超声对诊断乳腺恶性淋巴瘤的价值

目的评价超声诊断乳腺恶性淋巴瘤的临床价值。方法回顾性分析我院17例乳腺恶性淋巴瘤的超声表现,所有病例均经病理证实。结果本组病例均为女性。肿块大小0.7～5.5cm,14例可见明确肿块,3例表现为乳腺结构紊乱呈弥漫性低回声团而无明确肿块边界。多数肿块呈形态不规则低回声,内伴有条索状高回声,肿块边界不清,边缘不光整,后方回声增强,彩色多普勒显示血流信号较丰富。结论乳腺恶性淋巴瘤具有一定的超声特征,对该病的诊断具有一定的临床价值。     

乳腺囊内乳头状癌的声像图特征

目的:探讨乳腺囊内乳头状癌的高频声像图特征及其鉴别诊断。方法:回顾性分析11例经术后病理证实的乳腺囊内乳头状癌资料,超声观察病灶形态、大小、边界、内部回声、后方回声,以及病灶内及周围血流情况。结果:乳腺囊内乳头状癌声像图表现为边界清楚,囊壁上乳头状突起,形态不规则,基底部较宽,可有厚分隔,后方回声增强,彩色多普勒显示囊内实质结节内血流较丰富或边缘血流等特征。结论:乳腺囊内乳头状癌的超声表现具有一定的特征,有助于乳腺囊内乳头状癌的诊断及鉴别诊断。     

乳腺乳头腺瘤的超声表现

目的:探讨乳腺乳头腺瘤的高频超声图像特征.材料和方法:回顾性分析7例经术后病理证实的乳腺乳头腺瘤的超声图像资料.在灰阶声像图上观察病灶形状、大小、边界、内部回声及后方回声.应用彩色多普勒血流成像(CDFI)观察病灶内部及周围血流分布和供应情况.结果:6例乳腺乳头腺瘤声像图表现为乳头内圆形或椭圆形低回声结节,境界清楚,后方回声增强,彩色多普勒显示结节内少量血流或边缘血流.1例位于左乳乳头后方低回声结节,边界清晰,周边见薄的包膜回声,彩色多普勒显示其内中等量的血流信号.结论:乳腺乳头腺瘤是一种少见的乳腺良性肿瘤,超声检查有助于乳腺乳头腺瘤的诊断及鉴别诊断.     

乳腺叶状肿瘤的超声诊断(附33例分析)

目的探讨乳腺叶状肿瘤的声像图特点和超声诊断价值,以提高诊断水平。方法回顾分析33例经手术病理证实的乳腺叶状肿瘤患者,观察其超声的声像图表现:病变的部位、大小、形态、边界、内部回声与后方回声、有无液化和钙化,利用彩色多普勒超声观察肿块内部及周边的血流分布情况。结果 33例乳腺叶状肿瘤中,良性12例,交界性12例,恶性9例。乳腺叶状肿瘤的二维声像图表现:体积较大的分叶状肿块,边界清晰、规则,内部以实性低回声为主,回声大部分均匀,部分可见散在的无回声区,无或少有钙化,后方回声增强,所有肿块的内部和/或周边均可探及血流信号。结论超声对乳腺叶状肿瘤的定性诊断具有较高的临床应用价值。     

超声对乳腺叶状囊肉瘤的诊断价值

目的：探讨乳腺叶状囊肉瘤的声像图特点和超声诊断价值。方法：回顾分析12例经手术病理证实的乳腺叶状囊肉瘤的声像图表现；观察病变的部位、大小、形态、边界、内部与后方回声、有无液化和钙化；利用彩色多普勒超声观察肿块内部及周边的血流分布情况。结果：乳腺叶状囊肉瘤的二维声像图表现为：体积较大的分叶状肿块，边界多清晰、规则，内部以实性低回声为主，回声可不均匀，部分见有散在的无回声区，少有钙化，后方回声增强。所有肿块的内部和／或周边均可探及血流信号。彩色多普勒超声在判断肿瘤的病理分级方面价值有限。结论：超声对乳腺叶状囊肉瘤的定性诊断具有较高的临床应用价值。     

男性乳腺疾病的超声诊断

目的探讨男性乳腺常见疾病的声像图表现,以提高其诊断水平。方法 82例经超声检查并经临床证实的男性乳腺疾病,包括乳腺发育症65例,乳腺炎7例,乳腺癌5例,乳腺纤维腺瘤2例,乳腺脂肪瘤3例,对所有患者的声像图表现进行了回顾性分析。结果声像图显示男性乳腺疾病随病种而有不同表现,乳腺发育症呈弥漫型与结节型低回声区;乳腺癌呈边界不清和内部回声不均匀的病灶,常伴灶内微小钙化;急性乳腺炎表现为乳头周围局限性低回声区,边界清楚,回声均匀,而慢性乳腺炎表现为乳房内不均质低回声区;乳腺纤维腺瘤表现为椭圆形实质低回声光团,边缘光整;乳腺脂肪瘤表现为边界清楚的扁椭圆形稍高或低回声光团。本组2例慢性乳腺炎误诊为乳腺癌。诊断敏感性、特异性、准确性、阳性预测值及阴性预测值分别为100%,97.4%,96.3%,71.4%,97.4%。结论超声检测能直观显示男性乳腺病变的部位、大小、形态、内部回声及血流显像特征,有助于鉴别良性与恶性病变。     

常规超声在乳腺病灶良恶性鉴别中的临床应用价值

目的 探讨常规超声在乳腺病灶良恶性鉴别中的临床应用价值.方法 对94例乳腺肿块患者进行超声检查,将所得的二维及彩色多普勒声像图特征与手术病理检查结果进行对比分析.结果 对超声检查方法与病理诊断符合情况分析发现,超声检查发现良性肿块61例,诊断符合率为88.41％（61/69）;超声检查发现恶性肿块23例,诊断符合率为92.00％（23/25）;对良性组和恶性组的诊断符合率进行统计学分析发现两组的诊断符合率无统计学差异（x2=0.39,P＞0.05）.良性组和恶性组在二维超声声像图方面有明显不同,其中良性组的二维超声声像图多以界限清楚,有包膜,形态规则,内部回声较均匀,后方无衰减,而恶性组的二维超声声像图则多以边界欠清楚或不清楚,无包膜,形态不规则,内部回声不均匀,后方存在衰减.结论 彩色多普勒超声对乳腺良、恶性病变的形态学检查有重要鉴别诊断价值,二维灰阶声像图的特征是乳腺肿块的首要诊断依据.     

乳腺硬化性腺病伴纤维腺瘤形成1例

1病例资料
　　女,46岁。体检发现右侧乳腺实性结节就诊。患者无疼痛,无皮肤红肿、破溃,无发热,无乳头溢液。超声检查：右乳腺2点钟近乳头处大小约0.7 cm×0.5 cm的实性结节,边界欠清晰,形态不规则,后方回声衰减,内可见点状强回声钙化（图1A）。于右乳腺8点钟距乳头约1 cm处大小约0.9 cm×0.4 cm的实性结节,边界欠清晰,内可见粗大强回声钙化（图1B）。CDFI：结节内未见血流信号。超声诊断：右侧乳腺实性结节（2点钟位者 BI-RADS分4B级、8点钟位者 BI-RADS分级4A级）。在超声引导下旋切2点钟及8点钟肿物,完整切除送检。病理诊断：乳腺硬化性腺病伴纤维腺瘤形成。     

原发性乳腺淋巴瘤的彩色多普勒声像图分析及其价值

目的：回顾性分析11例原发性乳腺淋巴瘤的声像图表现,以提高超声对原发性乳腺淋巴瘤的认识及诊断水平。方法复习2005年-2013年来我院经活检或手术病理证实的11例乳腺原发性淋巴瘤的彩色多普勒超声表现,分析其声像图特征。结果11例患者中,10例可见具体肿块,1例表现为乳腺结构紊乱,呈弥漫性低回声而无明确肿块。乳腺淋巴瘤单发5例,多发6例。10例为低回声,1例为高回声。其中5例为形态不规则的极低回声,其内部伴有条索状强回声,肿块边界不清,后方回声多增强,彩色多普勒显示血流信号较丰富。结论乳腺团块边界欠清晰,形态欠规则的低或极低回声,内伴有条索状高回声,后方回声增强,血流丰富且肿块多发时。应考虑到乳腺淋巴瘤可能。     

彩色多普勒超声诊断乳腺脓肿临床价值分析

目的探讨彩色多普勒超声在乳腺脓肿诊断中的应用价值。方法对收治62例的乳腺脓肿患者应用彩色多普勒超声进行检查,观察乳腺组织的回声情况,肿块的形态、边界、大小及回声情况。结果 62例患者在经过彩色多普勒超声检查后,其乳腺组织回声均有不同程度的紊乱,紊乱程度分为高中低三个级别,其中中指标人数最多,其次是低指标;患者乳腺肿块大小不一,最大91mm,最小16mm;患者乳腺不同程度存在大小在1cm×1.5cm的无回声区域;在乳腺脓肿边缘存在局部增厚情况,而且边界不清楚;而乳腺导管存在不同程度的增粗。结论彩色多普勒是早期筛查乳腺疾病的重要检查方法,对于乳腺脓肿的诊断具有重要的临床价值。     

自动乳腺容积成像与手持超声对触诊阴性乳腺的诊断价值比较

目的 比较自动乳腺容积成像(ABUS)与手持超声(HHUS)对触诊阴性乳腺患者诊断价值的差异.资料与方法 纳入228例触诊阴性、术后经病理确诊乳腺患者的428枚手术切除乳腺病灶,比较ABUS与HHUS对病变检出率和诊断准确率的差异.结果 ABUS对触诊阴性乳腺患者病灶的检出率(97.2％)显著高于HHUS(87.6％)...     

Differentiation of benign and malignant breast lesions: A comparison between automatically generated breast volume scans and handheld ultrasound examinations

Objective

To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions.

Materials and methods

The study prospectively evaluated 239 lesions in 213 women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses.

Results

Among the 239 breast lesions studied, pathology revealed 85 (35.6%) malignant lesions and 154 (64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3% vs. 90.6%), specificity (80.5% vs. 82.5%), accuracy (85.8% vs. 85.3%), positive predictive value (73.0% vs. 74.0%), and negative predictive value (93.3% vs. 94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928 and 0.948, respectively).

Conclusions

The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging.     

Radiologists' Performance for Detecting Lesions and the Interobserver Variability of Automated Whole Breast Ultrasound

Objective

To compare the detection performance of the automated whole breast ultrasound (AWUS) with that of the hand-held breast ultrasound (HHUS) and to evaluate the interobserver variability in the interpretation of the AWUS.

Materials and Methods

AWUS was performed in 38 breast cancer patients. A total of 66 lesions were included: 38 breast cancers, 12 additional malignancies and 16 benign lesions. Three breast radiologists independently reviewed the AWUS data and analyzed the breast lesions according to the BI-RADS classification.

Results

The detection rate of malignancies was 98.0% for HHUS and 90.0%, 88.0% and 96.0% for the three readers of the AWUS. The sensitivity and the specificity were 98.0% and 62.5% in HHUS, 90.0% and 87.5% for reader 1, 88.0% and 81.3% for reader 2, and 96.0% and 93.8% for reader 3, in AWUS. There was no significant difference in the radiologists'' detection performance, sensitivity and specificity (p > 0.05) between the two modalities. The interobserver agreement was fair to good for the ultrasonographic features, categorization, size, and the location of breast masses.

Conclusion

AWUS is thought to be useful for detecting breast lesions. In comparison with HHUS, AWUS shows no significant difference in the detection rate, sensitivity and the specificity, with high degrees of interobserver agreement.     

Automated breast ultrasound: basic principles and emerging clinical applications

Automated breast ultrasound (ABUS) is a recently introduced ultrasonography technique, developed with the purpose to standardize breast ultrasonography and overcome some limitations of handheld ultrasound (HHUS), such as operator dependence and the considerable amount of medical time necessary to perform and interpret HHUS. This new ultrasonography technique separates the moment of image acquisition (that may be performed also by a technician) from that of its interpretation, increasing reproducibility, reducing operator-dependence and physician time. Moreover, multiplanar reconstructions, especially the coronal view, introduce new diagnostic information. ABUS, with those advantages, has the potential to be used as an adjunctive tool to screening mammography, especially in the dense breast, where mammography has a relatively low sensitivity. Women’s awareness of risks related to breast density is a hot topic, especially in the USA where legislative breast density notification laws increase the demand for supplemental ultrasound screening. Therefore, ABUS might have the potential to respond to this need. The purpose of this article is to present a summary of current state-of-the-art of ABUS technology and applications, with an emphasis on breast cancer screening. This article discusses also how to overcome some ABUS limitations, in order to be familiar with the new technique.     

Automated breast ultrasound: Supplemental screening for average-risk women with dense breasts

ObjectiveWe review ultrasound (US) options for supplemental breast cancer screening of average risk women with dense breasts.ConclusionPerformance data of physician-performed handheld US (HHUS), technologist-performed HHUS, and automated breast ultrasound (AUS) indicate that all are appropriate for adjunctive screening. Volumetric 3D acquisitions, reduced operator dependence, protocol standardization, reliable comparison with previous studies, independence of performance and interpretation, and whole breast depiction on coronal view may favor selection of AUS. Important considerations are workflow adjustments for physicians and staff.     

Interobserver reliability of automated breast volume scanner (ABVS) interpretation and agreement of ABVS findings with hand held breast ultrasound (HHUS), mammography and pathology results

Objectives

Handheld breast ultrasound (HHUS) lacks standardization and reproducibility. The automated breast volume scanner (ABVS) could overcome this limitation. To analyze the interobserver reliability of ABVS and the agreement with HHUS, mammography and pathology is the aim of this study.

Methods

All 42 study participants (=84 breasts) received an ABVS examination in addition to the conventional breast diagnostic work-up. 25 breasts (30%) showed at least one lesion. The scans were interpreted by six breast diagnostic specialists blinded to results of breast imaging and medical history. 32 lesions received histological work-up: 20 cancers were detected. We used kappa statistics to interpret agreement between examiners and diagnostic instruments.

Results

On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification of the 84 breasts an agreement (defined as ≥4 of 6 examiners) was achieved in 63 cases (75%) (mk = 0.35) and even improved when dichotomizing the interpretation in benign (BI-RADS 1, 2) and suspicious (BI-RADS 4, 5) to 98% (mk = 0.52). Agreement of ABVS examination to HHUS, mammography and pathology was fair to substantial depending on the specific analysis.

Conclusions

The development of an ABVS seems to be a promising diagnostic method with a good interobserver reliability, as well as a comparable good test criteria as HHUS.     

乳腺黏液腺癌的影像学特征和诊断价值

目的 探讨单纯型乳腺黏液腺癌(PMBC)和混合型乳腺黏液腺癌(MMBC)的影像学特征,评价超声、X线、MRI对乳腺黏液腺癌(MBC)的诊断价值.方法 回顾经手术病理证实的48例MBC患者术前的影像资料,分析PMBC和MMBC的超声、X线、MRI影像特征,进一步比较3种影像学的诊断价值.结果 在3种影像学检查中,PMBC多表现为规则的肿块(圆形、椭圆形或分叶状),边缘清晰;而MMBC多表现为不规则肿块,边缘呈浸润征象.在超声声像图中,MBC更多表现为囊实混合性回声,PMBC多表现为血供不丰富、后方回声增强;而MMBC大多血供丰富,后方回声不一.在MRI中,MBC在T2 WI上表现为高信号或明显高信号,在增强方式上,PMBC更多表现为边缘强化,以渐进性强化方式主,而MMBC更多表现为边缘强化或不均匀强化,以平台型强化方式为主.3种检查方法对2种类型的诊断准确率比较无差异,3种检查方法之间的诊断准确率比较也无统计学意义.结论 PMBC和MMBC在超声、X线、MRI影像上的表现各具有其一定的特征性,充分认识其影像学特征不仅能提供鉴别2种类型的依据,还能减少MBC的漏诊和误诊.     

乳腺叶状肿瘤声像图特征及误诊分析

目的探讨不同类型乳腺叶状肿瘤(PTB)的超声声像图特征并分析其误诊原因。方法选取61例不同类型PTB患者乳腺肿块的位置、大小、数目、形态、回声等形态学特征,对比超声检查确诊PTB以及误诊患者声像图特征,并与病理结果对照分析,总结误诊原因。结果1)本组PTB 61例,良性43例(70.5%),交界性10例(16.4%),恶性8例(13.1%),伴腋窝淋巴结转移1例(0.16%)。良性组肿块平均最大径(3.0±1.42)cm,交界性/恶性组肿块平均最大径(5.5±1.33)cm,两组间比较差异有统计学意义(P<0.01);交界性/恶性组PTB诊断准确率明显高于良性组(P<0.05);乳腺BI-RADS系统区分PTB肿块良恶性趋势差异有统计学意义(P<0.01);2)61例超声检查诊断PTB 19例,准确率31.1%(19/61),误诊42例,误诊率68.9%(42/61);超声检查确诊PTB组肿块大于3 cm者占比明显大于误诊为纤维腺瘤、乳腺癌和不定性肿块组(P<0.05);本组肿块声像图以分叶/融合状、回声不均匀、伴暗区、后方回声增强为主要特征,少见后方回声衰减及钙化(P<0.05);误诊为腺瘤组肿块多体积相对小、形态规则、回声均匀、少分隔(P<0.05),血流分布以0~I级为主;误诊为乳腺癌组肿块多形态不规则、回声不均匀(P<0.01),血流分布均以II~III级为主;不定性组肿块兼有腺瘤和乳腺癌两者特征。结论乳腺PTB在超声声像图具有特征性表现,对中、老年女性、较大不规则肿块、回声不均、伴暗区及后方回声增强、血流丰富者应考虑PTB,但超声检查声像图特征对于PTB鉴别诊断仍需进一步探究。     

How to optimize breast ultrasound

Breast cancer is the most common female cancer, and the second cause of cancer-related mortality of women in our society. Mammography is the gold-standard method of breast imaging. However it is not an optimal screening tool, especially in cases of dense breast parenchyma. Even when optimally performed, its sensitivity ranges between 69 and 90%. Ultrasound represents an additional diagnostic tool that raises the detection rate of benign and malignant breast lesions. It is the method of choice for differentiating solid from cystic lesions, for further characterizing mammographic findings and better appreciating palpable breast lesions. B-mode ultrasonography is used in every day practice. Harmonic imaging and compound imaging can be used to ameliorate the image contrast and resolution. Colour Doppler is used for studying lesion vascularization however there is no consensus as to whether it really permits to differentiate malignancies from benign lesions. New technical developments such as breast elastography, 3D ultrasound and dedicated ultrasound computed aided diagnosis (CAD) are promising methods for the future.     

乳腺浸润性导管癌超声影像特征分析

 目的 分析超声各特征性影像表现在乳腺浸润性导管癌中的诊断价值。方法 选取解放军总医院第六医学中心 2018-01至2019-12两年内收治的 135例乳腺浸润性导管癌患者纳入本研究,分析乳腺浸润性导管癌的超声影像特征、体检自检发现率以及淋巴结转移与病变大小、位置的相关性。结果 (1)单因素分析显示:形态不规则(91.11%)、边界不清楚(64.44％)、血流信号(44.44％)、微钙化(37.78%)、纵横比＞1(17.78％)、后方回声衰减(15.56％)超声诊断指标,与浸润性导管癌的诊断具有相关性;(2)与其他三个象限相比较,内上象限浸润性导管癌更容易被患者自检发现,占自检发现病例的34.93%;(3)内上象限及外上象限的浸润性导管癌更容易发生淋巴结转移(转移率为:内上:25.53%,内下:0.00%,外上:64.70%,外下:11.76%);(4)对＜3 cm的浸润性导管癌,其大小与腋窝淋巴结的转移没有相关性。结论 超声表现以形态不规则在乳腺浸润性导管癌中的发生率最高,且在早期病变中即表现出来;乳腺病变的自检检出率、乳腺癌淋巴转移率均与乳腺病变的大小和位置密切相关。