乳腺导管内乳头状瘤的X线诊断

目的：分析乳腺导管内乳头状瘤的X线表现．以提高其诊断准确性。方法：分析32例导管内乳头状瘤的X线平片及导管造影表现．并与病理结果对照。结果：24例X线诊断与病理相符。乳腺钼靶平片：26例无异常发现．6例有异常改变。乳导管造影：14例导管内充盈缺损；10例导管内杯口状堵塞；3例导管扩张；2例管壁不规则狭窄；1例导管分支变细聚拢．远端有一轮廓较清的类圆形块影．2例无异常发现。结论：乳腺导管造影结合平片是诊断导管内乳头状瘤的有效方法，但应注意与导管内癌、导管扩张鉴别。     

乳腺导管造影在乳腺导管内疾病诊断中的价值

目的分析乳腺导管造影在乳腺导管内疾病中的影像学表现,比较乳腺导管内疾病在乳腺导管造影与其他影像学检查的影像特点,及乳腺导管造影对导管内疾病诊断的优势,并分析其病理结果,以提高诊断水平。方法对临床表现为乳头溢液并经手术、病理证实的溢液乳腺疾病20例,包括乳腺癌3例、导管内乳头状瘤9例、乳腺导管扩张症6例及2例乳腺囊性增生病,回顾性分析其乳腺导管造影的影像表现及病理特征。结果本组20例:乳腺常规检查诊断导管扩张4例,乳腺囊性增生2例,乳头状瘤0例,乳腺癌1例;乳腺常规检查对乳腺导管内病变检出正确率40%。乳腺导管造影检查诊断导管扩张6例,乳腺囊性增生2例,乳头状瘤9例,乳腺癌2例;乳腺导管造影钼靶摄影对乳腺导管内病变检出正确率为95%。结论乳腺导管造影对溢液性乳腺疾病是一项安全而有效的检查方法,对乳腺导管内占位性病变的定位、定性诊断具有极高价值。对导管扩张症、乳腺囊性增生病等疾病亦能作出较准确的诊断。乳腺导管造影在导管内疾病及早期乳腺癌的诊断中具有不可替代的优势。     

乳腺导管造影在导管内占位性病变的应用价值

乳腺导管内占位性病变临床上较为常见,它是一组病理性质不同的疾病,常伴有乳头溢液。乳腺导管造影对明确病变部位、性质具有重要价值。本文收集我院2003年3月～2006年5月间经手术病理证实的45例导管内占位性病变乳腺导管造影资料进行总结,旨在提高对导管内占位性病变的术前诊断水平。     

乳腺良性病变的钼靶X线诊断

目的 探讨乳腺良性病变的钼靶X线诊断价值.方法 收集63例行钼靶摄片检查并经手术及病理证实的乳腺良性病变,对其临床及X线征象进行回顾性分析.结果 63例共发现肿块性病变64个,包括纤维腺瘤42例,囊肿10例,导管乳头状瘤7例.错构瘤2例,以及血管瘤2例.病变边界清晰者32个,部分边界清晰者22个,边界模糊者10个,伴有钙化的肿块12例.结论 钼靶X线检查对乳腺良性病变的诊断、鉴别诊断具有重要价值,应作为女性乳腺肿块性病变的首选检查方法.     

乳腺导管造影在溢液乳腺疾病诊断中的应用价值(附70例报告)

目的探讨乳腺导管造影在溢液乳腺疾病诊断中的应用价值。方法回顾性分析70例经手术及病理确诊的乳头溢液乳腺病的X线特点,结合临床及病理特征进行鉴别诊断。结果导管内乳头状瘤45例,导管癌5例,导管扩张症17例,导管增生伴炎症3例。结论乳腺导管造影在导管肿瘤良恶性的鉴别及导管炎性疾病的诊断中有极高的应用价值,可为临床提供准确的诊断和治疗依据。     

乳腺导管造影术在乳腺导管疾病中的应用

目的探讨乳腺导管造影在乳腺导管疾病诊断中的应用。方法回顾分析了56例乳腺导管造影疾病的造影检查资料,病例均经临床检查、钼靶摄片、乳导管造影检查及病理证实。结果肿瘤性病变25例,占44.64%,包括导管内乳头状瘤12例,导管内乳头状癌4例,浸润性导管癌9例;其中导管内乳头状瘤最为多见。非肿瘤性病变31例,占55.36%,其中单纯导管扩张症11例,导管扩张伴慢性乳腺炎18例,单纯导管炎症2例;其中以导管扩张伴慢性乳腺炎最为多见。结论乳腺导管造影术对乳腺导管系统疾病的诊断与鉴别诊断以及导管内乳头状癌的早期诊断具有重要的价值。     

导管内乳头状瘤的乳腺导管造影及病理诊断

乳腺导管内乳头状瘤为女性常见的乳腺肿瘤,多数患者乳头有血性、浆液性或血性浆液性溢液。由于导管内乳头状瘤小,临床检查不易扪及,该病变虽属良性病变,但伴有导管上皮增生时常被认为是癌前病变。为了早期诊断,乳腺钼靶X线摄片和乳腺导管造影是非常有价值的检查方法。     

血性溢液性乳腺疾病的导管造影检查与病理对照分析

目的 :探讨乳腺导管造影在血性溢液性乳腺疾病中的诊断价值。方法 :回顾性分析经临床病理证实的39例乳头血性溢液患者的导管造影X线表现,并与病理结果进行对比分析。结果:本组39例中,造影诊断导管内乳头状瘤27例(69.2%);乳腺癌9例(23.1%);导管扩张囊性增生1例(0.3%);导管炎症导管内分泌物潴留2例(0.5%)。经病理证实,导管造影诊断符合率为89.7%,误诊4例,占10.3%。结论 :乳腺导管造影对血性溢液性乳腺疾病的定性、定位具有较高的诊断价值,尤其对临床触及阴性的导管内乳头状瘤及早期乳腺癌能作出较准确诊断,提高了导管内占位性病变的检出率。     

溢液性乳腺病166例X线诊断

目的进一步提高溢液性乳腺病的X线诊断水平。方法回顾性分析经手术、病理证实,资料完整的166例溢液性乳腺病的乳腺导管造影表现。结果乳腺导管扩张症78例:导管扩张增粗、管壁光滑;导管扩张伴炎症2例:导管扩张、管壁毛糙,造影剂渗入间质;乳腺囊性小叶增生11例:末梢导管扩张呈囊状、管径粗细不均;导管内乳头状瘤49例:圆形、类圆形充盈缺损,导管呈“杯口状”中断,边缘光整;导管内乳头状癌、导管内癌26例:导管扩张后狭窄,导管中断呈“刀切样”平直,管腔僵硬,充盈缺损呈圆形菜花状或不规则状。肿瘤性病变75/166例,占45.1%;其中恶性病变26/75例,占15.7%。结论乳腺导管造影对溢液性乳腺病的诊断与鉴别诊断有重要价值。     

乳腺导管内乳头状瘤的X线诊断

目的分析乳腺导管内乳头状瘤的X线特征,以提高其诊断准确性。方法回顾性分析经手术病理证实80例导管内乳头状瘤的X线表现。结果乳导管造影示:24例显示类圆形充盈缺损,12例呈条柱状缺损,30例导管杯口状堵塞,48例导管显著扩张。结论乳腺导管造影是诊断导管内乳头状瘤的有效方法。     

乳腺导管造影的X线分析及临床应用

目的探讨乳腺导管造影的X线表现特征及其临床意义。方法本组600例乳头溢液患者行乳腺导管造影,且均经手术病理证实,其中乳头溢液为血性或浆液血性298例(占49.8%),浆液性150例(占25%),清水样106例(占17.7%),其它46例(占7.7%)。结果X线上乳腺导管分为3型:枝叶型354例,占59%;支干型127例,占26.2%;干型87例,占14.8%。主要X线病理表现:导管扩张578例(占96.3%),导管变形561例(占93.5%),导管内充盈缺损349例(占58.2%)及导管破坏39例(占6.5%)。乳腺癌42例(占7%),导管内乳头状瘤312例(占52%),导管扩张症129例(占21.5%),炎症26例(占4.3%),增生症49例(占8.2%),乳腺囊肿25例(占4.2%)以及阴性病例17例(占2.8%)。结论乳腺导管造影有助于乳头溢液的病因诊断。     

乳腺导管造影结合乳管内视镜对乳头溢液的诊断价值(附100例分析)

目的通过乳腺导管造影和乳管内视镜检查,进一步提高乳腺导管系统疾病的诊断正确率。方法回顾性分析100例乳腺导管系统疾病患者的乳腺导管造影与内视镜检资料。结果肿瘤样疾病占14%,包括导管内乳头状瘤、乳头状瘤病和导管内癌,以导管内乳头状瘤及乳头状瘤病多见,占12%。非肿瘤性疾病占71%,包括导管扩张症、导管扩张并慢性炎症、浆细胞性乳腺炎、乳腺囊肿、乳腺小叶增生、乳腺囊性增生,以导管扩张症多见,占42%。结论乳腺导管造影与乳管内视镜对导管系统疾病的诊断很有价值。     

Papillary lesions of the breast at percutaneous core-needle biopsy

PURPOSE: To retrospectively review the imaging and histologic findings in patients in whom a benign papillary lesion was diagnosed at core-needle breast biopsy. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board at each institution; patient consent was not required. The study was HIPAA compliant. The authors reviewed the findings from 42 patients (age range, 26-76 years; mean age, 54.3 years) with 43 benign papillary lesions diagnosed at core-needle biopsy. Thirty-six (84%) of the 43 lesions were surgically excised, and seven (16%) were followed up with long-term imaging. The authors assessed the radiographic findings, the histologic findings at core-needle biopsy, and the findings at subsequent surgical excision or imaging follow-up. Statistical analysis was performed on a per-patient basis and included the Blyth-Still-Casella procedure to construct exact 95% confidence intervals (CIs) and the Fisher exact test. RESULTS: At core-needle biopsy, lesions were diagnosed as papilloma (n = 29), sclerosing papilloma (n = 8), and benign papillary lesions not otherwise specified (n = 6). For the 36 lesions that were surgically excised, histologic follow-up showed no residual lesion in 10, intraductal papilloma in 14, intraductal papillomatosis in two, papilloma with adjacent foci of atypical ductal hyperplasia (ADH) in eight, and well-differentiated papillary ductal carcinoma in situ (DCIS) in two. Mammographic follow-up in the remaining seven lesions revealed stable calcifications in five (at 28-55 months) and no residual lesion in two (at 26-29 months). In nine of the 42 patients (21%), the diagnosis was upgraded to either ADH or DCIS (exact two-sided 95% CI = 11.4%, 36.4%). CONCLUSION: The results strongly suggest that papillary lesions diagnosed as benign at core-needle biopsy should be surgically excised because a substantial number of lesions were upgraded to ADH and DCIS at excision.     

Intraductal papillary mucinous tumors of the pancreas: helical CT with histopathologic correlation

PURPOSE: To evaluate the accuracy of preoperative computed tomography (CT) in predicting the location and type of ductal involvement and malignant transformation in intraductal papillary mucinous (IPM) pancreatic tumors and to determine the predictive factors for malignancy at CT. MATERIALS AND METHODS: The helical CT scans obtained in 36 operated on patients with a diagnosis of IPM pancreatic tumor were retrospectively assessed. CT-histopathologic correlation was then performed. RESULTS: The final diagnoses of IPM tumor were combined type (n = 26) and branch duct type (n = 10) lesions. Histologic analysis revealed adenocarcinoma (n = 9), hyperplasia (n = 8), low-grade dysplasia (n = 12), and high-grade dysplasia (n = 7). The lesions were located mainly in the head or uncinate process (n = 20) or were diffuse or multifocal (n = 12). In 12 patients (13 cases), CT-histopathologic correlation was poor, including that in the evaluation of ductal involvement (n = 7), evaluation of lesion location (n = 2), and diagnosis of malignant transformation (n = 4). The most specific predictive signs of malignancy were presence of diabetes and, at CT, a solid mass, main pancreatic duct dilatation greater than 10 mm, diffuse or multifocal involvement, and attenuating or calcified intraluminal content. CONCLUSION: The main causes of poor CT-histopathologic correlation were related to evaluation of main pancreatic duct involvement and diagnosis of malignant transformation. The association between diabetes and specific CT criteria was highly suggestive of malignancy.     

数字化三维立体导丝定位穿刺技术在乳腺微小病灶中的应用

目的:探讨数字化三维立体导丝定位穿刺术对乳腺微小病灶的诊断价值。方法:回顾性分析临床触诊阴性而影像学表现异常的患者41例(乳腺微小病灶43处),41例均行乳腺数字化三维立体导丝定位穿刺切除并进行病理学检查。结果:43处微小病灶均定位成功,病变完全切除。病理检查:恶性病变8处,其中原位癌3处,浸润性导管癌Ⅰ～Ⅱ级3处,导管内癌伴早期浸润1处,浸润性导管癌伴腋下淋巴结转移1处;良性病变35处。结论:乳腺数字化三维立体导丝定位穿刺技术定位准确、损伤小、诊断符合率高,是治疗乳腺微小病变的重要手段,也是发现早期乳腺癌的重要方法。     

乳腺隐匿性病灶的微创活检

目的:探讨X线立体定位下核芯针穿刺活检(SCNB)对乳腺隐匿性病灶(NPBL)的临床应用价值。方法:运用乳腺X线立体定位系统对59例NPBL进行SCNB,其中42例行手术切除,将活检标本病理结果与X线表现、手术标本病理结果进行对照。结果:59例SCNB结果中良性病变43例,恶性病变16例(导管原位癌5例、浸润性导管癌11例),其中26例良性病变及16例恶性病变共42例行手术治疗,术后病理结果为良性病变25例,恶性病变17例(导管原位癌5 例、浸润性导管癌11例、硬癌1例)。与手术病理结果对照,SCNB对NPBL的诊断敏感度为94％,特异度为100％。结论:SCNB是诊断NPBL简便、实用、微创的方法,可获得准确的组织病理学结果,提高早期乳腺癌的检出率及降低良性病变的手术活检率。     

The diagnostic value of galactography in patients with nipple discharge

To evaluate preoperative galactographic findings in the differentiation between the benign and malignant lesions in patients presenting spontaneous nipple discharge without mass. Of the 215 patients who have undergone the galactography, 181 cases with abnormal galactography had surgery performed. All galactrograms were reviewed and galactographic findings were correlated to the pathological results to determine diagnostic differentiation. Of the 181 cases we operated on, 112 cases were macroscopically bloody, with 30 cases having cancers (26.8%). Fifty-four cases with serous discharge had seven cancer cases (13.0%). No cancer cases with other color discharge were found. Of the 37 cancer cases, 11 cases had lesions located in the main mammary ducts (lactiferous duct and the segmental duct) (29.7%) and 26 cases had lesions in the peripheral ducts (the subsegmental duct and its branches) (70.3%) (P<.05). Of 113 cases with benign proliferative ductal lesions, 88 cases were located in the main mammary duct (77.9%) and 25 cases in the peripheral mammary duct (22.1%) (P<.05). Otherwise, 29 cancer cases (82.9%) had ductal obstructions and 28 cancer cases (75.7%) had irregular intraductal defects that appeared in the galactograms, which is different from the 113 benign proliferative ductal lesion cases that had 88 cases (71.7%) with ductal dilatation and 90 cases (79.6%) with lobular or smooth intraductal defects (P<.05). These results showed that the cancer cases had a higher rate of locating in the peripheral duct, irregular intraductal duct defects, and ductal obstruction, and a lower rate associated with ductal dilatation or torsion. The galactographic findings were evaluated using the tumor location, types of intraductal defects, ductal obstruction, and dilatation. Preoperative diagnostic galactography is useful in differentiating between the benign or malignant lesions in patients with spontaneous nipple discharge.     

乳腺钼靶X线低密度病变的诊断与鉴别诊断

目的 :探讨钼靶X线诊断乳腺低密度病变的价值。材料和方法 :回顾性分析 16例经手术病理证实的乳腺低密度病变的钼靶X线征象及B超、CT表现。结果 :脂肪瘤 8例 ,脂肪为主型纤维腺脂肪瘤 1例 ,低密度型乳汁潴留囊肿 3例 ,创伤后油脂囊肿 4例。最大病变 4cm× 4.5cm ,最小 0 .8cm× 1.5cm。均为低密度或以低密度为主体病变 ,13例密度均匀 ,1例内有分支状钙化 ,1例见弧线形或环线形边缘钙化 ,1例病变内散在斑点状中等密度影。圆形或类圆形 15例 ,分叶状 1例。边缘清楚 14例。结论 :钼靶X线结合B超、CT、临床对乳腺低密度病变可做出正确诊断。     

伴有乳头溢液乳腺癌与导管内乳头状瘤的乳腺导管造影诊断

目的：总结分析伴有乳头溢液乳腺癌以及导管内乳头状瘤的乳腺导管造影X线表现,评价两者的诊断与鉴别诊断价值。方法：回顾性分析经手术和病理证实的23例乳腺癌和36例乳腺导管内乳头状瘤患者的乳腺导管造影检查影像资料。结果：乳腺癌导管造影主要表现为分支导管内不规则的充盈缺损伴导管壁破坏、导管阻塞中断、“潭湖征”等较为典型的征象;导管内乳头状瘤的导管造影主要表现为大导管内光整的充盈缺损,导管壁多无破坏,并伴有导管扩张以及导管扭曲。乳腺瘤与乳头状瘤在充盈缺损、导管壁破坏、导管完全中断、导管扩张以及“潭湖征”等x线征象上差异有统计学意义（P〈0．05）。乳腺导管造影诊断伴有乳头溢液乳腺癌和乳头状瘤的符合率分别为78．3％和80．1％。结论：不规则的充盈缺损伴导管壁破坏、导管阻塞中断、“潭湖征”等征象及发生部位上乳腺癌和乳腺导管内乳头状瘤两者各有特点,是诊断和鉴别诊断的重点。