基于EMPIRE算法的数字乳腺断层合成X线成像结合重建二维及三维图像对乳腺良恶性病灶的鉴别诊断价值

【摘要】目的：探讨基于EMPIRE算法的数字乳腺断层合成X线成像（DBT）结合重建二维（s2D）及重建三维（s3D）图像对乳腺良恶性病灶的鉴别诊断价值。方法：前瞻性纳入经超声诊断为乳腺影像报告和数据系统（BI-RADS）分类为4类及以上、拟行手术或穿刺活检的126例患者，所有患者均行全屏数字乳腺X线成像（FFDM）和DBT检查，通过DBT图像后处理获得s2D、s3D图像。分别对FFDM、DBT结合s2D、DBT结合s3D、DBT结合FFDM图像进行分析，记录腺体的平均辐射剂量，对病灶的可见性进行分级，同时对病灶进行BI-RADS分类；对穿刺及手术标本进行病理分析，获得病变的组织类型。采用单因素方差分析比较四种不同组合图像的平均腺体辐射剂量，采用配对符号秩和检验比较四种组合图像的可见性评级，以病理学为金标准，采用受试者工作特征（ROC）曲线比较四种组合图像的诊断效能。结果：4例为穿刺病理证实，122例为手术病理证实。良性病灶61例，恶性病灶65例。FFDM、DBT-FFDM、DBT-s2D、DBT-s3D图像的单个体位平均腺体辐射剂量分别为（1.72±0.48）、（4.81±1.12）、（3.28±0.79）和（3.28±0.79）mGy，其差异具有统计学意义（P＜0.0001）。DBT-FFDM（116/126）、DBT-s2D（116/126）及DBT-s3D（117/126）较单独FFDM(98/126）显著提高病灶的可见性，其中DBT-s3D对病灶的可见性最高（93%）。FFDM、DBT-FFDM、DBT-s2D及DBT-s3D对乳腺良恶性病灶诊断的ROC曲线下面积分别为0.749，0.804，0.832，0.864。结论：基于EMPIRE迭代算法的DBT结合重建二维及三维图像能在一定程度上增加乳腺病灶的可见性，并提高乳腺良恶性病灶的鉴别诊断效能。     

乳腺摄影微钙化的Le Gal分型与病理的关系

目的：探讨乳腺摄影时微钙化病灶的LeGal分型与病理表现的相关性。方法：经病理证实的伴有乳腺微钙化灶的女性患者106例,术前均行数字化乳腺摄影检查,分析微钙化的影像学表现并进行LeGal分型。结果：本组患者中共发现111个微钙化病灶（5例为双乳病变）,经病理证实,恶性病灶50个（45．0％）,良性61个（55．0％）。微钙化LeGal分型中恶性病变的比例分别为：Ⅱ型29．6％（16／54）,Ⅲ型31．0％（9／29）,Ⅳ型87．0％（20／23）,Ⅴ型100％（5／5）。良恶性病灶的微钙化类型的差异有高度统计学意义（P〈0．01）,且随分型的升高,恶性病变的比例逐渐递增。Ⅱ型和Ⅲ型中,微钙化单位面积数量以及是否合并肿块在良恶性病变间的差异有统计学意义（P〈0．05）。结论：乳腺微钙化病灶的LeGal分型与其病理学表现间有明显相关性,结合其它影像学表现能提高对乳腺良恶性病变的诊断准确性。     

全数字化乳腺X线摄影在乳腺恶性病变诊断中的临床价值

目的 分析全数字化乳腺X线摄影（FFDM）在乳腺恶性病变诊断中的临床价值。方法 回顾性分析上海市普陀区妇婴保健院2019年6月至2020年6月接诊的170例乳腺结节患者资料，均给予FFDM检查，将病理诊断结果作为本研究金标准，统计FFDM检出率、诊断准确率、灵敏度、特异度，Kappa检验FFDM影像诊断评估结果与金标准的一致性，对比乳腺良、恶性结节组FFDM影像学征象。结果 病理诊断恶性23例，良性147例；FFDM检出良性151例，恶性19例。FFDM诊断准确率是95.3%，灵敏度是73.9%，特异度是98.6%,Kappa检验FFDM影像诊断评估结果与金标准的一致性较好（Kappa值=0.79）,P<0.05。恶性组肿块边缘毛刺率（95.6%）、肿块形态不规则率（43.5%）、钙化分布簇状（56.5%）、导管性分布率（30.4%）、钙化形态线形分支型率（47.8%）、细沙状率（47.8%）、血管增粗率（78.3%）均高于良性组（0.7%、0.7%、23.1%、0.7%、2.7%、0.7%、14.3%），差异有统计学意义（P<0.05）。结论 FFDM在乳腺恶性病变的诊断...     

数字乳腺断层成像与磁共振成像对乳腺肿瘤的诊断价值

【摘要】目的：通过对比全数字化乳腺摄影（FFDM）、数字乳腺三维成像（DBT）与MRI对乳腺肿瘤的鉴别诊断能力,评价不同影像检查方法对乳腺癌的诊断价值。方法：回顾性分析253例临床经病理证实为乳腺病变的女性患者的病例资料,均采用FFDM、DBT及MRI检查。观察肿瘤大小、形态、边缘、有无钙化等,强化方式、早期强化率（EER）、时间-信号强度曲线（TIC）及表观扩散系数（ADC）,根据乳腺影像报告数据系统（BI-RADS）进行分类,以病理结果为金标准,采用受试者操作特性曲线（ROC）分析不同检查方法对乳腺癌的诊断效能,评价单纯的FFDM、DBT、MRI对乳腺癌的诊断准确性。结果：253例乳腺病变患者中良性病灶112例,恶性病灶141例。FFDM、DBT及MRI诊断乳腺癌的ROC 曲线下面积分别是0.826、0.897、0.884;诊断其敏感度分别为84.2%、92.3%、95.6%;特异度分别为82.5%、85.5%、84.5%。DBT及MRI 诊断乳腺癌的曲线下面积大于FFDM,差异有统计学意义（P<0.001）,DBT与MRI诊断乳腺癌的曲线下面积差异无统计学意义（P>0.05）。结论：DBT及MRI较FFDM检查能够提高乳腺癌的诊断效能,DBT和MRI 对乳腺病灶的检出及诊断效能相近,但DBT更为经济适用,且禁忌证相对较少。     

乳腺低危团簇状分布钙化的BI-RADS分类建议及临床处理策略

【摘要】目的：探讨全数字化乳腺X线摄影（FFDM）筛查性检查中低危团簇状钙化灶的合理BI-RADS归类,提出相应的临床处理策略。方法：回顾性研究本院FFDM筛查性检查发现的99例低危团簇状钙化患者资料,患者1周内进行针对性第二眼超声检查,1个月内行穿刺活检或手术明确病理诊断。以病理学检查结果为标准,比较单纯FFDM和FFDM联合第二眼超声在诊断乳腺良恶性病灶上的差异。结果：99例患者经FFDM发现团簇状钙化灶共114处,其中乳腺良性病变94例,乳腺癌5例,恶性病变占5.05%。针对FFDM发现的低危团簇状分布钙化灶病例,本研究提出“BI-RADS 4F”分类类别,并在FFDM检查完成1周内进行第二眼超声检查,与单纯FFDM相比,FFDM联合第二眼超声检查检出了所有乳腺癌的病例,阳性似然比从2.91升至3.3,降低假阳性率,减少不必要的穿刺活检,两者比较差异有统计学意义（P=0.027）。结论：FFDM筛查性检查联合针对性第二眼超声检查,可显著提高低危团簇状钙化灶的乳腺癌检出率,降低假阳性率,避免不必要的有创活检。基于本研究结果的“乳腺团簇状分布钙化灶处理流程图”及增设“BI-RADS 4F”类别的建议对临床工作有参考意义。     

乳腺微钙化BI-RADS分类的临床阳性预测值分析

目的分析乳腺微钙化病变BI-RADS分类的阳性预测值及意义。方法收集经手术证实的52例乳腺患者资料,钼靶X线片均显示有微钙化。根据BI-RADS分类标准进行良恶性评估,分为3~5级,与病理结果对照比较。结果BI-RADS分类对3级病变的诊断准确率、5级病变的阳性预测值分别为100%、95.2%;恶性肿瘤组的阳性预测值达100%;良性病变组的评估中存在66.7%(10/15)高估现象;微钙化伴肿块或致密影的阳性预测值较单纯钙化组高;微钙化呈段样、区域性分布时恶性风险较高。结论乳腺微钙化BI-RADS分类对3级、5级病变的临床阳性预测有较高价值,但对4级微钙化病变诊断特异性较低,需结合其他检查,避免不必要的活检。     

阅片者间应用数字乳腺断层合成X线成像诊断乳腺疾病的可靠性分析

目的：比较阅片者间应用全屏数字化乳腺 X 线成像(FFDM)和数字乳腺断层合成 X 线成像(DBT)对乳腺疾病诊断及BI-RADS 分类的差异,评价 DBT 在诊断乳腺肿瘤方面的应用价值。方法收集疑似乳腺疾病病例300例,所有病例均经手术病理证实,其中良性118例,恶性182例,所有患者术前均行 FFDM 及 DBT 检查。分别由4名不同年资医师独立阅片进行诊断,以病理为金标准,比较阅片者间对乳腺病变诊断的差异。采用χ2及受试者工作特征(ROC)曲线分析方法进行统计。结果高年资医师阅读 FFDM 和 DBT 的诊断正确率分别为90%和91%,曲线下面积(AUC)分别为0.891和0.899;低年资医师阅读 FFDM 和DBT 影像的诊断正确率分别为82%和90%,AUC 分别为0.801和0.891。118例良性病变中 DBT 相比 FFDM,高、低年资医师分类为 BI-RADS 4a 类及以下的病例分别由82例提高到96例、41例提高到98例,分类为 BI-RADS 4b-5类的病例分别由19例降至16例、30例降至16例。182例恶性病变中 DBT 相比 FFDM,分类为 BI-RADS 4a-5类的病例高、低年资医师分别由167例提高到169例、152例提高到167例;BI-RADS 4a 类及以下的病例分别由12例降至10例、24例降至15例。高、低年资医师阅读 FFDM 分类为 BI-RADS 0类的病例分别为22例和53例,而阅读 DBT 后二者分别降至7例和4例。结论不同年资医师阅读 DBT 可以提高诊断的准确性,BI-RADS 分类与病理结果的一致性亦更高,以低年资医师提高更为显著。DBT 对提高乳腺肿瘤的检出率及诊断准确性具有很大的潜能。     

计算机体层激光乳腺摄影在乳腺病变中的应用

目的探讨计算机体层激光乳腺摄影（CTLM）诊断乳腺良恶性病变的可行性。方法对91例乳腺疾病病人的93个病变乳腺逐一进行CTLM检查,最后诊断均经病理证实。观察不同病变的CTLM表现,并将CTLM所见与临床检查提示的病变位置和病理诊断对照分析。结果成功获得84例病人的86个乳腺CTLM影像,检查成功率为92．5％（扫描层数≥6）。其中,恶性病变的乳腺扫描成功率为88．7％,良性病变成功率为100％（P〉0．05）。与乳腺良性肿瘤比较,恶性肿瘤在CTLM影像中表现出更常见（P〈0．01）和更明显（P〈0．01）的吸光增加。结论通过观察乳腺病变区域对激光的吸收情况。CTLM可以提供乳腺病变血管生成和血流多少的相关信息。     

MR-DWI的ADC与rADC在乳腺疾病良恶性鉴别诊断中的比较

目的：探讨磁共振扩散加权成像（DWI）的表观扩散系数（ADC）、相对表观扩散系数（rADC）的定量分析在确定乳腺病变良恶性中的诊断价值。方法：2013年1月-2014年1月220例符合研究纳入标准：①临床拟诊良、恶性肿瘤的患者;②乳腺 MRI 检查后在本院进行手术或粗针穿刺活检取得病理结果的患者;③乳腺 MRI 检查前未进行活检及各种干预性措施的患者;④病灶截面积≥25 mm2者;⑤患者乳腺纤维腺体组织为 ACR 分型中Ⅱ～Ⅳ型（即纤维腺体体积≥25％者）等的病例进行乳腺 MRI 的扩散成像（DWI）序列诊断价值的前瞻性研究。所有病例术前均接受 MRI 检查,包括 DWI （b＝800 s/mm2）。测量患者的病灶、对侧胸肌、同侧及对侧正常纤维腺体的 ADC 值,并计算2个相对表观扩散系数值,即rADC1＝病灶 ADC 值/对侧正常纤维腺体 ADC 值和 rADC2＝病灶 ADC 值/对侧胸大肌 ADC 值,比较 ADC 与 rADC 值对乳腺良恶性病变的诊断价值。结果：220例病灶中良性病变105例,恶性病变115例。当病灶 ADC 值的良恶性诊断阈值为1．20×10-3 mm 2/s 时,曲线下面积为0．923,其敏感度为88．7％,特异度为87．6％,诊断准确率达88．2％。当rADC1值的诊断阈值为0．70时,曲线下面积为0．834,其敏感度为82．6％,特异度为79．0％,诊断准确率达80．9％。当rADC2值的诊断阈值为0．81时,曲线下面积为0．873,其敏感度为83．5％,特异度为78．1％,诊断准确率达81．0％。结论：DWI 表观扩散系数（ADC）与相对表观扩散系数（rADC）的定量分析在确定乳腺良恶性病变性质中的具有较高诊断价值。当 b 值相同时,病灶表观扩散系数（ADC 值）对于乳腺疾病良恶性的鉴别诊断特异性高于相对表观扩散系数（rADC值）;其敏感性两者之间无明显统计学差异。胸大肌作为参照,其诊断价值与正常纤维腺体相当。     

BI-RADS影像特征的预测模型在乳腺不可触及钙化病变中的价值

目的 探讨乳腺不可触及钙化病变患者的临床及BI-RADS-X线影像特征,建立Logistic多变量预测模型评估乳腺病变良恶性的概率,以提高乳腺不可触及钙化病变诊断准确率.方法 回顾性分析133例(147个病灶)乳腺不可触及钙化病变,先根据个人经验对病变的X线影像资料进行分析并做出BI-RADS评估分类,与病理对照绘制受试者工作特征(ROC)曲线.之后再对病变X线影像及临床特征进行单因素及多因素分析,筛选与良恶性相关的影响因素,建立Logistic模型并选取合适截点,绘制ROC曲线.最后比较术前BI-RADS分类与Logistic模型对乳腺病变诊断准确性的差别.结果 术前BI-RADS分类判断病变良恶性得到曲线下面积(AUC)为0.867 9.患者临床特征(年龄、位置、病变所在象限)及BI-RADS-X影像特征(分布方式、形态特征、病变部位腺体密度)单因素分析结果显示上述特征差异均有统计学差异;Logistic回归多因素分析示年龄、象限及形态特征差异有统计学意义,建立方程判断病变良恶性得到Logistic模型的AUC为0.906 3.结论 Logistic模型对乳腺病变诊断的准确性高于术前BI-RADS分类,对乳腺病变的正确诊断具有一定的参考价值.     

Calcified filariasis of the breast: report of four cases

Circumscribed to endemic areas throughout tropical countries, filariasis is a rare and unknown disease in Europe. We report four cases of calcified filariasis involving the breast, supporting the diagnosis on the typical mammographic appearance of the calcified worms and the past history of filarial infection. Few reports have been published in the radiology literature about this infrequent manifestation of the parasitation. The purpose of this article is to show the mammographic characteristics of this disease that soon will be seen frequently in developed countries due to the increasing population from the endemic areas.     

Clip placement facilitating the approach to breast lesions

We describe a novel technique for marking non-palpable breast lesions with the aim of selecting the best approach prior to performing a biopsy. The technique employs a new coil, specifically designed for breast localization, guided by stereotaxy. This technique is reserved for selected cases in which the lesion is seen peripherally in only one mammographic view with negative or non-conclusive ultrasonographic results, and deeply seated after a stereotactic study. Once the coil is released beside the lesion, the shortest approach from the skin may be employed to perform the biopsy. To our knowledge, this is the first report of this technique.     

Breast Cancer from the Excisional Scar of a Benign Mass

Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.     

Hematologic malignancies of the breast: report of three cases

Involvement of the breast by hematologic malignancies is rare and remains an important diagnostic challenge for radiologists. We present the cases of 3 patients diagnosed with hematologic breast malignancies at our institutions. All cases were diagnosed by breast core biopsies, which revealed 2 cases of diffuse B-cell lymphoma and one case of myeloid sarcoma associated with acute myeloblastic leukemia (AML). This study focuses on describing the diagnostic features found on mammographic and sonographic imaging at initial presentation of lymphomas and leukemias affecting the breast.     

MRI of the breast: state of the art

Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5–12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prothesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication. Received 7 October 1997; Revision received 14 November 1997; Accepted 17 November 1997     

MRI of the breast in patients with metastatic disease of unknown primary

The objective of this study was to assess the value of contrast-enhanced dynamic breast imaging in patients with carcinoma of unknown primary (CUP). Fourteen patients presenting with metastatic disease compatible with breast cancer (axillary lymph node metastasis: n = 6; supraclavicular lymph node metastasis: n = 1; bone metastasis: n = 3; liver metastasis: n = 3; lung metastasis: n = 1), who had no evidence of tumor in X-ray mammograms and ultrasound, underwent bilateral dynamic breast MR imaging. Suspicious lesions were localized preoperatively using a stereotactic device for MR-guided localization procedures. Magnetic resonance imaging revealed suspicious lesions in 9 of 14 patients. Histopathology revealed invasive carcinoma of the breast in 6 of these patients. Two enhancing lesions were fibroadenomas; one proved to be sclerosing adenosis. In 5 patients MR imaging showed no abnormality. Follow-ups performed up to 1 year after initial treatment revealed no breast cancers in these 5 patients. In patients with metastatic disease of unknown primary, MRI of the breast depicts the primary in a considerable number of cases with normal conventional evaluation. Received: 20 February 1998; Revision received: 2 June 1998; Accepted: 10 July 1998     

超声检查在良恶性乳腺肿块评估中的作用

作者对１００例乳腺肿块的超声检查资料进行了回顾性分析，其中乳腺癌４２例，乳腺良性肿瘤和其他良性病变５８例，均经手术和病理证实。乳腺癌的超声诊断符合率为８３．３％，乳腺良性肿块的诊断符合率为６９．０％。结果表明，根据病灶的边界、形态、回声分布、后方有否衰减及周围组织有否浸润等声像图表现，对肿块的良恶性别断有一定的参考价值。但当病灶较小，特别是合并有较明显的乳腺病时，超胃检查对良恶性的判断常有其限度。     

Foreign Body Granulomas of the Breast Presenting as Bilateral Spiculated Masses

In Asia, mammography following the injection of foreign materials into the breasts for cosmetic augmentation is frequently seen and diagnosis based on the typical radiologic findings is straightforward.We report the unusual radiologic findings in two patients with foreign body granulomas caused by injected foreign materials and discovered incidentally during screening work up. The mammographic findings were bilateral, hyperdense, spiculated masses, with occasional microcalcification, and at sonography, markedly hypoechoic, spiculated solid masses, located near the pectoralis muscle and partly extending into it, were observed. These radiologic findings mimicked malignancy.     

Exploring correlations between the breast density of the women of Papua New Guinea and breast cancer risk factors

IntroductionPapua New Guinea (PNG), has experienced an increase in breast cancer incidence correlating to the westernisation of the country. Increased breast density is known to increase breast cancer risk. This study investigates if there are any factors unique to the women of PNG that may impact breast density and breast cancer risk.MethodA survey was undertaken of 1,161 women who had undergone mammographic imaging at the Pacific International Hospital (PIH). Results were correlated with the five Tabár mammographic parenchymal patterns (TP), recorded for each woman and geographical location, parity, breast size, occupation, marital and menstrual status, smoking and alcohol consumption, hormone replacement therapy (HRT), and exercise. Statistical analysis was undertaken using chi-square test, Fisher's exact test and Odds Ratio (OR).ResultsRelationships were identified between TP and parity (p < 0.001), marital status (p < 0.001), smoking (p < 0.001), alcohol intake (p = 0.029) and HRT (p = 0.029). There was no evidence of a relationship between pattern type and geographical location (p = 0.290), breast size (p = 0.592), occupation (p = 0.724), menstruation (p = 0.866) or exercise (p = 0.290). Married women, OR = 0.4004, CI 95% (0.2873–0.5579) and those with higher parity, OR 0.5034, CI 95% (0.3693–0.6862) were half as likely to have increased breast density reducing risk.ConclusionThere was no clear relationship across almost all data. Factors associated with increased breast density in PNG included parity, marital status, smoking, alcohol, and HRT use were evidenced in this snapshot of PNG women. Breast cancer risk was shown to be reduced for married women and those with increased parity.     

Sonographically-Guided 14-Gauge Core Needle Biopsy for Papillary Lesions of the Breast

Objective

We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy.

Materials and Methods

Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.

Results

Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%).

Conclusion

Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.