腺内典型良性结节、表现为结构扭曲及钙化灶的乳腺癌检出及诊断价值极高,但因乳腺腺体致密,X线仍存在假阳性。MRI可敏感检出乳腺包块,结合强化特点,准确鉴别病灶良恶性价值巨大。     

未见明显肿块及钙化的乳腺癌X线表现分析

目的:总结分析无明显肿块及钙化的乳腺癌钼靶X线片特征。方法:回顾性分析26例经手术及病理证实为乳腺癌,而钼靶X线片未见明显肿块及钙化病例的X线片、病史资料、B超检查等。结果:26例病例临床均触及肿块或结节,乳腺分型25例为散在纤维腺体型(少量腺体型)和不均质型(多量腺体型),病灶与腺体无明显分界。24例为乳腺浸润性导管癌,2例为浸润性小叶癌。结论:乳腺钼靶X线片未见明显肿块及钙化,而临床触及肿块或结节的病例,应结合B超及体检仔细分析X线片,并与对侧比较,能明显提高乳腺癌的诊断准确率。     

40例早期乳腺癌的临床X线分析

目的：通过对早期乳腺癌X线征象的认识，提高早期乳腺癌的诊断水平。方法：经手术病理证实的40例早期乳腺癌术前均行临床查体、X线摄片。结果：全组22例表现为肿瘤结节，19例表现簇样钙化，11例表现小灶致密影，7例局部结构紊乱，2例单支导管扩张。结论：早期乳腺癌无论在临床表现、影像学检查均可出现不典型特征，诊断早期乳腺癌除了重视特征性征象如毛刺状结节、簇样钙化外，还应重视小灶致密影、局部结构紊乱、单支导管扩张等间接征象。乳腺X线摄片及临床查体是发现早期乳腺癌的重要手段。     

未见明显肿块及钙化的乳腺癌X线表现分析

目的:总结分析无明显肿块及钙化的乳腺癌钼靶X线片特征.方法:回顾性分析26例经手术及病理证实为乳腺癌,而钼靶X线片未见明显肿块及钙化病例的X线片、病史资料、B超检查等.结果:26例病例临床均触及肿块或结节,乳腺分型25例为散在纤维腺体型(少量腺体型)和不均质型(多量腺体型),病灶与腺体无明显分界.24例为乳腺浸润性导管癌,2例为浸润性小叶癌.结论:乳腺钼靶X线片未见明显肿块及钙化,而临床触及肿块或结节的病例,应结合B超及体检仔细分析X线片,并与对侧比较,能明显提高乳腺癌的诊断准确率.     

乳腺微小癌的临床诊断

目的探讨肿块直径＜1.0 cm乳腺微小癌的临床诊断方法.方法对194例乳腺微小癌的临床检查,钼靶X线检查以及超声检查结果进行综合分析.结果临床检查:194例乳腺微小癌均为单发;肿块质地硬、活动差、边界不清的临床诊断阳性率高于肿块质地韧、软、活动好、边界清者;腋下触及淋巴的结临床诊断阳性率低于腋下未触及淋巴结者.钼靶X线检查:肿块影和细砂钙化与结构不良及腺体致密的钼靶X线表现相比,诊断阳性率高,平均年龄大.超声检查:数字彩色超声检查诊断乳腺微小癌阳性率高于普通B型超声检查.超声诊断可疑癌和乳腺癌的平均年龄大于超声诊断纤维瘤和增生结节的平均年龄.结论严格掌握乳腺微小肿块的临床诊断标准,高度注意钼靶X线片肿块影及细砂钙化表现,对腺体结构不良及腺体致密者不能轻率诊断良性.数字彩色超声检查可提高乳腺微小癌检查的阳性率.     

乳腺癌X线征象分析

目的:分析乳腺癌X线表现,提高乳腺癌X线诊断水平。方法:对46例经病理证实的乳腺癌X线表现作回顾性分析。结果:46例中肿块影28例,微小钙化14例,局限浸润7例,结构紊乱5例、乳管造影乳管不规则、管腔截断、显影间断2例,皮肤局限性增厚9例,乳头下陷及漏斗征7例,血管增多增粗15例,大导管征7例、腋下淋巴结13例。结论:钼靶乳腺X线摄影是诊断乳腺癌的最主要方法。肿块和微小钙化是乳腺癌主要X线征象,局限浸润、结构紊乱为不典型征象。对乳头溢液者行导管造影,结合间接征象,综合分析,可提高诊断率。     

钼靶X线下导丝定位乳腺微小病灶切除术在早期乳腺癌诊断中的应用

目的:探讨钼靶X线下导丝定位乳腺微小病灶切除术在早期乳腺癌诊断中的价值.方法: 对34例乳腺未触及肿块而钼靶X线乳腺摄片显示有结节或恶性可能的簇状钙化灶患者在钼靶X线引导下行乳腺微小病灶导丝定位切除术,术后快速冰冻病理检查.结果: 34例患者均一次成功定位,病理检查结果发现早期乳腺癌7人,其中原位癌4例,导管内癌2例,浸润性导管癌1例;良性病变27例.结论: 钼靶X线下导丝定位乳腺微小病灶切除术可明显提高早期乳腺癌的诊断水平.     

乳腺癌CT表现价值探讨

本文讨论12例乳腺癌CT表现。直接征象即肿块阴影,一般为圆形,卵圆形。肿块等于或高于腺体密度,边缘一般呈毛刺状参差不齐,有细小钙化。增强扫描CT值成倍增加为其特征性。间接征象有血管增粗增多,出现宽窄不一透亮带,皮肤增厚、收缩。乳后间隙消失,乳头内陷,腋下可见肿大淋巴结等。乳腺CT扫描适应症主要有乳腺钼靶照片的隐区部位,乳腺钼靶X线片上怀疑乳腺癌者,以及对致密型,青春期,哺乳期乳腺和乳腺癌根治术前了解肿块与周围组织关系等方面有一定意义。乳腺CT扫描也有局限性,它不适合于普查形式,对乳腺癌砂粒样钙化的特征性表现不如X线钼靶,对致密型乳腺中小于10mm的结节亦很难显示。     

乳腺癌钼铑双靶计算机X线摄影诊断分析

目的分析乳腺癌钼铑双靶计算机X线摄影（CR）影像表现,以提高乳腺癌的X线诊断水平。方法回顾分析经手术病理证实的65例乳腺癌患者的钼铑双靶CR影像表现,所有患者均摄取正、斜位片并经DrectviewCR900图像处理,5例隐约可见微小钙化而未见明确肿块影者,加照局部加压放大片,其中2例行术前三维立体定位,置放定位导丝,指导手术及病检。结果65例乳腺癌患者中,48例为浸润性导管癌,5例为浸润性小叶癌,2例髓样癌、4例硬癌、3例为导管内原位癌,2例管内癌伴早期浸润,1例乳头佩吉特病。CR表现：分叶状、不规则肿块20例,肿块伴恶性钙化29例,单纯恶性钙化型5例,乳腺局部结构紊乱和局限性致密浸润8例,星芒征3例;多伴有一项或多项次要征象。结论不规则肿块和恶性钙化是乳腺癌的最主要、最直接的X线征象,部分乳腺癌单纯以结构紊乱、非对称性致密或星芒征为主要表现。钼铑双靶计算机X线片摄影,可以充分显示乳腺癌的主要、次要X线征象,特别是对致密型乳腺内微小病灶的检出率有明显提高,是诊断乳腺癌的首选方法之一。     

Correlation Between Mammograghic Findings and Clinical/Pathologic Features in Women with Small Invasive Breast Carcinomas

Background: To study the relationship between mammographic findings and clinical/pathologic features inwomen with 1-15mm sized invasive breast cancer. Materials and Methods: We investigated a consecutive seriesof 134 cases diagnosed in Tianjin Medical University Cancer Institute and Hospital in 2007. Mammographicfindings were classified into five groups as follows :1) stellate mass without calcification; 2) non-stellate masswithout calcification; 3) intermediate suspicious calcification with or without associated mass; 4) higher probabilitymalignant calcification with or without associated mass; 5) focal asymmetry/distortion without associatedcalcification. Associations between mammographic and clinical/pathological features (menopause status/familyhistory/histologic grade/lymph node status and ER/PR/HER2 status) was analyzed through logistic regressionand chi square tests. Results: Compared to the stellate mass without calcification group, higher probabilitymalignant calcification patients were associated significantly with a positive lymph node status, always presentingin patients who were non-menopausal and with a family history of carcinoma. Conclusions: Higher probabilitymalignant calcifications with or without associated tumor masses are associated with clinical/pathologic featuresof poor prognosis.     

乳腺癌钼靶X线表现与c-erbB-2癌基因相关性

Objective： To investigate the correlativity between mammographic features and c-erbB-2 of breast cancer. Methods： The mammographic features of 165 patients, including calcification, distinct, esion concentration, breast cysitic hyperplasia accompanied, were studied comparatively with c-erbB-2 gene stained with immunohistochemical technique. Results： Of 165 cases, calcification impression was 84 cases （50.91%）, indistinct 80 cases （48.40%）, lesions were concentrated of 87 case （52.73%）, accompanied breast cysitic hyperplasia 85 cases （51.52%）. Conclusion： Mammographic features of breast cancer could show the status of c-erbB-2, the positive chance is higher with calcification, indistinct, lesion concentration and accompa- nied breast cysitic hyperplasia.     

Abscess in the non-lactating breast: Radiodiagnostic aspects

The value of mammography and ultrasound in evaluating abscesses in the non-lactating breast was assessed in 20 patients. Inflammatory breast masses in the non-lactating period are uncommon and the clinical diagnosis can be very difficult when signs of inflammation are absent. There were 20 patients ranging in age from 25 to 60 years in the present study; the mean age was 39.35 years. Patients presented with a lump and/or pain without other clinical signs of inflammation. Mammography was performed to exclude malignancy. Mammograms showed an ill-defined mass in 11 patients and an area of focal increased density in seven patients. Ultrasonograms showed echoic masses with central echopenia in 17 cases and central septation in three cases. Half the lesions were subareolar and half were peripheral. Two of 20 patients were treated by excision, three by incision and drainage, eight by aspiration and seven by antibiotics. The combination of mammographic and sonographic features may enable the radiologist to recognize this entity, thus preventing unnecessary surgery.     

CAD辅助X线诊断乳腺癌应用价值的探讨

目的：初步探讨在乳腺癌X线诊断中，辅助应用CAD系统的临床应用效果。方法：将本院自1999～2002年467例经手术病理证实的乳腺癌并具X线检查的病例，分别使用放射科医师独立诊断和其辅助应用CAD系统(激光扫描法)诊断，统计各自诊断发现肿块及微钙化的敏感性，并进行对比研究。结果：放射科医师独立诊断乳腺癌敏感性为80．94％，辅助CAD诊断敏感性为88．01％，其中对肿块检测敏感性分别为81．42％，89．38％；对微钙化检测敏感性分别为80．70％，94．74％。结论：放射科医师辅助CAD的应用使钼靶诊断乳腺癌检出率有一定的提高，尤其对于微钙化病灶。     

乳腺癌钼靶X线征象与VEGF、MVD表达的相关性

[目的]探讨乳腺癌钼靶X线征象与肿瘤血管内皮生长因子(VEGF)和微血管密度(MVD)表达的关系.[方法]对32例经手术病理证实的乳腺癌采用S-P免疫组化法,检测肿瘤标本中VEGF和MVD表达,分析其与术前钼靶X线征象的关系.[结果]VEGF与MVD值呈正相关关系(r=0.691,P＜0.01),VEGF和MVD表达与肿瘤的大小、毛刺征、钙化、血管增粗、腋窝淋巴结转移等X线征象有关(P＜0.05),而与皮肤增厚、乳头内陷无关(P＞0.05).[结论]乳腺癌钼靶X线部分征象与VFGF和MVD表达密切相关,通过这些征象,可推测乳腺癌的生物学行为,为临床上早期诊断、判断预后提供依据.     

Mammographic and sonographic features of tubular breast carcinoma

AIMS AND BACKGROUND: This study aimed to describe the mammographic and sonographic features of tubular carcinoma of the breast. METHODS: A retrospective review of 198 consecutive cases of surgically proven breast cancer revealed ten cases of tubular carcinoma of the breast. Only tumors with a tubular component of at least 75% were included in the study. Mean patient age was 56 +/- 9 years, range 35 to 70 years. RESULTS: The mean size of the tumors was 11 +/- 4 mm. On mammography, all tubular carcinomas appeared as an irregularly shaped mass with a central density in 6/10 cases. Eight tubular carcinomas were described as having spiculated margins. Microcalcifications were present in 4/10 cases. On ultrasound the tumor presented as a hypoechoic mass with irregular margins and posterior acoustic shadowing in 7/10 cases. In three cases the tumor presented as a hypoechoic mass with ill-defined margins and posterior acoustic shadowing. CONCLUSIONS: Although some specific mammographic and sonographic features may suggest the presence of a tubular carcinoma, the final differential diagnosis from other spiculated lesions of the breast should rely on histologic evidence only. Therefore, surgical biopsy should be recommended in all cases of stellate lesions of the breast detected at mammography or ultrasonogram.     

早期乳腺癌的X线征象分析

 目的　为进一步提高早期乳腺癌的X线诊断水平。方法　总结分析经手术病理证实的 5 8例女性早期乳腺癌的X线表现。结果　 5 8例中 16例见肿块影 ,16例见恶性钙化 ,12例见小灶致密影 ,15例见局部结构紊乱 ,8例见星芒征 ,7例见条索影。结论　对上述X线征象的认识 ,并重视结合触诊的阅片原则及辅助B超扫描 ,能提高早期乳腺癌的检出率