Detection of architectural distortion in prior screening mammograms using Gabor filters, phase portraits, fractal dimension, and texture analysis

Objective Mammography is a widely used screening tool for the early detection of breast cancer. One of the commonly missed signs of breast cancer is architectural distortion. The purpose of this study is to explore the application of fractal analysis and texture measures for the detection of architectural distortion in screening mammograms taken prior to the detection of breast cancer. Materials and methods A method based on Gabor filters and phase portrait analysis was used to detect initial candidates for sites of architectural distortion. A total of 386 regions of interest (ROIs) were automatically obtained from 14 “prior mammograms”, including 21 ROIs related to architectural distortion. From the corresponding set of 14 “detection mammograms”, 398 ROIs were obtained, including 18 related to breast cancer. For each ROI, the fractal dimension and Haralick’s texture features were computed. The fractal dimension of the ROIs was calculated using the circular average power spectrum technique. Results The average fractal dimension of the normal (false-positive) ROIs was significantly higher than that of the ROIs with architectural distortion (p = 0.006). For the “prior mammograms”, the best receiver operating characteristics (ROC) performance achieved, in terms of the area under the ROC curve, was 0.80 with a Bayesian classifier using four features including fractal dimension, entropy, sum entropy, and inverse difference moment. Analysis of the performance of the methods with free-response receiver operating characteristics indicated a sensitivity of 0.79 at 8.4 false positives per image in the detection of sites of architectural distortion in the “prior mammograms”. Conclusion Fractal dimension offers a promising way to detect the presence of architectural distortion in prior mammograms.     

基于分形特征序列的乳腺X线图像分类方法

目的表征乳腺图像中肿块部分纹理特征,通过纹理分析实现乳腺图像中肿块部分与正常腺体部分的分类。方法应用分形特征值表征乳腺图像纹理特征,利用多级分形特征提取法将乳腺图像分解成一系列细节图像,提取出多个分形特征值;利用分类精度、ROC曲线及曲线下面积(AUC)进行特征选择构建分形特征序列,最后应用支持向量机(SVM)方法进行分类。结果对60幅图像的可疑病变区域进行分形特征序列提取分析,SVM交叉验证分类精度达84.50%。结论基于分形维数的乳腺图像分类方法不仅能对肿块与正常腺体进行图像分类,还可有效表征乳腺图像的纹理信息,有助于提高乳腺肿块诊断的准确率。     

Reduction of false positives in the detection of architectural distortion in mammograms by using a geometrically constrained phase portrait model

Objective One of the commonly missed signs of breast cancer is architectural distortion. We have developed techniques for the detection of architectural distortion in mammograms, based on the analysis of oriented texture through the application of Gabor filters and a linear phase portrait model. In this paper, we propose constraining the shape of the general phase portrait model as a means to reduce the false-positive rate in the detection of architectural distortion. Material and methods The methods were tested with one set of 19 cases of architectural distortion and 41 normal mammograms, and with another set of 37 cases of architectural distortion. Results Sensitivity rates of 84% with 4.5 false positives per image and 81% with 10 false positives per image were obtained for the two sets of images. Conclusion The adoption of a constrained phase portrait model with a symmetric matrix and the incorporation of its condition number in the analysis resulted in a reduction in the false-positive rate in the detection of architectural distortion. The proposed techniques, dedicated for the detection and localization of architectural distortion, should lead to efficient detection of early signs of breast cancer.     

Measures of divergence of oriented patterns for the detection of architectural distortion in prior mammograms

Purpose We propose a method for the detection of architectural distortion in prior mammograms of interval-cancer cases based on the expected orientation of breast tissue patterns in mammograms. Methods The expected orientation of the breast tissue at each pixel was derived by using automatically detected landmarks including the breast boundary, the nipple, and the pectoral muscle (in mediolateral-oblique views). We hypothesize that the presence of architectural distortion changes the normal expected orientation of breast tissue patterns in a mammographic image. The angular deviation of the oriented structures in a given mammogram as compared to the expected orientation was analyzed to detect potential sites of architectural distortion using a measure of divergence of oriented patterns. Each potential site of architectural distortion was then characterized using measures of spicularity and angular dispersion specifically designed to represent spiculating patterns. The novel features for the characterization of spiculating patterns include an index of divergence of spicules computed from the intensity image and Gabor magnitude response using the Gabor angle response; radially weighted difference and angle-weighted difference (AWD) measures of the intensity, Gabor magnitude, and Gabor angle response; and AWD in the entropy of spicules computed from the intensity, Gabor magnitude, and Gabor angle response. Results Using the newly proposed features with a database of 106 prior mammograms of 56 interval-cancer cases and 52 mammograms of 13 normal cases, through feature selection and pattern classification with an artificial neural network, an area under the receiver operating characteristic curve of 0.75 was obtained. Free-response receiver operating characteristic analysis indicated a sensitivity of 0.80 at 5.3 false positives (FPs) per patient. Combining the features proposed in the present paper with others described in our previous works led to significant improvement with a sensitivity of 0.80 at 3.7 FPs per patient. Conclusion The proposed methods can detect architectural distortion in prior mammograms taken 15 months (on the average) before clinical diagnosis of breast cancer, but the FP rate needs to be reduced.     

动态增强MRI定量评估乳腺良恶性病变的效能

目的 探讨动态增强磁共振成像（DCE-MRI）评价乳腺良恶性病变中病灶及背景实质血流动力学参数的价值。方法 收集41例接受乳腺DCE-MRI检查的患者（共45个病灶）,其中良性病变21个（良性组）,恶性病变24个（恶性组）,测量病灶及背景实质的容量转移常数（K_trans）、速率常数（K_ep）、血浆分数（V_p）,对2组各参数进行统计学分析;以病理结果为金标准,评价各参数诊断乳腺恶性病灶的效能。结果 恶性组病灶K_trans和K_ep、背景实质K_trans和K_ep均高于良性组（P均<0.05）。2组病灶V_p和背景实质V_p差异均无统计学意义（P均>0.05）。诊断乳腺恶性病变时,背景实质K_trans的AUC较其他参数高,敏感度、特异度分别为87.50%、76.19%。所有参数联合的Logistic回归模型AUC值最高,为0.86（P<0.001）。结论 DCE-MRI相关参数中,背景实质K_trans对乳腺疾病的诊断价值较高。定量分析DCE-MRI数据有助于鉴别乳腺良恶性病变,其背景实质的血流动力学特征有望成为无创诊断乳腺病变的新方法。     

乳腺结构扭曲征象的X线分析

目的描述乳腺结构扭曲征象的钼靶X线表现,提高诊断准确性。方法分析33例经组织病理学诊断乳腺结构扭曲病变的钼靶X线表现,包括密度、边缘、病变区结构及触诊检查特点。33例中,良性病变18例,恶性病变15例,其中术后改变5例,脂肪坏死伴有间质纤维化1例,囊性增生症6例,炎症4例,硬化性乳腺病2例,导管原位癌2例,浸润性导管癌6例,浸润性小叶癌3例,黏液癌2例,Paget病2例。结果33例乳腺结构不良,钼靶X线摄片表现为高密度17例,等密度16例。边缘有浸润10例,模糊12例,星芒状改变11例。结构消失17例,可分辨16例。触诊质硬14例,柔韧11例,斑片状增厚8例。边缘浸润及结构消失倾向恶性病变,差别有统计学意义（P值分别为0.01和0.025）,而其他征象及触诊在良、恶性病变间的差别无统计学意义。结论乳腺结构不良钼靶X线表现多样,分析其边界及结构有助于良恶性病变的鉴别诊断。     

采用声触诊组织量化技术定量分析正常乳腺实质

目的探讨声脉冲辐射力(ARFI)声触诊组织量化(VTQ)技术定量分析正常乳腺实质的价值。方法检测100名正常女性双侧乳腺实质的VTQ值,并结合钼靶X线结果、不同年龄段及生理阶段进行分析。结果本组无脂肪型乳腺。双侧乳腺实质厚度在不同钼靶X线结构分型间差异无统计学意义(P均>0.05)。随着钼靶X线腺体结构致密度的增加,双侧乳腺实质VTQ值增加,不均匀致密型乳腺VTQ值高于散在分布型乳腺(P<0.01);多量致密型乳腺VTQ值高于不均匀致密型乳腺(P<0.05)。双侧乳腺实质厚度及VTQ值在不同年龄组间的差异无统计学意义(P均>0.05)。双侧乳腺实质厚度和VTQ值在性成熟期大于老年期(P均<0.05)。结论利用VTQ值可定量分析乳腺的密度。     

Measures of angular spread and entropy for the detection of architectural distortion in prior mammograms

Purpose

Architectural distortion is an important sign of early breast cancer. We present methods for computer-aided detection of architectural distortion in mammograms acquired prior to the diagnosis of breast cancer in the interval between scheduled screening sessions.

Methods

Potential sites of architectural distortion were detected using node maps obtained through the application of a bank of Gabor filters and linear phase portrait modeling. A total of 4,224 regions of interest (ROIs) were automatically obtained from 106 prior mammograms of 56 interval-cancer cases, including 301 true-positive ROIs, and from 52 mammograms of 13 normal cases. Each ROI was represented by three types of entropy measures of angular histograms composed with the Gabor magnitude response, angle, coherence, orientation strength, and the angular spread of power in the Fourier spectrum, including Shannon’s entropy, Tsallis entropy for nonextensive systems, and Rényi entropy for extensive systems.

Results

Using the entropy measures with stepwise logistic regression and the leave-one-patient-out method for feature selection and cross-validation, an artificial neural network resulted in an area under the receiver operating characteristic curve of 0.75. Free-response receiver operating characteristics indicated a sensitivity of 0.80 at 5.2 false positives (FPs) per patient.

Conclusion

The proposed methods can detect architectural distortion in prior mammograms taken 15 months (on the average) before clinical diagnosis of breast cancer, with a high sensitivity and a moderate number of FPs per patient. The results are promising and may be improved with additional features to characterize subtle abnormalities and larger databases including prior mammograms.     

乳腺单纯性浸润性小叶癌的临床、X线、超声特征

目的 观察乳腺单纯性浸润性小叶癌(ILC)的临床、X线和超声检查特征,评价联合应用三种方法的价值.方法 回顾55例经手术病理证实为单纯性ILC的详细检查结果,分析得出假阴性结果的原因.结果 主要临床检查结果为肿块(96.15%)和腺体增厚(3.85%).主要X线检查结果为边缘不规则肿块(65.38%)和结构扭曲(23.08%).主要超声检查结果为肿块(98.00%)和结构紊乱(2.00%).临床、X线、超声对病灶的定性诊断准确率分别为94.55%、83.87%、98.04%,联合应用的准确率为100%.结论 超声检测ILC病灶的准确性高于X线检查.联合应用临床、X线、超声可提高ILC的术前诊断准确率.     

Metaplastic carcinoma of the breast: mammographic and sonographic findings

PURPOSE: We investigated the mammographic, sonographic, and pathologic findings in metaplastic carcinoma of the breast. METHODS: The mammographic (n = 16) and sonographic (n = 11) findings in 16 patients with metaplastic carcinoma of the breast were analyzed retrospectively along with pathologic findings. Whenever possible, results of preoperative fine-needle aspiration biopsy and immunohistochemical studies were obtained. RESULTS: All patients presented with a palpable breast mass. The mean size of the lesions at pathologic examination was 4.2 cm. On mammography, 15 patients had a mass (1 patient had 2 masses), and 1 patient had only clustered microcalcifications without an associated mass. The mean longest diameter of the 16 masses on mammography was 4.6 cm. Eleven lesions (69%) were round to ovoid in shape, 13 lesions (81%) showed ill-defined or obscured margins, and 10 lesions (63%) showed associated architectural distortion. On sonography, 6 (55%) of 11 lesions were round to ovoid, 9 lesions (82%) had well-defined margins, and 6 lesions (55%) showed complex echogenicity with solid and cystic components. At pathologic examination, 4 of these 6 lesions showed hemorrhagic or cystic necrosis. Axillary lymph nodes were positive in 6 (40%) of 15 patients in whom axillary node dissection was performed. CONCLUSIONS: Metaplastic carcinoma of the breast manifests as a rapidly growing, mammographically ill-defined round mass with associated architectural distortion on mammograms. Complex echogenicity with solid and cystic components may be seen sonographically and is related to hemorrhagic or cystic necrosis seen pathologically.     

超声造影对乳腺X线摄影BI-RADS 3~5类病变的诊断效能

目的 探讨CEUS对乳腺X线摄影（MG）诊断为BI-RADS 3～5类病变的诊断价值。方法 对120例乳腺摄影诊断为BI-RADS 3～5类病变的患者行CEUS检查,所有患者均于影像学检查后接受病理检查。以病理结果为金标准,计算MG与CEUS的诊断敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）,并进行统计学分析,比较其诊断效能。结果 120例中,MG诊断为BI-RADS 3类病变37例,其中CEUS诊断2例真阳性,4例假阳性;BI-RADS 4类病变60例,CEUS诊断14例真阳性,33例真阴性;BI-RADS 5类病变23例,CEUS诊断18例真阳性,2例假阳性,3例CEUS诊断阴性者均为假阴性。MG与CEUS对BI-RADS 3～5类病变的诊断敏感度差异无统计学意义（95.12% vs 82.93%, P=0.366）,CEUS的诊断特异度明显高于MG（81.01% vs 44.30%, P<0.001）;MG与CEUS的PPV和NPV差异均有统计学意义（P均<0.05）。结论 CEUS应用于乳腺摄影BI-RADS 3、4、5类病变中,可提高其诊断特异度;对于BI-RADS 3类病变,CEUS阴性诊断可增强诊断信心。     

常规MRI纹理分析鉴别诊断眼眶淋巴瘤与炎性假瘤

目的 探讨常规MRI纹理分析在眼眶淋巴瘤和炎性假瘤鉴别诊断中的应用价值。方法 回顾性分析经病理或治疗随访证实的15例眼眶淋巴瘤及17例炎性假瘤患者的MRI资料。应用MaZda软件手工勾画ROI,并提取T1WI、脂肪抑制T2WI及脂肪抑制T1WI增强扫描图像中病变的纹理特征。通过Fisher系数、分类错误概率联合平均相关系数（POE+ACC）、交互信息（MI）及三者联合（FPM）的方法选择最佳纹理参数集合。使用线性判别分析（LDA）和非线性判别分析（NDA）进行纹理分类。比较最佳分类序列上两种病变的纹理特征差异。结果 T1WI及T2WI最佳纹理参数主要源于共生矩阵及游程矩阵,增强T1WI最佳纹理参数主要源于共生矩阵及直方图。T2WI纹理特征鉴别眼眶淋巴瘤及炎性假瘤能力最佳,其中FPM选择纹理特征联合NDA分类的误判率最低,为1.56%。眼眶淋巴瘤T2WI纹理特征参数中的能量及长游程补偿均高于炎性假瘤（P均<0.005）,而熵及短游程补偿均低于炎性假瘤（P均<0.005）。结论 常规MR图像纹理分析可用于鉴别眼眶淋巴瘤和炎性假瘤。     

Tissue Doppler Imaging and Tissue Strain Imaging for the Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis B

We studied the feasibility of evaluating the stages of liver fibrosis with tissue Doppler imaging (TDI) and tissue strain imaging (TSI) for patients with chronic hepatitis B virus infection. One hundred ten patients were divided into two groups: normal adult group (n = 38) and chronic liver disease group (n = 72, patients infected with HBVs). The chronic liver disease group was divided into three subgroups on the basis of the Scheuer scoring system and clinical evidence: mild fibrosis (S0 and S1, n = 11), moderate fibrosis (S2 and S3, n = 27) and cirrhosis (S4 and clinically typical cirrhosis, n = 34) groups. TDI was performed for a chosen oblique section. Four regions of interest (ROIs), A–D, were chosen in the hepatic parenchyma based on the direction of propagation from the heart to the liver. Strain rate curves were obtained on the basis of TDI and TSI findings. Strain peak rates (SPRs) of all ROIs and the differences in times to SPRs for the four ROIs (T_A-B, T_B-C and T_C-D) in the hepatic parenchyma were measured with TDI and TSI. Strain rate curves were analyzed for each ROI. The strain rate curves for the normal adult group were synchronous, whereas those for the chronic liver disease group were asynchronous. SPRs of the ROIs gradually decreased with the progression of liver fibrosis. The SPRs of ROI B significantly correlated with chronic liver disease severity (r = 0.991, p < 0.05). Areas under the curve (AUCs) of the ROI A and ROI B SPRs at the moderate fibrosis and cirrhosis stages were 0.86 ± 0.06, 0.81 ± 0.56 and 0.90 ± 0.65, 0.92 ± 0.04, respectively. The AUC of the SPRs of ROIs A and B correlated better than the platelet/age/phosphatase/α-fetoprotein/aspartate aminotransferase (PAPAS) index for advanced fibrosis. The differences in time to SPRs among the peaks of the four ROIs (T_A-B, T_B-C and T_C-D) gradually increased with the progression of liver fibrosis. TDI and TSI with quantitative measurements using tissue Doppler analysis software (TDIQ, GE Medical Systems, Horten, Norway) provided reliable information for evaluating non-invasive liver fibrosis in patients with chronic hepatitis B.     

Blood Flow and Glucose Metabolism in Stage IV Breast Cancer: Heterogeneity of Response During Chemotherapy

Objective  The purpose of the study was to compare early changes in blood flow (BF) and glucose metabolism (MR_glu) in metastatic breast cancer lesions of patients treated with chemotherapy. Methods  Eleven women with stage IV cancer and lesions in breast, lymph nodes, liver, and bone were scanned before treatment and after the first course of chemotherapy. BF, distribution volume of water (V _d), MR_glu/BF ratio, MR_glu and its corresponding rate constants K ₁ and k ₃ were compared per tumor lesion before and during therapy. Results  At baseline, mean BF and MR_glu varied among different tumor lesions, but mean V _d was comparable in all lesions. After one course of chemotherapy, mean MR_glu decreased in all lesions. Mean BF decreased in breast and node lesions and increased in bone lesions. V _d decreased in breast and nodes, but did not change in bone lesions. The MR_glu/BF ratio decreased in breast and bone lesions and increased in node lesions. In patients with multiple tumor lesions BF and MR_glu response could be very heterogeneous, even within similar types of metastases. BF and MR_glu increased in lesions of patients who experienced early disease progression or showed no response during clinical follow-up. Conclusion  BF and MR_glu changes separately give unique information on different aspects of tumor response to chemotherapy. Changes in BF and MR_glu parameters can be remarkably heterogeneous in patients with multiple lesions.     

X线纹理分析鉴别诊断乳腺叶状肿瘤与纤维腺瘤

目的 探讨X线纹理分析鉴别诊断乳腺叶状瘤（BPTs）与乳腺纤维腺瘤（BF）的价值。方法 回顾性分析32例BPTs和32例BF患者的术前乳腺X线片。采用MaZda 4.6软件手动勾画病灶最大层面ROI。分别采用Fisher系数、聚类偏差概率结合平均关联系数（POE+ACC）、协同信息（MI）及联合应用上述3种方法（MI+PA+F）选择ROI内最具鉴别价值的纹理特征参数,并与术后病理结果对照,比较影像医师主观阅片与采用纹理分析诊断BPTs及BF错判率的差异。结果 影像医师鉴别BPTs与BF的错判率为20.31%（13/64）;采用Fisher系数进行纹理特征分析的错判率为14.06%（9/64）,POE+ACC为23.44%（15/64）,MI为25.00%（16/64）,MI+PA+F为3.12%（2/64）。MI+PA+F的错判率低于影像医师主观阅片及POE-ACC、MI（P均<0.05）。结论 X线纹理分析可用于鉴别BPTs和BF。     

The Nipple‐Areolar Complex

Objective. The purpose of this presentation is to show the radiologic findings of normal variants and benign and malignant diseases that affect the nipple‐areolar complex. Methods. We evaluated the imaging findings of nipple‐areolar complex lesions, using multiple breast imaging modalities including mammography, sonography, galactography, contrast‐enhanced magnetic resonance imaging (MRI), and positron emission tomography/computed tomography. Results. Radiologic features of nipple‐areolar complex lesions, including Montgomery tubercles, nipple inversion, benign calcifications, inflammation, duct dilatations, intraductal papillomas, fibroadenomas, neurofibromatosis, dermatosis of the nipple, and breast malignancy, have been illustrated. Conclusions. A clinical examination is essential and an appropriate imaging evaluation with multiple modalities is often necessary to accurately diagnose an underlying abnormality of the nipple‐areolar complex. Given the limitations of conventional mammography, supplemental mammographic views often are needed, and sonography may be performed to further characterize a mammographic or clinical finding. Also, contrast‐enhanced MRI may be useful for additional evaluation.     

剪切波弹性成像联合CEUS校正乳腺影像报告和数据系统3~5类乳腺病变

目的 探讨剪切波弹性成像（SWE）联合CEUS在校正乳腺影像报告和数据系统（BI-RADS）3~5类乳腺肿瘤中的应用价值。方法 收集50例乳腺病变患者（57个病灶）,其中良性病灶28个,恶性29个。对所有病灶术前行常规超声、SWE和CEUS检查,以常规超声进行BI-RADS分类,并采用SWE、CEUS及SWE联合CEUS对BI-RADS分类进行校正。以病理结果为金标准,计算常规超声、SWE、CEUS及SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率。结果 SWE参数最大杨氏模量值（E_max）诊断乳腺良恶性病灶的临界值为87.2 kPa,CEUS的临界值为8.5分,SWE联合CEUS的多因素Logistic回归模型为Y（P）=-18.785+0.161X₁+11.822X₂,X₁为E_max,X₂为增强后病灶大小改变。SWE联合CEUS将11个病灶正确降为3级,4个病灶误诊;SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率分别为100%（29/29）、85.71%（24/28）和92.98%（53/57）。结论 SWE联合CEUS对BI-RADS 3~5类乳腺病灶具有良好的校正作用,可提高超声诊断正确率。     

平扫CT特征联合纹理分析鉴别经治乳腺癌患者肺部单发转移癌与原发腺癌北大核心CSCD

目的评估基于平扫CT特征及纹理分析联合模型鉴别经治乳腺癌患者单发肺内病灶为乳腺癌孤立性肺转移(SPMBC)或原发性肺腺癌(PLA)的价值。方法回顾性分析111例经治乳腺癌伴术后病理证实的SPMBC(SPMBC组,n=54)或PLA(PLA组,n=57)患者,对比其肺内病灶CT表现。采用MaZda软件提取并筛选CT所示病灶最佳纹理参数,以集成算法为分类器,针对组间差异有统计学意义的CT表现、最佳纹理参数或联合二者分别构建CT特征模型、纹理特征模型及联合模型,以鉴别SPMBC与PLA;以5折交叉验证法及受试者工作特征(ROC)曲线评估各模型的诊断效能。结果CT特征模型、纹理特征模型及联合模型鉴别经治乳腺癌患者伴SPMBC与PLA的平均曲线下面积分别为0.64±0.08、0.82±0.07及0.85±0.05。CT特征模型的平均分类准确率(0.60±0.09)低于纹理特征模型及联合模型(0.78±0.09、0.82±0.08,t=-3.14、-4.06,P均<0.05),纹理特征模型平均分类准确率与联合模型差异无统计学意义(t=-0.66,P>0.05)。结论平扫CT特征联合纹理分析有助于鉴别诊断经治乳腺癌患者SPMBC与PLA。     

全数字化乳腺X线摄影在乳腺癌诊断中的作用

目的分析经手术病理证实的乳腺病变在全数字化乳腺摄影（FFDM）中的影像学表现,提高X线在乳腺癌诊断中的准确性。方法搜集2008年1月-2010年10月313例行FFDM检查、手术和病理证实的乳腺病变患者的临床资料及乳腺X线片,由放射科医师对患者的X线片观察并分析,参照乳腺影像学报告和数据系统（BI-RADS）进行分级,以术后病理结果为金标准,评价FFDM检查诊断乳腺癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值,并分析误诊和漏诊的原因。结果病理结果显示,313例乳腺标本中,乳腺癌194例,乳腺良性病变119例。在乳腺恶性病变中,X线主要表现为单纯肿块型83例,钙化型95例,结构扭曲6例,不对称致密影8例,乳腺内弥漫性腺体结构模糊2例。X线诊断假阳性18例,假阴性20例。FFDM检查对乳腺癌诊断的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别约89.2%、84.9%、87.7%、90.6%、82.8%。误诊的主要原因是肿块的边缘形态、微小钙化等类似于恶性;漏诊的主要原因是乳腺腺体致密、不对称致密影及微小结构扭曲。结论数字化乳腺X线摄影在乳腺癌诊断中具有较高的价值。     

Sonographic Appearances of Benign and Malignant Male Breast Disease With Mammographic and Pathologic Correlation

Objective. Imaging of the male breast is most often performed for the evaluation of a clinical abnormality such as breast enlargement or tenderness, a palpable mass, nipple skin changes, or nipple discharge. Most breast lesions encountered in men are benign. Malignant breast lesions are less frequent; breast cancer accounts for less than 1% of all male cancers in the United States. The initial imaging evaluation of a finding in the male breast is performed with mammography. Sonography is frequently used as an adjunct to mammography but is less often used as the primary imaging modality. The objective of this article is to provide readers with a thorough review of the sonographic appearances of benign and malignant male breast disease. Methods. We reviewed our institution's case database to identify male patients who underwent mammography, sonography, and subsequent biopsy of a breast lesion. These cases were collected and reviewed to select the best imaging examples. Results. A spectrum of benign and malignant male breast disease is presented with corresponding sonographic, mammographic, and pathologic imaging. For each entity, the salient imaging findings and typical clinical presentation are discussed. Conclusions. Most studies in the literature have reported on the mammographic and sonographic imaging features of primary breast carcinoma in men. However, very little has been reported on the sonographic appearance of benign and malignant male breast conditions. Recognition and correct identification of pathologic male breast entities on sonography is essential to determine appropriate management recommendations and avoid unnecessary biopsies.