MRI、CT与乳腺X线钼靶摄影诊断乳腺疾病的价值比较

目的:探究MRI、CT与乳腺X线钼靶摄影三种检查方式对乳腺疾病的诊断价值,为临床治疗乳腺疾病提供理论参考。方法:选择2018年1月—2019年1月期间在我院接受治疗的96例乳腺疾病患者作为本次实验探究的研究对象,所有患者均进行MRI检查、CT扫描与乳腺X线钼靶摄影检查,比较三种检查方式对乳腺疾病的诊断准确率。结果:MRI的诊断准确率显著高于CT扫描和乳腺X线钼靶摄影,CT扫描的诊断准确率显著高于乳腺X线钼靶摄影,具有统计学意义(P<0.05)。结论:相对而言,乳腺X线钼靶摄影更适用于早期乳腺疾病的检查,MRI检查和CT扫描可有效提高乳腺疾病的诊断准确率,三种检查方法各有利弊,建议根据患者病情和个人情况,选择恰当的检查方法,或多种联合使用,能够有效提高患者的诊断准确率,对后期治疗方法的选择具有较高的参考意义,有利于提升预后效果。     

计算机立体定位活检不可触及的乳腺病变

目的:探讨计算机立体定位活检不能触及的乳腺病变的诊断价值。方法:对102例临床不能触及的乳腺病变进行计算机立体定位活检,包括计算机立体定位穿刺活检(SCNB)和细针活检切检(SNLB)两种方式。结果:以SCNB检查61例,诊断符合率95.1%;以SNLB检查41例,36例定位满意,满意率87.8%。结论:计算机立体定位活检定位准确、创伤小、操作简单,对不可触及的乳腺病变的定位定性诊断以及对早期乳腺癌的诊断有重要价值。     

彩色多普勒超声与钼靶X线摄影检查对乳腺黏液癌的诊断价值分析

目的分析乳腺黏液癌的超声声像图特点及乳腺钼靶X线摄影检查结果,以提高两种影像检查对乳腺黏液癌的诊断符合率。 方法对2010年1月至2017年1月在常州第二人民医院乳腺外科经手术病理确诊的43例乳腺黏液癌患者(共44个病灶)的超声声像图做回顾性分析,记录超声表现,包括肿块数量、大小、边界、形态、内部回声、后方回声及肿块内部是否伴微钙化、腋下淋巴结受累及肿块内部血流情况;钼靶X线摄影检查记录肿块形态、边缘、密度及钙化情况;对比分析超声检查与钼靶X线摄影的诊断符合率。 结果35例术前超声诊断与术后病理诊断符合,超声检查诊断符合率为81.4%(35/43);32例术前钼靶X线摄影检查诊断与术后病理诊断符合,乳腺钼靶X线摄影检查诊断符合率为74.4%(32/43);二者诊断效能差异无统计学意义(χ²＝0.61,P＝0.43)。93.0%(40/43)的病例被超声或钼靶X线摄影其中之一检查诊断疑似为恶性;60.5%(26/43)病例被术前超声和钼靶X线摄影诊断均疑似恶性。 结论超声检查与钼靶X线摄影检查对乳腺黏液癌均具有较高的诊断符合率,二者联合可进一步提高诊断效能;若超声或钼靶X线摄影检查诊断疑似为恶性,应行穿刺活检及组织病理学以明确诊断。     

Benign breast disease

The author presents an overview of benign breast disease. History, epidemiology, risk factors, hormonal influence, and clinical features are discussed. Appropriate treatment for mastalgia, diffuse nodularity, mastitis, and dominant lumps is presented. The importance of patient education, clinical breast examination, mammography, and patient reassurance is stressed. Benign breast disease in men is also discussed.     

A review of current evidence-based clinical applications for breast magnetic resonance imaging

Magnetic resonance imaging (MRI) is an important new tool for imaging of the breast. MRI has now been demonstrated to be the most sensitive imaging method for detecting breast carcinoma, allowing depiction of cancers that are occult on mammography, ultrasound, and clinical breast examination. This is tempered by imperfect specificity due to overlap in the features of benign and malignant lesions, and by higher examination cost and more limited availability compared to other breast imaging tests. This article describes the current evidence-based clinical indications for use of breast MRI. Specifically, MRI has been shown to be advantageous for cancer assessment for screening patients at high risk, evaluating patients with a new breast cancer diagnosis, monitoring patients undergoing neoadjuvant chemotherapy, and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. This tool has also been shown to be useful for the evaluation of silicone breast implant integrity. Employment of breast MRI as a problem solving technique for equivocal mammographic or clinical findings is controversial. For each of these clinical applications, the evidence regarding the diagnostic accuracy of breast MRI will be reviewed. An understanding of the current evidence will facilitate the most appropriate utilization of this important medical resource.     

超声“萤火虫”技术联合X线钼靶摄影可提高乳腺导管内原位癌的检出率

  目的  探讨超声“萤火虫”技术与X线钼靶摄影对乳腺导管内原位癌(DCIS)的临床应用价值。  方法  选取2019年12月~ 2021年12月收治的疑似乳腺导管内原位癌患者98例作为研究对象。98例患者均在本院行手术治疗,术前均行超声“萤火虫”技术及X线钼靶检查,统计两种检查对乳腺导管内原位癌的检出情况,以病理诊断作为金标准,对两种影像学检查方式进行对比,比较单一检查与联合检查的诊断价值。  结果  98例乳腺导管内原位癌患者均为单发病灶,良性病变59例,恶性病变39例。超声“萤火虫”技术对乳腺导管内原位癌诊断的敏感度较X线钼靶高(71.8% vs 61.5%),特异性较X线钼靶低(66.1% vs 76.3%),但两者对乳腺DCIS的诊断价值差异无统计学意义(P > 0.05)。超声“萤火虫”技术联合X线钼靶对乳腺DCIS诊断的敏感度、特异性和准确度分别为92.3%、91.5%及91.8%,均高于单纯超声“萤火虫”技术诊断(71.8%、66.1%、68.4%)和单纯X线钼靶(61.5%、76.3%、70.4%),差异有统计学意义(P < 0.05)。  结论  超声“萤火虫”技术联合X线钼靶摄影在诊断乳腺DCIS时具有较高敏感度、特异性和准确度,有助于提高乳腺DCIS的诊断准确率,为临床诊断提供更多价值。      

Concepts for differential diagnosis in breast MR imaging

There is broad agreement in that breast MR imaging, compared with all other contemporary breast imaging techniques, offers the highest sensitivity for primary and recurrent invasive breast cancer. For a long time, however, the modality suffered from the reputation of offering only a limited specificity. In addition, the allegedly low sensitivity for intraductal breast cancer hampered the more widespread use of breast MR imaging. More recent results, however, suggest that the specificity and positive predictive value of breast MR imaging are at least equivalent to those of mammography and that the sensitivity for ductal carcinoma in situ (DCIS) is at least comparable to mammography, if not higher. Apart from increasing reader experience, this progress is mainly attributable to the fact that in parallel with improved MR imaging technology, more refined interpretation criteria became available. These criteria allow a substantially improved diagnosis of malignant masses and of DCIS. This article provides an overview on the current status of the diagnosis criteria that are used for differential diagnosis in breast MR imaging and on the diagnostic accuracy that is achievable with breast MR imaging.     

高频超声和X线钼靶在乳腺癌诊断中的对照研究

目的：探讨二维与彩色多普勒超声检查以及X线钼靶检查联合应用对乳腺癌诊断的实用价值。方法：136例女性乳腺癌患者均行手术并经病理学证实，采用高频二维与彩色多普勒超声检查和X线钼靶检查对乳腺肿块进行诊断与鉴别诊断。结果：彩超对乳腺癌的敏感性为87.5%，X线钼靶对乳腺癌的敏感性为73.5%，超声与X线钼靶联合应用的敏感性为92.6％。结论：利用高频超声与X线钼靶检查的互补性可显著提高乳腺癌的诊断率。     

乳腺钼靶联合超声和CA153、CEA、CA125在早期乳腺浸润性导管癌中的应用

目的:探究乳腺钼靶联合超声以及血清糖链抗原153(carbohydrate antigen 153,CA153)、血清癌胚抗原(carcinoembryonic antigen,CEA)、血清糖链抗原125(carbohydrate antigen 125,CA125)在诊断早期乳腺浸润性导管癌中的应用价值,为患者的临床诊断提供指导。方法:选择2017年2月至2019年7月皖北煤电集团总医院收治的60例早期乳腺浸润性导管癌患者作为观察组,另选择同期皖北煤电集团总医院收治的60例良性乳腺肿块患者作为对照组。对比两组患者的乳腺钼靶和超声的影像学特征以及血清CA153、CEA和CA125阳性率,同时对乳腺钼靶、超声和肿瘤标志物检测及3项联合在早期乳腺浸润性导管癌中的诊断效能进行比较。结果:两组患者在乳腺钼靶和超声上均有典型性特征,差异有统计学意义(P<0.05)。观察组患者的血清CA153、CEA和CA125阳性检出率均明显高于对照组,差异有统计学意义(P<0.05)。三项联合检查在诊断早期乳腺浸润性导管癌中的敏感度、准确度和阴性预测值分别为93.33%、88.33%和92.59%,均明显高于乳腺钼靶、乳腺超声和肿瘤标志物检测(分别为73.33%、74.17%、73.77%;76.67%、77.50%、7.05%;70.00%、72.50%、71.43%),差异有统计学意义(P<0.05)。三项联合检查的特异度(83.33%)、阳性预测值(84.85%)与乳腺钼靶、乳腺超声和肿瘤标志物检测(分别为75.00%、78.83%、75.00%和74.58%、77.97%、73.68%)比较,差异无统计学意义(P>0.05)。结论:乳腺钼靶联合超声和血清CA153、CEA、CA125检测能够有效提高早期乳腺浸润性导管癌的诊断准确率,对其早期诊治具有重要意义。     

乳腺数字X线检查联合多普勒超声检查对乳腺良恶性病变诊断效能研究

目的:观察乳腺数字X线检查联合多普勒超声检查对乳腺良恶性病变诊断价值。方法:选取2018年1月-2019年5月期间在我院收治的乳腺良恶性病变病人80例作为研究对象,对所有病人进行乳腺数字X线检查和多普勒超声检查。对比单独行乳腺数字X线检查、单独行多普勒超声检查及两种检查联合的诊断准确率。结果:联合检查准确率高于单独行乳腺数字X线检查或者单独行多普勒超声检查准确率(P<0.05),组间数据差异明显,差异存在统计学意义。结论:乳腺数字X线检查联合多普勒超声检查,对乳腺良恶性病变病人诊断准确率更高,显影清晰,减少误诊率和漏诊率,临床价值显著。     

Modern methods in the diagnosis of breast disease (author's trans)]

240 patients attending a surgical clinic for breast diseases were examined clinically and subjected to mammography, thermography and ultrasonic investigation. Histological reports are available in 98 cases, enabling an evaluation of the accuracy of the used diagnostic methods. The most efficient diagnostic method is X-ray mammography, followed by thermography and ultrasound diagnosis, but these procedures are still fraught with methodological and technical problems.     

钼靶结合MRI对微小乳腺癌的诊断价值分析

目的：探讨全数字化X线乳腺钼靶摄影、3.0 T MRI检查对微小乳腺癌的诊断价值。材料与方法回顾性分析31例经手术证实的微小乳腺癌患者的全数字化X线乳腺钼靶及3.0 T MRI检查资料,分析其影像学特征,并统计对比钼靶、MRI单独和联合应用的诊断准确率。结果 X线乳腺钼靶摄影准确率为64.5%(20/31),MRI 检查诊断准确率为90.3%(28/31),联合应用诊断准确率为96.7%(30/31),高于两者单独应用,差异有统计学意义(P＜0.05)。结论微小乳腺癌X线乳腺钼靶摄影、MRI表现具有一定的特征性,两者联合应用有助于提高乳腺癌的诊断正确率。     

原发性淋巴瘤的超声声像图及钼靶X线摄影特征分析

目的分析原发性淋巴瘤的超声声像图及钼靶X线摄影特征。方法回顾性分析13例经病理证实的原发性淋巴瘤患者的临床资料、超声声像图及钼靶X线摄影图像。结果 13例患者共15个病灶,9例伴有患侧腋窝淋巴结肿大,均为单侧发生非霍奇金淋巴瘤。13例患者行超声检查,9例行钼靶X线摄影检查。超声声像图多表现为:卵圆形(7/15)或分叶状(5/15)、边界清晰(10/15)低回声为主的肿块,部分肿块(7/15)伴后方回声增高,均未见肿块周围蟹足样改变、高回声晕环、后方回声衰减及肿块内钙化。多数肿块(11/15)内见丰富的动脉血流信号。钼靶X线摄影多表现为:卵圆形(5/8)或分叶状(3/8)的边界清晰(7/8)和高密度(7/8)肿块。2例乳腺腺体较致密,未见明确肿块,均未见毛刺、钙化、皮肤增厚及乳头凹陷。结论原发性淋巴瘤的超声及钼靶X线摄影表现均无特异性。在结合超声声像图肿块血流信号特征考虑恶性可能,而钼靶X线摄影表现为良性或不典型乳腺癌者应考虑到乳腺原发性淋巴瘤可能,进一步进行组织学活检以明确乳腺原发性淋巴瘤的诊断。     

乳腺良恶性病变的钼靶X线征象与病理特征

目的：评价钼靶X线检查对乳腺良恶性病变的诊断价值，初步探讨其病理特征。方法：对96例乳腺病变患者进行X线钼靶检查，分析比较病变的边缘特征、钙化等征象，并与病理结果进行对照。结果：96例患者中术前钼靶X线诊断为乳腺癌40例，良性病变56例。经病理证实乳腺癌42例，良性病变54例。钼靶X线正确诊断90例，正确诊断率为93．75％。分析X线钼靶检查结果与手术病理结果一致性较好，乳腺良恶性病变肿块边缘特征的差异有显著性（P〈0．01）。结论：X线钼靶检查是诊断乳腺病变的有效手段，良恶性病变在肿块边缘、钙化等方面具有不同的影像学特征，不同征象是以不同的病理为基础的。     

钼靶摄片立体定位穿刺乳腺活检的价值

目的 探讨钼靶摄片立体定位穿刺活检技术在早期乳腺癌诊断上价值。方法 对22例钼靶X片上乳腺有可疑病灶而无任何临床体征的患者,在X线定位下穿刺活检,明确诊断后采取不同手术方式治疗,手术病理对照。结果22例中8例（占36.4％）为乳腺癌,均行改良根治术;14例（占63.6％）为良性。空心针穿刺活检（CNB）与手术结果符合20例,诊断符合率90.9％。结论 X线钼靶摄片及定位穿刺活检可早期发现乳腺癌,提高诊断隐匿性乳腺癌的准确性,为外科制定手术方案提供依据。     

Common breast problems

A palpable mass, mastalgia, and nipple discharge are common breast symptoms for which patients seek medical attention. Patients should be evaluated initially with a detailed clinical history and physical examination. Most women presenting with a breast mass will require imaging and further workup to exclude cancer. Diagnostic mammography is usually the imaging study of choice, but ultrasonography is more sensitive in women younger than 30 years. Any suspicious mass that is detected on physical examination, mammography, or ultrasonography should be biopsied. Biopsy options include fine-needle aspiration, core needle biopsy, and excisional biopsy. Mastalgia is usually not an indication of underlying malignancy. Oral contraceptives, hormone therapy, psychotropic drugs, and some cardiovascular agents have been associated with mastalgia. Focal breast pain should be evaluated with diagnostic imaging. Targeted ultrasonography can be used alone to evaluate focal breast pain in women younger than 30 years, and as an adjunct to mammography in women 30 years and older. Treatment options include acetaminophen and nonsteroidal anti-inflammatory drugs. The first step in the diagnostic workup for patients with nipple discharge is classification of the discharge as pathologic or physiologic. Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilateral, or associated with a breast mass. Patients with pathologic discharge should be referred to a surgeon. Galactorrhea is the most common cause of physiologic discharge not associated with pregnancy or lactation. Prolactin and thyroid-stimulating hormone levels should be checked in patients with galactorrhea.     

乳腺癌MRI影像组学的研究进展

乳腺癌是全世界女性最常见的恶性肿瘤之一,也是患癌女性的主要死因。提高诊断准确性、早期评估乳腺癌预后及治疗效果是临床实践中的关键问题。MRI因其较高的软组织分辨率,目前仍是诊断乳腺癌的常用成像方式。相对于乳房X线摄影和超声,MRI可以提供更全面的诊断信息。影像组学是一个高通量提取和定量分析影像特征的新研究领域,近年来受到广泛关注并应用于肿瘤领域。作者就乳腺癌MRI影像组学方面的研究进展进行综述。     

乳腺钼靶联合MR检查在早期乳腺癌诊断中的应用价值分析

目的:探究乳腺钼靶联合MR检查在诊断早期乳腺癌中临床应用价值。方法:选择2018年3月—2019年3月我院乳腺癌104例患者,将其随机分为对照组和实验组各52例,对照组进行常规的MR检查,实验组患者实施乳腺钼靶联合MR检查,统计分析两组乳腺癌患者的诊断准确率。结果:相比于对照组,实验组的检查结果更接近病理学检验结果,实验组的病灶数量、同乳晕间距、周围浸润、钙化以及腋窝淋巴结转移情况均显著优于对照组(P<0.05);实验组患者的诊断结果与病理学检验结果符合率更高,且实验组患者的乳腺癌诊断正确率显著高于对照组(P<0.05),组间差异具有统计学意义。结论:乳腺钼靶联合MR检查在诊断早期乳腺癌中具有较高的临床应用价值,能够有效提高早期乳腺癌的诊断准确率。     

乳腺癌钼靶X线放大摄影的诊断价值

目的 探讨钼靶X线放大摄影在乳腺癌中的诊断价值。方法 回顾性分析50例经手术病理证实的乳腺癌普通钼靶X线摄影及钼靶X线放大摄影的资料,比较两种方法在显示病变方面的差异。结果 钼靶X线放大摄影在显示肿块的毛刺、分叶、钙化方面明显优于普通X线摄影,在显示乳腺癌的间接征象方面也优于普通钼靶X线摄影。结论 加伏钼靶X线放大摄影可提高乳腺癌诊断的准确率和精确性。     

乳腺病变动态增强MRI、乳腺摄影片、超声、病理对照研究

目的比较动态增强MRI、乳腺摄影片、超声对乳腺病变,尤其是乳腺癌的诊断价值。方法对30例乳腺病变的61个病灶的三种影像学检查手段与病理结果相对照,计算每种检查方法的灵敏度、特异度等指标并两两比较。结果超声、乳腺X线摄影、动态增强MRI对61个乳腺病灶的诊断灵敏度、特异度分别为:41.2%、84.6%,35.3%、87.2%,94.1%、94.9%;超声、乳腺X线摄影联合检查的灵敏度、特异度为47.6%、85.4%。动态增强MRI与乳腺摄影诊断正确率的差别有统计学意义(χ2=32.378,P=0.000);乳腺摄影和超声间的差别无统计学意义(χ2=0.569,P=0.451)。结论对乳腺病变的检查,动态增强MRI较X线摄影和超声的诊断效果更好。