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。     

乳腺肿块的钼靶X线诊断与术后病理对照分析

目的 应用钼靶检查鉴别乳房肿块的性质,探讨其与手术病理结果的关系。方法 155例乳腺肿块患者均行两侧乳腺侧位和轴位摄影,并与手术病理结果对照分析。结果 在155例乳腺肿块患者中,X线钼靶诊断乳腺癌准确度为91．1％（51／56）;乳腺纤维瘤准确度为91．3％（42／46）;乳腺增生准确度为92．6％（38／41）;导管内乳头状瘤准确率为83．3％（10／12）。结论 X线钼靶乳腺摄影对乳腺肿块性质的诊断与鉴别诊断很有价值,良好的投照方法与临床体征相结合有助于乳腺肿块性质的诊断。     

乳腺X线摄影钙化灶对乳腺疾病的诊断意义

目的探讨乳腺X线钙化在乳腺良、恶性疾病诊断中的意义。方法对1998年1月-2005年10月经手术或穿刺活检病理证实的281例乳腺X线片钙化。回顾性分析乳腺良恶性疾病的钙化特点。结果281例乳腺钙化中181例为乳腺癌,占64．4％,良性疾病100例,占35．6％。乳腺恶性钙化一般具有颗粒较细、数目较多、密度较低、分布相对较广的特点。形态多为泥沙样、叉样、短棒状、断针样、多种形状,部分钙化沿导管走行。良性乳腺钙化一般具有颗粒较粗、数目较少、密度较高、分布局限的特点。形态多为沙砾样、斑片状、轨道状、圆孔状。结论乳腺X线摄影钙化在诊断乳腺良恶性疾病中具有重要作用。     

微小乳腺癌的直接数字化X线征象与临床查体及病理关系的分析

目的分析微小乳腺癌的直接数字化X线征象,并探讨其与临床查体及病理的关系。方法回顾性分析经手术、病理证实的微小乳腺癌68例。采用直接数字化乳腺X线机后处理工作站屏幕阅读方式。结果X线征象为结节者39例,单纯钙化14例,结构紊乱8例,致密影7例,除单纯钙化外,其他征象伴有钙化者37例。临床触诊阳性42例,阴性26例。本组15例(占22%)为非浸润性癌,不可触及微小癌中46%为非浸润性癌。结论微小乳腺癌X线表现为结节、单纯钙化、结构紊乱或致密影,细钙化是微小癌重要X线征象。直接数字化X线摄影对诊断临床触诊阴性的微小乳腺癌有重要价值。     

乳腺X线检查对乳腺肿块的诊断价值分析

目的:探讨X线对乳腺肿块的诊断价值.方法:回顾性对102例乳腺肿块患者进行乳腺X线检查,并与病理对照,分析乳腺良恶性肿块的X线平片特征,并探讨其诊断标准.结果:102例乳腺肿块中,经病理证实,良性72例,其中乳腺增生30例,纤维腺瘤24例,积乳囊肿8例,X线检出8例,炎性肿块6例,脂肪坏死4例,X线检出2,恶性肿块30例,其病理类型为单纯癌14例,浸润性导管癌8例,浸润性小叶癌4例,髓样癌4例.结论:X线对乳腺良恶性肿瘤的诊断具有一定的特征性,尤其是肿块内砂粒样钙化.     

乳腺X线摄影、超声与MRI增强检查在乳腺疾病诊断中的比较

目的:比较乳腺X线摄影、超声与磁共振增强检查在乳腺良恶性病变中的诊断价值。方法:回顾分析2008年1月至2009年1月107例乳腺疾病病人的影像学资料,所有病人均进行乳腺X线摄影、超声与MRI动态增强检查,按照美国放射学会推荐的"乳腺影像报告和数据系统"(BI-RADS)进行分类,以手术病理诊断为金标准,应用受试者工作特征曲线(ROC)评价不同检查方法及联合检测的价值。结果:107例病人共检出117个病灶,以BI-RADS分级4类以上为检查阳性,结果显示MRI增强检查的灵敏度优于乳腺X线摄影(97.06%比80.88%,P=0.003)和超声(97.06%比88.24%,P=0.049),而其特异度不低于乳腺X线摄影和超声(P=0.274和P=0.798)。ROC分析结果显示,MRI增强检查的曲线下面积明显大于乳腺X线摄影(0.935比0.867,P=0.001)和超声(0.935比0.886,P=0.001),而联合3种检查方法曲线下面积最大,明显大于单独行乳腺X线摄影(P=0.001)、超声(P=0.005)和MRI增强检查(P=0.008)。结论:MRI增强检查在有症状的乳腺疾病病人中的诊断价值高于乳腺X线摄影和超声,联合运用三种检查方法,诊断价值可进一步提高。     

X线检查阴性乳腺导管原位癌的临床病理特点

【摘要】〓目的〓探讨乳腺X线检查(MG)阴性的乳腺导管原位癌(DCIS)及DCIS伴微浸润(DCIS-MI)的临床及诊断特点。方法〓对我院2012年1月~2013年8月32例MG检查阴性的DCIS及DCIS-MI的临床病理资料进行回顾性分析。结果〓MG阴性导管原位癌临床表现为单纯乳头溢液占71.9%(23/32),乳腺肿块占15.6%(5/32)例,良性钙化12.5%(4/32)例。MG检查阴性导管原位癌中腺体高密度、低核分级、PR阳性、HER2(-)或(+)病例的比例明显高于同期MG检查阳性组,且差异有统计学意义(P<0.05)。补充其他诊断检查的结果显示,乳腺超声敏感性为18.7%(6/32),磁共振(MRI)敏感性可达为87.5%(28/32),对表现为乳头溢液的病例,乳管镜诊断的敏感性为52.2%(12/23)。结论〓MG阴性的导管原位癌临床病理生物学指标相对较好,MRI检查可进一步提高其检出率,乳管镜对于乳头溢液的病例是有益的补充检查手段。     

乳腺导管内癌的影像学诊断研究进展

乳腺癌已成为全球发病率最高的女性恶性肿瘤之一。乳腺导管原位癌(ductal carcinoma in situ,DCIS)即导管内癌,作为一种早期乳腺癌,具有可能发展成为浸润性乳腺癌的风险[1],根据最新报道,有11.2%的DCIS病人在10年内发展为浸润性癌,是正常人的5倍以上[2]。与浸润性癌相比,     

数字乳腺断层摄影定性诊断乳腺肿块

目的观察数字乳腺断层摄影(DBT)定性诊断乳腺肿块的效能。方法回顾性分析85例女性乳腺肿块患者,以组织病理学结果为诊断金标准,采用受试者工作特征(ROC)曲线分析全数字化乳腺X线摄影(FFDM)、DBT及FFDM+DBT的定性诊断效能。结果于85例共检出89个乳腺肿块,病理诊断良性病变56个、恶性病变33个。FFDM、DBT及FFDM+DBT定性诊断乳腺肿块的敏感度分别为69.64%、87.50%、和87.50%,特异度分别为69.70%、78.79%和84.85%,准确率分别为69.66%、84.27%和86.52%,AUC分别为0.75[95%CI(0.65,0.84)]、0.92[95%CI(0.84,0.97)]和0.93[95%CI(0.86,0.98)];DBT、FFDM+DBT的敏感度、特异度、准确率及AUC均大于FFDM(P均0.05),DBT与FFDM+DBT差异均无统计学意义(P均0.05)。结论 DBT可定性诊断乳腺肿块,且其诊断效能高于FFDM。     

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。     

Ultrasound‐guided wire localization of focal ductal dilatation in the evaluation and treatment of pathologic nipple discharge

Patients presenting with pathologic nipple discharge (PND) often pose a diagnostic and therapeutic challenge. We used ultrasound to identify focal ductal dilatation—hypothesized to be a radiographic manifestation of the causative lesion—in patients with PND and no relevant clinical or radiographic findings. Twenty‐two excisions guided by ultrasound wire localization of focal duct dilation were performed. Surgical pathology revealed papilloma in 20 cases (91%); atypia or carcinoma was detected in 7 cases (32%). The ultrasound finding of focal duct dilatation enables excision of otherwise occult though clinically significant lesions and is worthy of further study.     

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.     

Relationship between mammographic breast density and tamoxifen in women with breast cancer

Previous studies have reported that tamoxifen use is associated with a decrease in mammographic breast density. This is a potentially valuable finding since mammographic sensitivity is limited by breast density. Anything that reduces breast density would theoretically enhance the sensitivity of mammography for the detection of breast cancer in women at an earlier stage when it is more curable. We performed a retrospective study investigating the potential effect of tamoxifen on breast density. The data for this retrospective study were collected from the records of 52 charts from a single medical oncologist. Patients with breast cancer were selected regardless of stage or age at the time of diagnosis or treatment, as long as their charts had records of bilateral mammograms. For each breast on each woman, both mediolateral oblique and craniocaudal views were reviewed independently by two radiologists on two separate occasions to obtain inter- and intraobserver variability. Two methods of classifying breast density were used: the Breast Imaging Reporting and Data System (BI-RADS), and measurements of percent density. Only age and menopausal status were found to be associated with breast density. There was no correlation between breast density and tamoxifen use (past or present). Our study shows no association between tamoxifen use and breast density. We confirm previous observations that breast density is inversely correlated with age and postmenopausal status.     

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.     

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.     

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。     

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.