154例乳腺癌新辅助化疗后X线表现与病理对照

目的：探讨X线平片对乳腺癌新辅助化疗后残余病灶的诊断准确性。方法：回顾性分析154例乳腺癌新辅助化疗患者的病例资料,将脂肪型及少量腺体型乳腺归为Ⅰ型,多量腺体型及致密型乳腺归为Ⅱ型。对所有病例进行术前X线表现与术后病理的对照分析。结果：本组中Ⅰ型35例,其中X线平片表现与术后病理一致者31例（88.58%）,不一致者4例（11.42%）,X线高估病灶范围3例,低估1例。Ⅱ型119例,一致者30例（25.21%）,不一致者89例（74.79%）,89例中高估者66例（其中44例X线仅表现为多形性钙化）,假阴性者23例。X线平片对Ⅰ型乳腺癌新辅助化疗后残余病变的诊断准确性高于Ⅱ型（P〈0.001）。结论：X线片对Ⅰ型乳腺癌新辅助化疗后残余病变诊断准确性明显高于Ⅱ型;X线片对Ⅱ型中仅表现为多形性钙化者,不能准确判断其癌灶是否残存以及病变范围。     

乳腺X线摄影BI-RADS 0级诊断的分析探究

目的：对乳腺影像报告和数据系统BI-RADS 0级诊断的成因进行探索。方法收集我院2012年10月～2013年5月期间,乳腺摄影BI-RADS诊断为0级的女性患者53位,0级病灶共55例,回顾性分析此类病灶的影像学表现并统计各种表现中恶性病变所占比例。结果诊断为BI-RADS 0级的病灶均出现在致密型（33例）或混合型腺体（22例）中,无脂肪型腺体。乳腺摄影BI-RADS 0级病灶的常见影像表现有：①腺体局部结构异常（不对称致密或结构扭曲紊乱）20例;②边界不清的可疑结节影28例;③可疑钙化灶28例。各种影像可单独或合并存在,恶性病变所占比例由高到低分别为：仅表现为可疑钙化者57．1％（4/7）,可疑结节伴可疑钙化者27．3％（3/11）,腺体局部结构异常伴可疑钙化者20％（2/10）,仅表现为腺体局部结构异常者10％（1/10）,仅表现为可疑结节者5．9％（1/17）。结论由于各种主客观原因,乳腺摄影的BI-RADS 0级诊断无法避免。对于致密或混合型腺体,需要特别注意上述BI-RADS 0级病灶的常见影像表现,尤其是可疑钙化灶的存在。     

乳腺微小钙化的高频超声诊断价值

目的：探讨乳腺良恶性钙化的声像图特征,评价高频超声对乳腺微小钙化灶的诊断价值。方法：回顾性分析84例乳腺钙化患者的术前超声表现,并与手术病理及钼靶乳腺摄片结果相对照,对比分析乳腺良恶性钙化的声像图特点及其诊断价值。结果：乳腺微小钙化灶的高频检出率为82．6％,其中在恶性钙化中的超声检出率达92．7％,而在良性微小钙化中的检出率为61．5％。超声诊断乳腺恶性微小钙化灶的敏感性、特异性分别为78．8％和84．4％,尤其是对伴有肿块的乳腺微小钙化灶的诊断正确率更高。结论：高频超声可以有效地检出并识别乳腺内的微小钙化灶,超声微小钙化灶征象对乳腺癌的诊断具有很大的价值。     

钼靶X线摄片在乳腺癌诊断中的应用价值

目的讨论钼靶X线对诊断乳腺癌的应用价值。方法回顾性分析17例经手术病理证实的乳腺癌X线表现,包括直接征象和间接征象。结果17例乳腺癌患者的X线征象:肿块见于15例,占88.24%,钙化8例,占47.06%,乳腺导管扩张2例,占11.7%,乳晕增厚7例,占41.18%,乳头凹陷8例,占47.06%,乳后间隙肿块3例,占17.65%,液下淋巴结肿大8例,占47.06%。结论钼靶X线摄影是诊断乳腺癌的首选方法。     

乳腺癌的钼靶X线诊断（216例报告及文献复习）

目的提高钼靶X线对乳腺癌的诊断水平。方法回顾性分析了经手术病理证实的216例乳腺癌的钼靶X线表现。结果本组216例患者中，钼靶X线正确诊断180例，诊断准确率为83．33％。病变位于外上象限116例（53．70％）；清晰显示肿块者150例（69．44％），有毛刺者48例（22．22％），钙化者128例（59．26％），腺体结构紊乱、扭曲伴非对称性致密影者24例（11．11％）。结论钼靶X线摄影能很好地反映乳腺癌的病理特征，因而对乳腺癌的早期诊断与鉴别诊断有重要意义。     

Post-lumpectomy breast calcifications: Can original tumor features assist in determining need for biopsy?

ObjectiveThe objective of our study was to determine whether, in the digital era, imaging features of a primary breast tumor can be used to influence the decision to biopsy ipsilateral breast calcifications that occur following surgery in women treated with breast conservation surgery (BCS).Materials and methodsWe retrospectively identified women treated with BCS who subsequently developed suspicious calcifications in the treated breast (BI-RADS 4 or 5) from January 2012 – December 2018. Only cases with histopathological diagnosis by stereotactic or surgical biopsy were included. Pathology reports were reviewed, and biopsy results were considered malignant if invasive carcinoma or ductal carcinoma in situ (DCIS) was found. All other results were considered benign.Fisher's exact test was done comparing frequencies of malignancy between those patients whose original tumor had calcifications versus those whose original tumors were not calcified.ResultsOf 90 women with suspicious calcifications on a post-BCS mammogram, 65 (72.2%) were biopsy proven benign and 25 (27.8%) were malignant. The original tumor presented without calcifications in 39 patients (43%), and 51 (57%) had calcifications with or without associated mass, focal asymmetry, or architectural distortion. New calcifications were less likely to be malignant if the original tumor presented without calcifications (5/39; 12.8%) as compared to original tumors with calcifications (20/51; 38.5%) [p-value < 0.05].ConclusionNew calcifications after BCS are significantly less likely to be malignant if the original tumor presented without calcifications. However, with a PPV of 12.8%, even calcifications in a patient with a non-calcified primary tumor require biopsy.     

Occult calcified breast lesions

Neither mammography nor cytology can distinguish precancerous tissue abnormalities from an infiltrative early carcinoma of the female breast. Radiologically detected microcalcifications can be the sole sign of precancerous stages or of already infiltrating mammary carcinoma. For this reason calcifications that are grouped together in a defined area or show up at a stage of multiple dissemination have to be resected and must be identified in the resected sample immediately. Between 1964 and 1990 we examined 82 163 women clinically, mammographically and in many cases sonographically at Erlangen University Hospital, FRG — by far the largest published series. In 1393 cases microcalcifications in the mammary tissues were resected and histologically diagnosed. In 1 in 4 cases we discovered a carcinoma or carcinoma in situ. The percentage we found (26.9%) corresponds with the results of other research groups. In order to avoid delays in the diagnosis of breast cancer effective cooperation between those physicians dealing with diagnosis and those performing surgery is essential. Mistakes can occur during a routine procedure, so we follow the principle that doubtful cases must be histologically evaluated.Correspondence to: E. M. Paterok     

Ductal carcinoma in situ: mammographic findings and clinical implications

Mammograms, specimen radiographs, and pathology reports of 51 women with ductal cancer in situ (DCIS) in 54 breasts were retrospectively analyzed. Reason for presentation was known for 44 women, including six with symptoms due to DCIS and 16 who either had been previously treated for or had (contralateral) breast cancer. Mammographic patterns of DCIS were microcalcifications in 37 of 54 (68%) lesions and calcifications within a mass in 16 (30%). Multifocal DCIS, evidenced radiographically by patterns of more than one mass, more than one cluster of microcalcifications, or parallel linear, irregular intraductal calcifications, was seen in 35 of 54 (65%) breasts but only on specimen radiographs in four of these. In 22 (41%) lesions maximum tumor expanse was greater than 2.5 cm, and all were multicentric. Multicentricity of tumor and tumor size greater than 2.5 cm may indicate need for therapies more radical than simple excision. Breast irradiation has been shown to significantly diminish recurrence rates in these patients. Mammography and specimen radiography with magnification may be appropriate in these cases to identify all possible tumor sites in the involved breast.     

Paraffin tissue block radiography: adjunct to breast specimen radiography

Radiography of specimens is an essential step in confirming excision of nonpalpable breast lesions. On occasion, however, the pathologist may not identify the lesion histologically. The authors report five cases in which suspicious microcalcifications were included in the excised tissue but were not identified by the pathologist. In all five, paraffin tissue block radiography enabled identification of the specific blocks containing the microcalcifications. The correct tissue blocks were then sectioned again, and the microcalcifications were identified histopathologically. In one case, the initial diagnosis of intraductal hyperplasia was changed to intraductal carcinoma with focal invasion. When the pathologist cannot identify the calcifications on initial histopathologic sections, this technique may assist in identification of the mammographic abnormality.     

数字乳腺摄影的计算机辅助诊断在乳腺癌筛查中的应用

目的:探讨数字钼靶乳腺摄影及计算机辅助诊断(CAD)在乳腺癌筛查诊断中的价值。方法:2010年1月至2011年1月我院数字乳腺钼靶摄片并经手术证实的40例纳入研究,包括乳腺癌35例(其中原位癌6例)和乳腺腺体增生5例。术前分别在普通显示器上读片诊断和工作站上使用CAD软件读片诊断,然后比较分析。结果:使用普通医用显示器的乳腺癌诊断的敏感性为71.4%,准确性75%;使用CAD分析的乳腺癌诊断的敏感性为88.6%,准确性90%。应用CAD对微钙化检出的敏感性明显高于普通医用显示器(P=0.032)。结论:数字乳腺摄影结合CAD有助于乳腺癌筛查诊断。     

CT在乳腺疾病诊断中的应用

目的:探讨CT在乳腺疾病检查与诊断中的应用价值,以提高对乳腺疾病的诊断水平。方法:对152例乳腺疾病患者行CT平扫、薄层扫描、增强扫描等,并对检查结果加以分析。结果:152例中发现乳腺疾病十余种,乳腺癌、乳腺纤维腺瘤、乳腺小叶增生、男性乳腺发育症占了其中大多数。CT诊断准确的共134例,准确率为88.2%。结论:CT对乳腺疾病的检出率及对病变定位、定性的准确性总体上高于钼靶片,可检查到钼靶摄影中存在的一些盲区,具有较高的临床应用价值。其缺点是对细小钙化的敏感性不高。     

Role of high magnification specimen radiography in surgical and core biopsies of the breast

The clinical relevance of a high magnification specimen radiography (HMSR) system in breast biopsies was evaluated and compared with conventional specimen radiography with a mammography system (SRM). 100 surgical biopsies of 72 patients and 248 core biopsies of 30 patients were examined in (a) maximal 20-fold HMSR in combination with storage phosphors and (b) 1.8-fold SRM using a film-screen system. Detection of calcifications/soft tissue lesions and the impact on management were evaluated. In surgical biopsies, SRM could detect only 22% of individual microcalcifications, 39% of calcified lesions and 67% of soft tissue lesions identified with HMSR. Calcifications down to 10 microns were identified with HMSR. In five biopsies, peripheral calcifications leading to additional resection were recognized only with HMSR; in three of these they were indicative of malignant tissue. In core biopsies, only 12% of individual microcalcifications seen with HMSR were identified with SRM. 52% and 16% of all cores were calcified on HMSR and SRM, respectively. Microcalcifications within cores were found only with HMSR in 41% of patients with calcified lesions. In conclusion, the better detectability of microcalcifications with HMSR led to justified additional tissue resections in surgical patients and reduced the number of core biopsies required in interventional patients.     

全数字化乳腺摄影对临床不可触及乳腺癌的诊断价值

目的:通过分析研究临床不可触及乳腺癌的数字化钼铑双靶乳腺X线摄影影像表现,探讨其诊断价值。方法:回顾分析经临床和病理证实的临床不可触及乳腺癌33例,所有病例均行全数字化钼铑双靶乳腺X线机检查,常规体位包括:双侧乳腺均行头尾位、内外斜位摄片,必要时加照局部点压,或局部点压放大摄影。通过双侧乳腺图像对比,观察其影像学表现,然后统计分析其诊断价值。结果:单纯性钙化14例;致密小结节4例;不对称性局限性致密影3例;局部结构紊乱4例;其他5例,如乳头内陷及乳头后漏斗征,血管影迂曲、增多、增粗,皮肤增厚及皮下脂肪浑浊;无异常X线表现3例。结论:全数字化乳腺摄影在发现早期乳腺癌方面有不可替代的优势,特别是对临床不可触及的早期乳腺癌的发现具有重要价值。     

乳腺叶状肿瘤26例数字钼靶X线分析

目的分析乳腺叶状肿瘤的X线表现,探讨钼靶X线摄影对乳腺叶状肿瘤的诊断价值。方法回顾分析我院26例经手术病理证实的乳腺叶状肿瘤患者术前乳腺X线检查资料。结果26例乳腺叶状肿瘤中,良性21例(80.8%)交界性3例(11.5%)恶性2例(7.7%)。其中18例乳腺叶状肿瘤多位于外上象限,直径1.7～9.3cm,19例肿块表现为圆形、边缘光整,5例表现为分叶状,7例为多发肿块,2例为边缘模糊、有毛刺征,1例发现钙化灶,21例发现"透明晕"。结论妇女乳房内肿块大、分叶状且周边有"透明晕"是乳腺叶状肿瘤较特征的X线征象,近期肿块迅速增大有助于叶状肿瘤的诊断。X线表现与组织学分型有一定关系,边缘模糊,有毛刺提示恶性程度较高。认识乳腺叶状肿瘤的病理表现和X线特征,有助于提高术前诊断率。     

哺乳期和哺乳期后女性乳腺疾病的超声诊断

目的探讨哺乳期和哺乳期后女性乳腺疾病的声像图特征及临床价值。方法应用高频超声探测哺乳期和哺乳期后女性患者的乳腺病变,对不同类型的声像图进行回顾性总结和分析,重点研究积乳囊肿的声像图特征。结果本组97例,其中乳汁淤积伴感染(乳腺炎)30例,乳腺脓肿25例,积乳囊肿30例,积乳囊肿实变7例,积乳囊肿钙化5例。结论结合病史、临床表现及彩色多普勒超声有助于乳腺疾病的诊断及鉴别诊断,超声检查是一种操作简便、实用而有效的影像学诊断方法。     

微小钙化在早期乳腺癌X线诊断中的应用价值

目的探讨乳腺钙化在全数字化乳腺X线摄影中的表现特征及其对早期乳腺癌的诊断价值。方法回顾性分析160例乳腺X线钼靶片中表现为微小钙化的病例,观察钙化的数目、形态、大小、分布、密度等,并与手术病理结果做对照。结果乳腺良、恶性疾病均可出现钙化。本组病例乳腺恶性病变112例,其中导管原位癌24例,浸润性导管癌88例,良性病变48例。钙化呈簇状分布、沿导管方向走行或呈蠕虫型、混合型形态的钙化多见于乳腺癌,弥漫性分布及粗颗粒型或融合型形态的钙化多见于乳腺良性病变。结论分析乳腺X线片中微小钙化形态学表现、密度、数目、走向分布及钙化与肿块的关系,能显著提高乳腺良恶性病变的诊断正确率,对早期乳腺癌的诊断具有极其重要价值。     

乳腺癌钼靶X线征象探讨

目的　探讨乳腺癌X线各种征象 ,提高钼靶X线对乳腺癌诊断的准确性。方法　对 48例经病理证实的乳腺癌X线表现作回顾性分析。结果　 48例乳腺癌X线直接显示肿块影 3 8例 ,钙化灶 3 6例 ,大导管相 6例 ,厚皮征 3例 ,漏斗征 4例 ,异常血管 5例 ,塔尖征 6例 ,牛角征 8例。结论　钼靶X线乳腺摄影是诊断乳腺癌的首选方法 ,结合乳腺癌各种X线征象分析 ,一般可做出正确诊断。     

Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection

PURPOSE: To retrospectively determine the mammographic characteristics of cancers missed at screening mammography and assess the ability of computer-aided detection (CAD) to mark the missed cancers. MATERIALS AND METHODS: A multicenter retrospective study accrued 1,083 consecutive cases of breast cancer detected at screening mammography. Prior mammograms were available in 427 cases. Of these, 286 had lesions visible in retrospect. The 286 cases underwent blinded review by panels of radiologists; a majority recommended recall for 112 cases. Two experienced radiologists compared prior mammograms in 110 of these cases with the subsequent screening mammograms (when cancer was detected), noting mammographic characteristics of breast density, lesion type, size, morphology, and subjective reasons for possible miss. The prior mammograms were then analyzed with a CAD program. RESULTS: There were 110 patients with 115 cancers. On the prior mammograms with missed cancers, 35 (30%) of the 115 lesions were calcifications, with 17 of 35 (49%) clustered or pleomorphic. Eighty of the 115 (70%) were mass lesions, with 32 of 80 (40%) spiculated or irregular. For calcifications and masses, the most frequently suggested reasons for possible miss were dense breasts (12 of 35; 34%) and distracting lesions (35 of 80; 44%), respectively. CAD marked 30 (86%) of 35 missed calcifications and 58 (73%) of 80 missed masses. CONCLUSION: Detection errors affected cases with calcifications and masses. CAD marked most (77%; 88 of 115) cancers missed at screening mammography that radiologists retrospectively judged to merit recall.     

数字钼靶X线摄影对早期乳腺癌诊断的应用研究

目的评价早期乳腺癌的数字钼靶x线摄影表现。方法收集我院自2003年10月至2013年3月共10150名乳腺检查及体检者,回顾性分析经手术病理证实的56例早期乳腺癌的数字钼靶x线片,分析其临床表现、年龄特征、病理类型及x线表现特征。结果①无临床表现者49例,发病年龄27～76岁,其中40～49岁年龄段者占总病例数的42％,X线表现钙化27例（其中18例无肿块）,小结节19例（34％）。非对称性局限性密度增高影伴结构扭曲或紊乱10例（18％）;未扪及肿块者22例（39％）;导管原位癌（DCIS）及导管原位癌伴早期浸润37例（66％）,浸润性导管癌17例（30％）,浸润性小叶癌2例（4％）。②乳腺数字钼靶X线可显示早期乳腺癌病变微细结构。结论数字钼靶x线成像可以更清晰地显示乳腺病变的特征,对早期乳腺癌的诊断具有重要意义和价值。     

乳腺Paget病X线病理对照研究

目的 :对照分析乳腺 Paget病术前 X线、标本 X线和病理所见。方法 :分析 11例病理证实的 Paget病。其中 8例 ,对手术切除的新鲜标本 ,经冷冻处理后 ,进行了切片和 X线摄影。由放射科和病理科医师共同检查分析每个有价值的部位。结果 :5例乳头扁平或缺损变形。 8例乳晕皮肤增厚 ,其中 6例并发乳晕后三角影。 5例出现肿块。 6例显示钙化。结论 :乳头乳晕的改变和可追踪到乳头的钙化是特征性 X线表现 ,X线检查对本病的诊断颇有价值