彩色多普勒超声、超声弹性成像与钼靶X线诊断乳腺疾病的价值

目的分析比较彩色多普勒超声、超声弹性成像与钼靶X线诊断乳腺疾病的价值。方法将2016-02—2017-02间在河南科技大学第一附属医院就诊的264例(288个病灶)乳腺疾病患者,分别使用彩色多普勒超声、超声弹性成像、钼靶X线和联合的方法进行诊断。以病理学检查结果为金标准,比较其诊断结果。结果 (1)病理诊断经288个病灶中有173例患者为良性,115例患者为恶性。(2)彩色多普勒超声的敏感性为84.3%(97/115),特异性为83.2%(144/173),准确性为83.7%(241/288)。钼靶X线诊断的敏感性为79.13%(91/115),特异性为76.3%(132/173),准确性为77.4%(223/288)。三者联合应用的敏感性为93.8%(107/114),特异性为93.0%(107/115),准确性为92.0%(265/288)。联合检查结果明显优于超声弹性成像、彩色多普勒及钼靶X线检查,差异有统计学意义(P0.05)。结论彩色多普勒超声、超声弹性成像与钼靶X线诊断乳腺疾病各有优势及不足。超声的敏感性比较好,超声弹性成像适用于检测弹性系数比较大的肿块,钼靶X线虽然对钙化有较高的敏感性,但是在诊断致密性乳腺及小乳房时敏感性比较差。三种方法联合检查,可有效提高乳腺疾病诊断的敏感性、特异性和准确性。     

超声弹性成像及钼靶X线诊断乳腺疾病价值对比研究

目的 探讨超声弹性成像及钼靶X线诊断乳腺疾病的价值。方法 2009年3月至2010年8月,山东省滨州市邹平计划生育妇幼保健服务中心对65例女性病人共72个病灶术前行超声弹性成像及钼靶X线检查,以手术病理为诊断标准,对比分析两者诊断乳腺疾病的准确性。结果 病理诊断良性53个病灶,恶性19个病灶。超声弹性成像诊断乳腺恶性病变的灵敏度、特异度和约登指数分别为84.2%、96.2%、0.804。钼靶X线诊断乳腺恶性病变的灵敏度、特异度和约登指数分别为68.4%、92.4%、0.608。结论 超声弹性成像诊断乳腺病变的准确性高于钼靶X线,两者结合可提高乳腺恶性病变诊断的准确性。     

乳腺肿块Sono CT高频超声显像与钼靶X线诊断对照研究

目的 分析比较Sono CT高频超声显像与钼靶X线摄影法对乳腺肿块的临床诊断价值。方法 193例乳腺肿块患者，其中乳腺癌58例，良性肿块135例，在术前1周内同时行Sono CT高频超声显像和钼靶X线摄影检查。结果 超声诊断早期乳腺癌46例，其敏感性79．31％，特异性94．81％，准确性90．16％。钼靶诊断早期乳腺癌47例，其敏感性和特异性为81．03％和89．63％，准确性为87．05％。超声对于良性肿瘤分类诊断的敏感性、特异性和准确性均高于钼靶。结论 Sono CT高频超声与钼靶X线摄影比较，发现前者对早期乳腺癌的敏感性和阴性预测值近于后者，特异性和阳性预测值则高于后者，而对于良性肿瘤的分类诊断前者优于后者。     

62例乳腺钙化灶的结果分析

目的探讨乳腺钙化灶对乳腺癌的诊断意义。方法回顾性分析62例乳腺钼靶X线摄影钙化灶的形状、大小、分布与病理结果的关系。结果62例乳腺钙化中25例为乳性癌，占40％，良性疾病37例，占60％，乳性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。结论乳腺钼靶X线摄影钙化在诊断乳腺良恶性疾病中具有重要作用。     

乳腺钼靶X线三维立体定位系统引导下导丝定位活检的临床应用

目的探讨乳腺钼靶X线三维立体定位系统引导下导丝定位手术活检在临床不能触及肿块的乳腺病变中的价值及可行性。 方法回顾性研究2013年4月至2015年10月间收治的乳腺钼靶X线异常女性患者67例,对临床不能触及的乳腺病灶行导丝定位手术活检及病理检查。 结果67例病灶均一次定位成功,发现乳腺癌17例（25.4%）,癌前病变（导管上皮非典型增生及导管内乳头状瘤）13例（19.4%）,其他良性病变37例（55.2%）。影像表现为微钙化灶的46例病例中乳腺恶性病变共16例（34.8%）,癌前病变8例（17.4%）,其他良性病变22例（47.8%）;非钙化组的21例病例中良性病变20例（95.2%）,恶性病变1例（4.8%）。与影像表现为非钙化组比较,对于临床不能触及的乳腺病灶,乳腺钼靶X线影像表现为微钙化时乳腺癌检出率更高（χ²=5.369,P=0.021）。 结论钼靶X线三维立体定位系统引导下导丝定位活检可以发现容易漏诊的早期乳腺癌及癌前病变,该方法简便、准确,值得推广。     

超声检测乳腺癌微小钙化的影响因素及与钼靶X线摄影的对比

【摘要】〓目的〓比较超声与钼靶X线摄影检测乳腺癌微小钙化的一致性,探讨影响超声检测乳腺癌微小钙化的影响因素。方法〓87例乳腺癌行超声及钼靶X线摄影检查,分析二者的乳腺病灶及微小钙化的特点,比较二者检测的一致性,分析超声检测微小钙化的影响因素。结果〓超声对病灶的显示率及诊断恶性的准确率均高于钼靶(χ2=9.911,P=0.002)。二者在微小钙化的检出方面无统计学差异(P>0.05),具有较高的一致性(k=0.652)。以钼靶显示微小钙化作为标准,超声检测微小钙化的敏感度为82.1%,特异度为83.3%,假阳性率16.7%,假阴性率为17.9%。钼靶上微小钙化的大小及密集程度影响其超声检测(P<0.05)。结论〓超声较钼靶X线摄影能更敏感地检测及诊断乳腺恶性病变;超声能有效地检测乳腺癌微小钙化,但易受微小钙化的大小及密集程度的影响。     

不同临床及影像学特征对良恶性乳头溢液疾病鉴别诊断价值分析

目的 探讨不同临床及影像学特征对良性及恶性乳头溢液疾病的诊断价值。 方法 回顾性分析2011年1月至2016年2月上海交通大学医学院附属瑞金医院因乳头溢液行手术治疗的233例病人的临床资料。乳腺癌33例（14.2%）,乳腺良性疾病200例（85.8%）。分析不同临床及影像学特征病人良性及恶性乳头溢液的检出率,计算乳腺X线摄影、乳腺超声、乳腺MRI及联合检查对乳腺癌诊断的灵敏度。 结果 血性溢液（P=0.008）、乳腺X线摄影伴可疑恶性钙化（P<0.001）、MRI表现为段样强化（P=0.003）、流出型时间-信号强度曲线（P=0.023）的病人乳腺癌检出率明显增高,差异有统计学意义。乳腺X线摄影对恶性乳头溢液诊断的灵敏度较低（57.6%）,劣于超声检查（87.9%,P=0.012）及MRI检查（93.9%,P=0.001）。乳腺X线摄影联合超声或MRI诊断的灵敏度分别为90.9%及100.0%,显著高于单用乳腺X线检查（P=0.004,P<0.001）。结论 对于不伴肿块的乳头溢液,血性溢液、乳腺X线摄影伴可疑恶性钙化、MRI段样强化、时间-信号强度曲线为流出型的病人患乳腺癌的风险较高。乳腺X线摄影对乳头溢液潜在恶性病变的检出率较低,联合超声或MRI检查可提高检出率。     

反向传播神经网络结合超声诊断乳腺癌

目的：探讨利用反向传播神经网络结合超声对乳腺癌的诊断价值。方法：选择55例乳腺癌进行常规超声及超声造影,了解有无微钙化灶,通过应用Qontraxt软件绘制时间-强度曲线,以其中35个病例的峰值强度、达峰时间、曲线尖度及曲线下面积及有无钙化为输入变量,肿瘤的良恶性为输出变量,建立反向传播神经网络,并用其预测另20例的肿瘤良恶性。结果：利用微钙化灶对乳腺癌诊断的敏感性、特异性和准确率分别为69.7%、90.9%、60.6%;超声造影对乳腺癌诊断的敏感性、特异性和准确率分别为87.9%、81.8%、69.7%;反向传播神经网络联合超声造影和微钙化灶对乳腺癌诊断的敏感性、特异性和准确率分别为91.7%、87.5%、79.2%。结论：选择合适的超声造影和常规超声参数建立的反向传播神经网络,可提高乳腺肿瘤良恶性判断的准确性。     

钼靶X射线与乳腺超声对乳腺肿瘤的诊断效能对比

目的对比分析钼靶X射线与乳腺超声对乳腺肿瘤的诊断效果。方法选取2019年1月至2020年1月本院收治的82例经病理检查确诊为乳腺癌的患者为研究对象,所有患者入院时均先后接受钼靶X射线与乳腺超声检查,比较两种检查方式的诊断效果。结果在乳腺密度5级诊断率的比较上,两者检查低密度乳腺的5级诊断率比较差异无统计学意义(P0.05),乳腺超声检查高密度乳腺的5级诊断率高于钼靶X射线(P0.05);乳腺超声对肿块微钙化灶的显示率低于钼靶X射线(P0.05),两种检查技术对肿块边界欠清及毛刺的显示率比较差异无统计学意义(P0.05)。结论对于高密度型乳腺癌的诊断,乳腺超声较钼靶X射线更具优势,但针对肿块微钙化灶的显示率方面,钼靶X射线更加敏感。建议在病灶较小的乳腺肿瘤检查中辅助应用钼靶X射线,有助于提高检出率。     

X线钼靶与B超对乳腺良恶性病变诊断的ROC曲线分析

目的:探讨X线钼靶与B超对乳腺良恶性病变诊断价值,加强乳腺癌的预防及提高对乳腺癌患者的早期诊断和治疗。方法:乳腺良恶性病变患者120例分别进行X线钼靶与B超检查,对诊断效果进行ROC曲线分析。结果:钼靶X线诊断的敏感性为96.8%,特异性为82.8%;B超诊断的敏感性与特异性为98.6%和98.0%。B超诊断的特异性高于X线诊断(P<0.05)。ROC曲线分析显示X线钼靶和B超用于乳腺良性病变诊断无显著统计学意义(P>0.05),对乳腺癌的诊断效果差异有统计学意义(P>0.05)。结论:钼靶X线难以显示致密腺体内的病灶,而B超不受干扰可进行多方位扫查的优点恰好弥补了钼靶X线的不足,使得其对于乳腺癌诊断的特异性加强。     

MicroPure成像技术鉴别诊断乳腺良恶性肿瘤

目的评价MicroPure成像技术检测乳腺肿瘤微钙化及鉴别乳腺良恶性肿瘤的价值。方法对经钼靶x线检查证实存在微钙化灶的110例乳腺肿瘤患者（125个肿瘤）进行常规高频超声及配有MicroPure成像技术的超声检查,记录微钙化灶检出率,对乳腺肿瘤进行BI-RADS分级。以术后病理结果为金标准,比较常规高频超声及MicroPure成像技术诊断乳腺恶性肿瘤的准确率;绘制ROC曲线,比较两种方法诊断乳腺恶性肿瘤的能力。结果MicroPure成像技术对于微钙化的检出率（125／125,100％）高于常规高频超声（97／125,77．60％,χ2=29．32,P〈0．05）。对低回声病灶的微钙化,MicroPure成像技术的检出率（69／69,100％）与常规高频超声（67／69,97．10％）差异无统计学意义（χ2=0．507,P〉0．05）;而对非低回声病灶的微钙化,MicroPure成像技术的检出率（56／56,100％）明显高于常规高频超声（30／56,53．57％,χ2=31．31,P〈0．05）。MicroPure成像技术诊断乳腺恶性肿瘤的特异度、敏感度及准确率分别为86．21％（50／58）、95．52％（64／67）、91．20％（114／125）,常规高频超声则分别为86．21％（50／58）、74．63％（50／67）和80．00％（100／125）,二者诊断敏感度和准确率差异有统计学意义（P均〈0．05）。MicroPure成像技术诊断乳腺恶性肿瘤ROC曲线下面积（0．944）大于常规高频超声（0．859）。结论MicroPure成像技术可提高乳腺病灶微钙化的检出率,进而提高诊断乳腺恶性肿瘤的敏感度和准确率。     

Radiological,Histological and Chemical Analysis of Breast Microcalcifications: Diagnostic Value and Biological Significance

Classification of mammary microcalcifications is based on radiological and histological characteristics that are routinely evaluated during the diagnostic path for the identification of breast cancer, or in patients at risk of developing breast cancer. The main aim of this study was to explore the relationship between the imaging parameters most commonly used for the study of mammary microcalcifications and the corresponding histological and chemical properties. To this end, we matched the radiographic characteristics of microcalcifications to breast lesion type, histology of microcalcifications and elemental composition of microcalcifications as obtained by energy dispersive x ray (EDX)-microanalysis. In addition, we investigated the properties of breast cancer microenvironment, under the hypothesis that microcalcification formation could result from a mineralization process similar to that occurring during bone osteogenesis. In this context, breast lesions with and without microcalcifications were compared in terms of the expression of the main molecules detected during bone mineralization (BMP-2, BMP-4, PTX3, RANKL OPN and RUNX2). Our data indicate that microcalcifications classified by mammography as “casting type” are prevalently made of hydroxyapatite magnesium substituted and are associated with breast cancer types with the poorest prognosis. Moreover, breast cancer cells close to microcalcifications expressed higher levels of bone mineralization markers as compared to cells found in breast lesions without microcalcifications. Notably, breast lesions with microcalcifications were characterized by the presence of breast-osteoblast-like cells. In depth studies of microcalcifications characteristics could support a new interpretation about the genesis of ectopic calcification in mammary tissue. Candidating this phenomenon as an integral part of the tumorigenic process therefore has the potential to improve the clinical management of patients early during their diagnostic path.     

高频B超在中国妇女致密型乳腺的乳腺癌筛查中的应用

目的：探讨超声检查及定位在中国妇女致密型乳腺发生的早期乳腺癌筛查中的作用。方法：对2002年2月—2006年4月来湘雅医院乳腺科门诊就诊及体检中心健康检查的5万余名女性行乳腺高频超声检查，筛查出乳腺肿块4 000余例，其中经手术病理证实的致密型乳腺患者乳腺癌142例（肿块最大横径均≤2cm），将患者的超声检查与钼靶片结果资料进行分析对比。结果：在142例致密型乳腺的乳腺癌患者中，超声发现微小钙化47例（33.10％），敏感性达74.60％，准确率为88.73％;钼靶发现泥沙样钙化38例（26.76％），敏感性60.32％，准确率为82.39％。钙化灶的检出率为44.37％。其中超声发现微小肿块110例（77.46％），敏感性88.71％，准确率为90.14％;钼靶片发现100例（70.42％），敏感性80.65％，准确率为83.10％。12例临床上未扪及肿块患者均在超声定位下准确地切除病灶。结论：（1）高频超声检查在中国妇女致密型乳腺的乳腺癌筛查中检出小肿块及恶性钙化的敏感性以及准确率要高于钼靶片检查。（2）高频超声检查可作为年青妇女、致密型乳腺以及扁平型乳腺早期乳腺癌筛查的有效方法之一，它不仅提高早期乳腺癌的诊断率也提高了保乳率，值得推广使用。     

数字钼靶计算机辅助诊断系统检测微钙化团簇的诊断能力评价

目的:自主开发的计算机辅助诊断系统-MCAD,检测数字化乳腺片上的微钙化团簇,提高早期乳腺癌的诊断准确率.方法:从互联网上的权威性数字化乳腺影像数据库下载69个病例,用于有效性研究;对国内29例含微钙化团簇的乳腺癌x线片进行回顾性研究;对国内826例乳腺筛查x线片进行前瞻性研究.将MCAD系统对所有数字化乳腺片上的微钙化团簇检测结果与放射科医师诊断结果比较.结果:在有效性研究中,MCAD系统诊断微钙化团簇的敏感性显著高于两位放射科医师(0.925 vs 0.716,0.75,P＜0.01),特异性则低于放射科医师(0.719 vs 0.938,0.938,P＜0.001),平均每幅图像上有假团簇0.6个.在回顾性研究中,MCAD系统的诊断敏感性高于放射科医师(0.914 vs 0.716,0.8,P=0.098),假阳性团簇的检出数显著高于放射科医师(0.93 vs 0.03,0.07,P＜0.001).在前瞻性研究中,使用MCAD系统亦获得了更高的诊断准确率.结论:MCAD系统对微钙化团簇的检测具有高敏感度,可帮助放射科医师发现隐匿于乳腺片复杂背景中的微钙化团簇,对乳腺癌的早期诊断具有重要意义.     

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。     

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications

The purpose of this study is to introduce and evaluate the usefulness of the combination of wire localization and ultrasound (US)-guided, vacuum-assisted breast biopsy (VAB) to histologically diagnose mammographically detected clustered microcalcifications in the absence of sonographic and clinically palpable masses. Fifty-eight consecutive patients (mean age 53 years) with 58 mammographically detected microcalcification clusters underwent mammographically guided wire localization followed by VAB with US guidance for targeting the wire. Mammography of the specimens obtained was performed in all cases for identification of microcalcifications. The procedure took approximately 24 min (range, 18–52 min). No significant immediate and delayed complications were observed. Microcalcifications were evident on both specimen radiographs and microscopic slides in 56 cases (97%). The combination of wire localization and US-guided VAB could provide an accurate and useful method for diagnosing mammographically detected, clustered microcalcifications.     

Radiotransparency of Polyvinylpyrrolidone-Hydrogel and Hydrogel Breast Implants: A Quantitative Analysis with Mastectomy Specimens

Breast cancer is the most common cancer in women. Past evidence suggested that women with silicone implants who had cancer presented with more advanced disease and had the worst prognosis due to difficulty visualizing early lesions on mammography. Hence, new filling materials have been developed. In this study, 10 mastectomy specimens were used. Mammograms of specimens alone and specimens covering polyvinylpyrrolidone-hydrogel and hydrogel implants were performed. The variables studied were number of mammograms necessary to examine each specimen, kilovolts and milliamperes of each mammogram, number of isolated microcalcifications, microcalcification clusters and macroscopic calcifications, and rarefaction areas. No significant differences were found in number of mammograms (p = 0.439), isolated microcalcifications (p = 0.178), macrocalcifications (p = 1.0), and presence of rarefaction areas (p = 0.368). The difference in number of microcalcification clusters was significant (p = 0.0498). Significant differences (p < 0.001) also were observed in the kilovolts and milliamperes of the mammograms performed for specimens alone versus those with implants. Polyvinylpyrrolidone-hydrogel and hydrogel breast implants allow adequate visualization of mammary glands at the expense of greater radiation doses, although it must be considered that the experimental situation does not fully match the real clinical setting.     

Viscoelastic Imaging of Breast Tumor Microenvironment With Ultrasound

Imaging systems are most effective for detection and classification when they exploit contrast mechanisms specific to particular disease processes. A common example is mammography, where the contrast depends on local changes in cell density and the presence of microcalcifications. Unfortunately the specificity for classifying malignant breast disease is relatively low for many current diagnostic techniques. This paper describes a new ultrasonic technique for imaging the viscoelastic properties of breast tissue. The mechanical properties of glandular breast tissue, like most biopolymers, react to mechanical stimuli in a manner specific to the microenvironment of the tissue. Elastic properties allow noninvasive imaging of desmoplasia while viscous properties describe metabolism-dependent features such as pH. These ultrasonic methods are providing new tools for studying disease mechanisms as well as improving diagnosis.     

Breast ultrasound in breast cancer surveillance; incremental cancers found at what cost?

PurposeTo determine the diagnostic parameters of breast ultrasound (US) in the setting of routine radiological surveillance after a diagnosis of breast cancer and evaluate costs of the inclusion of breast US as well as any survival benefit of US detected cases of recurrence in surveillance.Methods622 patients underwent breast cancer surgery and follow up at Austin Health from July 2009 to December 2015. Retrospective data analysis was performed to determine; diagnostic parameters, financial costs of US and survival outcomes of US detected cases of recurrence.ResultsPatients underwent 1–9 years of breast cancer surveillance, with a median of 4.24 years. 390 (62.7%) patients underwent additional breast US surveillance to mammography. 232 (38.3%) fit criteria for use of additional breast US. 199 abnormal imaging episodes occurred, leading to 16 screen detected-cases of locoregional recurrence. US alone generated 107 abnormal images and found 9 cancers. US had a sensitivity of 44.1%, specificity of 95.2% and positive predictive value of 11.7% in comparison to mammography; 20.6%, 97.4% and 9.9% respectively. US had a biopsy rate of 4.0% and lead to an incremental cancer detection rate of 0.38%. The cost of incremental cancer found was $31,463.72 AUD. Survival outcomes based on method of detection of recurrence were insignificant (p value = 0.71).ConclusionsBreast US has a sensitivity of 44.1% and detected seven recurrences that were mammographically occult. Breast US has a similar PPV to mammography in surveillance. Breast US generated considerable biopsy rates and costs. Survival analysis was not able to detect any benefit of US detected cases of recurrence.