超声弹性成像与乳腺钼靶摄影对乳腺癌诊断的对比研究

目的:研究超声弹性成像与钼靶摄影对乳腺癌的诊断价值。方法:回顾性分析110个乳腺肿物,术前行超声弹性成像及乳腺钼靶摄影检查,以病理结果对照分析,计算两种方法诊断乳腺疾病的敏感性、特异性、准确性。结果:超声弹性成像诊断结节的敏感性、特异性、准确性分别是79.41%、78.94%、79.10%。乳腺钼靶摄影诊断结节的敏感性、特异性、准确性分别是68.75%、76.92%、74.55%,超声弹性成像与乳腺钼靶摄影诊断结果有统计学差异(P<0.01)。结论:超声弹性成像作为辅助诊断的模式之一,需结合钼靶摄影检查,有助于提高乳腺检查的准确性。     

乳腺钼靶摄影结合CAD诊断乳腺癌的价值

目的: 评价乳腺钼靶摄影结合计算机辅助检测(CAD)诊断乳腺癌的作用.材料和方法: 101个经CAD辅助诊断的病灶得到病理证实为乳腺癌,计算CAD的检出率;比较1名医生使用CAD前、后与医生双读片对乳腺癌的检出率;比较医生使用CAD前、后对于乳腺癌的诊断率.结果: CAD对于乳腺癌的检出率为89.1%,使用CAD后早期乳腺癌的检出率提高了16.3%,与医生双读片的检出率无显著性差异;使用CAD后乳腺癌诊断的假阴性率下降16.8%.结论: CAD可以替代双读片,提高早期乳腺癌的检出率,并降低乳腺癌诊断的假阴性率.     

全野数字乳腺摄影系统在乳腺检查中的应用价值研究

目的:探讨全野数字乳腺摄影系统在乳腺检查中的应用价值。方法:收集我院进行乳腺检查患者321例进行研究评价,其中,CR乳腺摄影148例,全野数字乳腺摄影173例,分析评价检查时间、图像质量、诊断阳性率,乳腺癌的诊断敏感性、特异性、准确性。结果:CR乳腺摄影平均检查时间13.6min/人,甲级片率91%、诊断阳性率83.1%,其敏感性、特异性、准确性分别为86.8%、89.4%、88.6%。全野数字乳腺摄影系统平均检查时间5.7min/人,甲级片率97%,诊断阳性率92.5%,其诊断敏感性、特异性、准确性分别为91.8%、93.7%、93.1%。结论:全野数字乳腺摄影成像技术优于CR钼靶成像技术,且曝光剂量大大减少,提高了图像质量和乳腺疾病的诊断阳性率,减少了检查时间,乳腺癌的诊断敏感性、特异性、准确性都有提高。     

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。     

钼靶乳腺摄影及定位穿刺在诊疗乳腺癌中的价值

目的:探讨钼靶乳腺摄影及立体定位穿刺活检对乳腺癌诊断和治疗的价值。材料和方法:手术病理证实的100例乳腺癌术前均经X线钼靶摄影及定位穿刺作病理学检查。结果:100例乳腺癌中X线钼靶摄影及定位穿刺活检诊断乳腺癌92例,准确性为92%。结论:X线钼靶摄影及定位穿刺活检可提高乳腺癌诊断的准确性,为外科制定手术方案提供依据。     

全数字化乳腺钼靶X线摄影与彩超对早期乳腺癌的诊断价值

目的:探讨全数字化乳腺钼靶X线摄影和彩色多普勒超声对早期乳腺癌的诊断价值。方法:回顾性分析我院2006年1月²012年10月173例直径<1cm乳腺肿瘤患者的临床资料,将全数字化乳腺钼靶摄影和彩超结果与病理结果对照,比较2种检查方法的诊断准确性。结果:经病理证实173例中128例为早期乳腺癌,全数字化乳腺摄影和彩色多普勒超声对早期乳腺癌的诊断符合率分别为83.8%和76.9%,对>40岁的早期乳腺癌的诊断符合率分别为93.00%和74.82%,差异有统计学意义(P<0.05)。结论:全数字化乳腺摄影和超声都是乳腺疾病最常用的诊断方法,全数字化乳腺摄影对早期乳腺癌的诊断准确更高,尤其适合于40岁以上女性患者。     

BI-RADS分类标准在高危人群乳腺癌钼铑双靶X线摄影筛查中的应用

目的 :探讨影像报告和数据系统(BI-RADS)在鲁西北高危人群乳腺癌钼铑双靶X线摄影筛查中的应用价值。方法 :1 371例触诊阳性及有家族史人群作为筛查对象,均行全数字钼铑双靶X线摄影,并根据第5版BI-RADS分类标准进行图像分析,将BI-RADS分类评估结果与病理结果进行比较。结果:钼铑双靶X线摄影筛查乳腺癌辐射剂量明显减低,有效减少散射线;与病理结果比较,BI-RADS分类对乳腺病变的诊断符合率为83.67%,敏感度89.85%,特异度78.80%,阳性预测值为76.90%,阴性预测值为90.81%;受试者工作特征曲线下面积为0.701。结论:全数字钼铑双靶X线摄影辐射剂量低,且BI-RADS分类标准对乳腺癌的诊断和鉴别诊断有重要作用,有利于指导临床治疗方案的制订。     

比较传统钼靶与钼靶+断层融合技术在乳腺癌筛查中的应用:Oslo断层成像试验

正摘要在临床工作中数字乳腺断层摄影(DBT)正逐渐取代数字乳腺钼靶(DM)检查。针对上述2项检查的准确性以及合成融合钼靶摄影(SM)和计算机辅助检测(CAD)的作用,     

结合二维乳腺成像经验,阅片者在使用三维断层成像系统后,诊断能力有否改变?

<正>摘要目的评估具有多年数字钼靶摄影诊断经验及大阅读量的阅片者的诊断能力是否会随着使用数字乳腺三维断层成像系统(DBT)和二维乳腺钼靶成像而发生改变。材料与方法在取得知情同意后,8 869名女性(年龄29~85岁,平均56岁)被招募进行TOMMY试验(一项在英国国民健康服务的乳腺癌筛查方案中综合对比乳腺数字摄影的试验),该     

超声和钼靶X线联合诊断乳腺肿瘤

目的:探讨超声和钼靶X线摄影单独和联合诊断乳腺肿瘤的临床应用价值。材料和方法:对114例乳腺肿瘤患者(其中乳腺癌86例,乳腺良性肿瘤28例)行超声和钼靶单独和联合诊断,并与病理诊断结果对照。结果:超声对乳腺良性肿瘤诊断符合率明显高于钼靶(P<0.05),而对乳腺癌诊断符合率两者无显著性差异(P>0.05)。两者联合诊断乳腺良、恶性肿瘤符合率显著高于单独使用钼靶或超声(P<0.05)。结论:超声和钼靶检查各有其优势,选择性应用联合诊断可提高乳腺肿瘤的诊断水平。     

自编图像数字化处理软件，提高乳癌X线诊断率（附128例分析）

目的研究自编计算机图像处理软件,提高钼靶X线片中乳癌的诊断率.材料与方法应用图像数字处理的计算机技术编制软件,对128例乳腺癌X线片(包括8例Tn级乳腺癌、19例假阳性和25例假阴性病乳腺癌)进行图像分析,并作回顾性研究.结果经处理的乳腺X线片图像清晰度明显提高,良、恶性肿瘤图像有明显的差异,早期乳腺癌微小钙化灶的显示尤为清晰.结论自编的计算机软件,应用于乳腺钼靶X线片的数字化图像处理,有利于提高早期乳腺癌诊断率.     

高频超声与全数字化乳腺摄影联合诊断乳腺导管癌的临床应用

目的:探讨乳腺导管癌的高频超声表现,并评价高频超声联合全数字化乳腺摄影检查对乳腺导管癌的诊断价值。方法:分析46例经病理证实的乳腺导管癌的超声表现,与相应病理结果进行对比分析。46例患者均行高频超声和全数字乳腺摄影检查。结果:高频超声探及到肿块46例,诊断乳腺癌45例,诊断率达98%。全数字化乳腺摄影诊断乳腺癌46例,诊断率达100%。高频超声和全数字化摄影对乳腺导管癌检出率无差别且无统计学意义(P>0.05)。结论:高频超声与全数字化乳腺摄影联合应用,可提高乳腺癌诊断的敏感性和准确性。     

Community-based mammography practice: services, charges, and interpretation methods

OBJECTIVE: The purpose of our study was to accurately describe facility characteristics among community-based screening and diagnostic mammography practices in the United States. MATERIALS AND METHODS: A survey was developed and applied to community-based facilities providing screening mammography in three geographically distinct locations in the states of Washington, Colorado, and New Hampshire. The facility survey was conducted between December 2001 and September 2002. Characteristics surveyed included facility type, services offered, charges for screening and diagnostic mammography, information systems, and interpretation methods, including the frequency of double interpretation. RESULTS: Among 45 responding facilities, services offered included screening mammography at all facilities, diagnostic mammography at 34 facilities (76%), breast sonography at 30 (67%), breast MRI at seven (16%), and nuclear medicine breast scanning at seven (16%). Most facilities surveyed were radiology practices in nonhospital settings. Eight facilities (18%) reported performing clinical breast examinations routinely along with screening mammography. Only five screening sites (11%) used computer-aided detection (CAD) and only two (5%) used digital mammography. Nearly two thirds of facilities interpreted screening mammography examinations on-site, whereas 91% of facilities interpreted diagnostic examinations on-site. Only three facilities (7%) interpreted screening examinations on line as they were performed. Approximately half of facilities reported using some type of double interpretation, although the methods of double interpretation and the fraction of cases double-interpreted varied widely across facilities. On average, approximately 15% of screening examinations and 10% of diagnostic examinations were reported as being double-interpreted. CONCLUSION: Comparison of this survey's results with those collected a decade earlier indicates dramatic changes in the practice of mammography, including a clear distinction between screening and diagnostic mammography, batch interpretation of screening mammograms, and improved quality assurance and medical audit tools. Diffusion of new technologies such as CAD and digital mammography was not widespread. The methods of double-interpretation and the fraction of cases double-interpreted varied widely across study sites.     

Performance parameters for screening and diagnostic mammography: specialist and general radiologists

PURPOSE: To evaluate performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies. MATERIALS AND METHODS: Data (ie, patient age; family history of breast cancer; availability of previous mammograms for comparison; and abnormal interpretation, cancer detection, and stage 0-I cancer detection rates) were derived from review of mammographic studies obtained from January 1997 through August 2001. The breast imaging specialists have substantially more initial training in mammography and at least six times more continuing education in mammography, and they interpret 10 times more mammographic studies per year than the general radiologists. Differences between specialist and general radiologist performances at both screening and diagnostic examinations were assessed for significance by using Student t and chi(2) tests. RESULTS: The study involved 47,798 screening and 13,286 diagnostic mammographic examinations. Abnormal interpretation rates for screening mammography (ie, recall rate) were 4.9% for specialists and 7.1% for generalists (P <.001); and for diagnostic mammography (ie, recommended biopsy rate), 15.8% and 9.9%, respectively (P <.001). Cancer detection rates at screening mammography were 6.0 cancer cases per 1,000 examinations for specialists and 3.4 per 1,000 for generalists (P =.007); and at diagnostic mammography, 59.0 per 1,000 and 36.6 per 1,000, respectively (P <.001). Stage 0-I cancer detection rates at screening mammography were 5.3 cancer cases per 1,000 examinations for specialists and 3.0 per 1,000 for generalists (P =.012); and at diagnostic mammography, 43.9 per 1,000 and 27.0 per 1,000, respectively (P <.001). CONCLUSION: Specialist radiologists detect more cancers and more early-stage cancers, recommend more biopsies, and have lower recall rates than general radiologists.     

Digital mammography: what do we and what don’t we know?

High-quality full-field digital mammography has been available now for several years and is increasingly used for both diagnostic and screening mammography. A number of different detector technologies exist, which all have their specific advantages and disadvantages. Diagnostic accuracy of digital mammography has been shown to be at least equivalent to film-screen mammography in a general screening population. Digital mammography is superior to screen-film mammography in younger women with dense breasts due to its ability to selectively optimize contrast in areas of dense parenchyma. This advantage is especially important in women with a genetic predisposition for breast cancer, where intensified early detection programs may have to start from 25 to 30 years of age. Tailored image processing and computer-aided diagnosis hold the potential to further improve the early detection of breast cancer. However, at present no consensus exists among radiologists on which processing is optimal for digital mammograms. Image processing may also vary significantly among vendors with so far limited interoperability. This review aims to summarize the available information regarding the impact of digital mammography on workflow and breast cancer diagnosis.     

临床查体、乳腺超声及X线检查诊断中国人乳腺癌的评价

目的 评价临床查体、乳腺超声及X线检查在诊断中国人乳腺癌中的价值,并比较3种检查的灵敏度、特异度和准确度,分析其联合诊断的意义.方法 对同期乳腺普查和门诊发现的112例可疑乳腺癌的病例(普查组38例,门诊组74例)均进行乳腺查体、超声及X线检查,并作穿刺或手术取活检明确病理诊断.3种检查的结果与病理诊断对照,分别计算出各自的灵敏度、特异度、准确度、阳性预测值及κ值.结果 112例可疑乳腺癌病例中有61例乳腺癌,1例良性病变.乳腺临床查体、超声、X线检查的灵敏度分别为68.85%、88.52%、72.13%;特异度分别为88.23%、21.57%、56.86%;准确度分别为77.68%、58.04%、65.18%.三者两两联合后,乳腺超声与X线检查的灵敏度最高,为98.36%(P＜0.05),但特异度差,仅为3.92%(P＜0.05),准确度为55.36%,而临床查体与X线联合检查的灵敏度虽然较低,为85.25%,但特异度和准确度均较高,分别为56.86%和70.27%.结论 临床查体、乳腺超声、X线检查诊断乳腺癌各有特点.其中乳腺超声的灵敏度最高(P＜0.05),临床查体的特异度最好(P＜0.05),线检查对癌前病变及0期乳腺癌的检出率最高(P＜0.05).若三者联合使用,可以互相补充,减少漏诊,提高早期乳腺癌的检出率,满足大规模乳腺癌普查的需要.     

The positive predictive value for diagnosis of breast cancer full-field digital mammography versus film-screen mammography in the diagnostic mammographic population

RATIONALE AND OBJECTIVES: Diagnostic mammography is performed on women with clinical symptoms that suggest breast cancer or women for whom further mammographic evaluation has been requested because of an abnormal screening mammography. We assessed whether the use of full-field digital mammography would improve the positive predictive value (PPV) for the diagnosis of breast cancer in a diagnostic population compared with film-screen mammography. MATERIALS AND METHODS: From January 2002 to December 2003, 11,621 patients underwent diagnostic mammography at the University of North Carolina Hospital, Chapel Hill. Among these 11,621 patients, 1400 lesions in 1121 patients underwent biopsy. We included the biopsy-performed lesions, so PPV3 was used for comparison of PPVs between film-screen mammography and full-field digital mammography. Six breast radiologists interpreted the images using the Breast Imaging Reporting and Data System of the American College of Radiology. PPV3s were compared between film-screen and full-field digital mammography in the entire study cohort and in specified subgroups according to different radiologists, breast density, and lesion type on mammography. The chi(2) and Fisher's exact tests were used for comparison of PPV3s between two modalities of mammography with the Bonferroni procedure for subgroup analysis. RESULTS: In the entire study cohort, PPV3s of full-field digital mammography and film-screen mammography were similar (difference in PPV3,-0.007; 95% confidence interval, -0.081 to 0.068; P = .8602). In predefined subgroups, there was no difference in PPV3 by the radiologist, breast density, or lesion type between two modalities of mammography (P > .005). CONCLUSION: There is no improvement in PPV for the diagnosis of breast cancer with full-field digital mammography compared with film-screen mammography in a large diagnostic population.     

全数字化乳腺摄影对乳腺疾病的诊断价值

目的 评价全数字化乳腺摄影在临床中对乳腺疾病的诊断价值.方法 回顾215例经手术或活检的术前全数字化乳腺摄影资料,对比影像诊断与最终病理诊断异同.分析不同疾病的误诊原因,初步分析及探讨全数字化乳腺摄影对乳腺疾病的诊断价值.结果 215例经手术或活检的病例中,132例被病理确诊为乳腺癌,83例被诊断为良性病变.在被病理证实为乳腺癌的132例乳腺癌病例中,14例被全数字化乳腺摄影诊断漏诊或误诊.而同时被影像诊断为恶性病变可能的130例(BI-RADS大于4级)的病例中,12例最终病理诊断确定为良性病变.结论 全数字化乳腺摄影是乳腺疾病的重要检查手段,尤其对发现及筛查乳腺癌具有重要价值,但对某些乳腺良性病变,其诊断准确率较低,需要结合其他临床诊断方式.     

Computer-aided mass detection based on ipsilateral multiview mammograms

RATIONALE AND OBJECTIVES: Recent reports on advances in computer-aided detection (CAD) indicate that current schemes miss early-stage breast cancers and result in a relatively large false-positive detection rate in order to achieve a high sensitivity rate for mass detection. This paper is inspired by the interpretation procedure from mammographers. The abnormal diagnosis can be derived from multiple views but is not available through single-view image analysis. MATERIALS AND METHODS: A new multiview CAD system for early-stage breast cancer detection, which is based on modifying the optimized CAD algorithms from our prior single-view CAD system for constructing an adaptive ipsilateral multiview concurrent CAD system, is presented in this paper. The selection and design for the training and testing ipsilateral multiview mammogram databases are described here. RESULTS: The performance evaluation of the developed ipsilateral multiview CAD system using free-response receiver operating characteristic analysis and computerized receiver operating characteristic experiments are presented. The results indicated that the proposed multiview CAD system is significantly superior to the single-view CAD systems based on statistically standard P-values. CONCLUSION: This paper addresses a very important and timely project. It is related to two main problems regarding the development of breast cancer detection and diagnosis: early-stage detection and diagnosis of breast cancer with digital mammogram, and overall improvement of CAD system performance for clinical implementation. In order to improve the efficacy, accuracy, and efficiency of the current CAD scheme, an entirely new class of CAD method is required. This paper is unique in that a comprehensive and state-of-the-art approach is proposed for the CAD scheme of digital mammography. From the design aspect of the CAD scheme, the proposed ipsilateral multiview CAD method is innovative and quite different from current single-view CAD methods.