早期乳腺癌影像学检查现状与展望

乳腺癌是一种严重威胁女性身心健康的恶性肿瘤,在我国,其发病率位居大城市女性恶性肿瘤的第一位,而且发病率呈逐年增长趋势。目前很多影像学检查方法被应用于乳腺的早期筛查,如乳腺检查（CBE）、乳腺X线摄影、超声成像（US）、计算机断层摄影（CT）、磁共振成像（MRI）、正电子发射断层显像术（PET）和乳腺热层析成像等,尤其是乳腺组织活检的应用,旨在提高早期乳腺癌的检出率。     

早期乳腺癌影像学检查现状与展望

乳腺癌是一种严重威胁女性身心健康的恶性肿瘤,在我国,其发病率位居大城市女性恶性肿瘤的第一位,而且发病率呈逐年增长趋势。目前很多影像学检查方法被应用于乳腺的早期筛查,如乳腺检查（CBE）、乳腺X线摄影、超声成像（US）、计算机断层摄影（CT）、磁共振成像（MRI）、正电子发射断层显像术（PET）和乳腺热层析成像等,尤其是乳腺组织活检的应用,旨在提高早期乳腺癌的检出率。     

重视颈部肿块的诊断

鉴于人类颈部的组织结构致密 ,以致任何新生物和感染都可使其中的 30 0多个淋巴结及 10余个筋膜间隙之一受累 ,而导致颈部肿块成为病人的始发症状。据亚特兰大医院 1972年统计 ,在 2 32 2 5 6例外科住院病人中 ,有 774 8例为颈部肿块 ,其中 4 6.8%来自甲状腺 ,5 3.2 %为非甲状腺疾病所致。通常临床较多遇见的是颈部淋巴结肿大 ,如慢性淋巴结炎、淋巴结结核、淋巴结转移或原发性淋巴瘤。而非淋巴结病变有甲状腺和甲状旁腺疾病、先天性囊肿 (甲状舌管囊肿、腮裂囊肿 )和腮腺肿瘤。较少见的尚有脂肪瘤、纤维瘤、动脉瘤、动脉体瘤、神经鞘膜瘤、…     

超声诊断胆囊息肉样病变与病理对照的研究

目的探讨超声诊断的胆囊息肉样病变(polypoid lesions of the gallbladder,PLG)中各种疾病所占比例及其相应的声像学特点,超声诊断胆固醇性息肉的可靠性。方法对556例超声诊断的PLG的病理结果进行分类,并分析不同大小的胆固醇性息肉超声检查的病理符合率。结果556例超声诊断的PLG中,胆固醇性息肉446例(80.2%),腺瘤性息肉86例(15.5%),炎性息肉18例(3.2%),腺肌症6例(1.1%)。97.3%的胆固醇性息肉长径<1.0cm,且64.6%病例的息肉为多发。超声拟诊胆固醇性息肉的病理符合率可达91.3%。腺瘤性息肉中,长径超过1.0cm者占61.6%,且34.0%有不典型增生或恶变;但也有25%的恶变发生在1.0cm以下的腺瘤中。结论PLG中80%以上为胆固醇性息肉;15.5%为腺瘤性息肉,发生恶变者多≥1.0cm,0.7~0.9cm的腺瘤性息肉也有恶变的可能。超声根据声像学特征作出的胆固醇息肉拟诊的病理符合率可达91.3%,因此是可信的。     

超声乳腺影像学报告及数据系统鉴别诊断乳腺小肿块

目的探讨超声乳腺影像学报告及数据系统(BI-RADS)标准化描述术语鉴别诊断乳腺小肿块(最大直径均≤1.5cm)的价值。方法利用BI-RADS超声术语对159例患者共186个乳腺小肿块进行描述,并对这些超声征象进行二分类Logistic回归分析。结果良性肿块123个(123/186,66.13%),恶性肿块63个(63/186,33.87%)。超声对恶性肿块诊断的敏感度、特异度、准确率分别为71.43%(45/63)、87.80%(108/123)、82.26%(153/186)。单因素分析显示乳腺良恶性小肿块的形态、边缘、生长方向、后方回声、内部微钙化差异有统计学意义(P0.05);多因素分析显示边缘毛刺和内部微钙化进入回归模型(P0.05)。结论边缘毛刺及肿块内部微钙化对鉴别乳腺良恶性小肿块最具价值。     

肝脏微小占位病变的影像学诊断及评价

肝脏微小病变是指直径≤1．0cm的肝脏占位性病变。由于病灶太小，影像学上易漏诊或误诊，特别是肝癌，一经发现，体积均较大，已到晚期。本文着重介绍微小肝癌和其他常见肝脏微小占位病变的影像学检查及评价。     

胆囊息肉样病变的诊治进展

胆囊息肉样病变（polypoid lesions of gallbladder，PLG）系指胆囊壁向腔内呈息肉样突起的一类病变的总称，又称“胆囊隆起性病变”，是形态学的名称。可以是球形或半球形，有蒂或无蒂。随着影像学技术在临床上广泛应用，胆囊息肉样病变的检出率逐渐增多。与此同时，它所包含的疾病种类也逐渐增多，目前已包含有20余种，既有良性病变，也有恶性肿瘤。临床工作中不时会遇到该类疾病。因此，在临床诊断及治疗上需要谨慎对待。     

乳腺肿瘤的影像学进展

影像学检查在乳腺疾病的筛查和诊断中具有重要价值。目前使用的影像学方法主要包括红外线扫描、超声、钼靶X线摄影、CT、MRI和核医学检查等。这些方法各有利弊,临床医生需根据患者病情合理选择,以达到早诊断、早治疗的目的。     

胆囊息肉样病变的诊断和治疗

1990年1月至2002年12月，我院为154例胆囊息肉样病变(polypoid lesions of gallbladder，PLG)施行了胆囊切除术。结合文献报告如下：     

246例胆囊息肉样病变的流行病学分析

目的 了解胆囊自肉样病变（PLG）的发病情况,病理与临床间的关系。方法 回顾性分析了1989-1998年期间连续246例手术切除的PLG临床及病理学资料。结果 246例PLG占同期胆囊工除术的10.9%。非肿瘤性息肉占87.4%（215/246）。肿瘤性息肉占12.6%（31/246）,肿瘤性息肉倾向于大于10mm,单发,广基,年龄大于50岁及合并有胆囊结石者。结论 胆囊肿瘤性息肉样病变有恶变倾向,主单发,直径大于10mm,广基的病变应手术治疗。特别是年龄大于50岁及合并有胆囊结石者。应重视PLG的定期随访。     

Incidence and outcomes of incidental breast lesions detected on cross‐sectional imaging examinations

The aim of this study was to determine the frequency and outcomes of incidental breast lesions detected on nonbreast specific cross‐sectional imaging examinations. A retrospective review of the medical records was performed to identify all patients without a known history of breast cancer, who had an incidentally discovered breast lesion detected on a nonbreast imaging examination performed at our institution between September 2008 and August 2012 for this IRB‐approved, HIPAA compliant study. Outcomes of the incidental lesions were determined by follow‐up with dedicated breast imaging (mammography, breast ultrasound, and/or breast MRI) or results of biopsy, if performed. Imaging modality of detection, imaging features, patient age, patient location at the time of the nonbreast imaging examination, type of follow‐up, and final outcome were recorded. Rates of malignancy were also calculated, and comparison was made across the different cross‐sectional imaging modalities. Kruskal‐Wallis and Fisher's exact tests were used to identify factors associated with an increased rate of malignancy. Logistic regression was used to model the risk of malignancy as a function of continuous predictors (such as patient age or lesion size); odds ratios and 95% confidence intervals were obtained. A total of 292 patients with incidental breast lesions were identified, 242 of whom had incidental lesions were noted on computed tomography (CT) studies, 25 on magnetic resonance imaging (MRI), and 25 on positron emission tomography (PET). Although most of the incidental breast lesions were detected on CT examinations, PET studies had the highest rate of detection of incidental breast lesions per number of studies performed (rate of incidental breast lesion detection on PET studies was 0.29%, compared to 0.10% for CT and 0.01% for MRI). Of the 121 of 292 (41%) patients who received dedicated breast imaging work‐up at our institution, 40 of 121 (33%) underwent biopsy and 25 of 121 (21%) had malignancy. There was a significantly increased rate of malignancy in older patients (odds ratio: 1.05, 95% CI: 1.02‐1.093; P = .006). Additionally, patients with PET‐detected incidental breast lesions had a significantly higher rate of malignancy (55%), compared to patients with CT‐detected (35%) and MRI‐detected (8%) incidental breast lesions (P = .038). The rate of malignancy upon follow‐up of incidental breast lesions detected on nonbreast imaging examinations in this retrospective study was 21%, supporting the importance of emphasizing further work‐up of all incidentally detected breast lesions with dedicated breast imaging. Additionally, we found that PET examinations had the highest rate of detection of incidental breast lesions and the highest rate of malignancy, which suggests that PET examinations may be more specific for predicting the likelihood of malignancy of incidental breast lesions, compared to CT and MRI.     

乳腺良性病变病理诊断应重视的问题

简要介绍一组易误诊的乳腺良性病变,包括乳腺炎症性及反应性病变、乳腺良性上皮性病变、良性腺肌上皮病变、良性间叶性肿瘤、良性纤维上皮性肿瘤、乳头部良性肿瘤。乳腺良性疾病存在多种组织学变异,有时诊断困难,此时应在光镜下仔细观察,结合临床和大体,必要时做免疫组化进一步明确诊断。     

乳腺癌癌前病变的治疗

病理组织学检查是诊断癌前病变的最可靠标准。目前公认的癌前病变有: （1）小叶及导管不典型增生; （2） 柱状上皮不典型增生; （3） 小叶原位癌; （4） 乳头状病变;（5） 异常增生放射状瘢痕。治疗癌前病变的最有效方法是手术切除。但是必须权衡手术范围与外形美观之间的矛盾,既不要切除范围过大,造成不必要的组织缺失,也不要切除范围过小而留下复发隐患。导管原位癌是乳腺癌的早期阶段,但是,纯粹的导管原位癌不具有侵袭性,被看作癌前病变和癌的中间状态。手术切除、放疗加降低风险的内分泌治疗是导管原位癌主要治疗方法。     

Curettage of benign bone tumors and tumor like lesions: A retrospective analysis

Background:

Curettage is one of the most common treatment options for benign lytic bone tumors and tumor like lesions. The resultant defect is usually filled. We report our outcome curettage of benign bone tumors and tumor like lesions without filling the cavity.

Materials and Methods:

We retrospectively studied 42 patients (28 males and 14 females) with benign bone tumors who had undergone curettage without grafting or filling of the defect by any other bone graft substitute. The age of the patients ranged from 14 to 66 years. The most common histological diagnosis was that of giant cell tumor followed by simple bone cyst, aneurysamal bone cyst, enchondroma, fibrous dysplasia, chondromyxoid fibroma, and chondroblastoma and giant cell reparative granuloma. Of the 15 giant cell tumors, 4 were radiographic grade 1 lesions, 8 were grade 2 and 3 grade 3. The mean maximum diameter of the cysts was 5.1 (range 1.1-9 cm) cm and the mean volume of the lesions was 34.89 cm³ (range 0.94-194.52 cm³). The plain radiographs of the part before and after curettage were reviewed to establish the size of the initial defect and the rate of reconstitution, filling and remodeling of the bone defect. Patients were reviewed every 3 monthly for a minimum period of 2 years.

Results:

Most of the bone defects completely reconstituted to a normal appearance while the rest filled partially. Two patients had preoperative and three had postoperative fractures. All the fractures healed uneventfully. Local recurrence occurred in three patients with giant cell tumor who were then reoperated. All other patients had unrestricted activities of daily living after surgery. The rate of bone reconstitution, risk of subsequent fracture or the incidence of complications was related to the size of the cyst/tumor at diagnosis. The benign cystic bone lesions with volume greater than approximately 70 cm³ were found to have higher incidence of complications.

Conclusion:

This study demonstrates the natural healing ability of bone without filling with bone grafts or bone graft substitutes. In selected sizes and locations of the benign lytic tumors and tumor like lesions extended curettage alone can be sufficient.     

乳腺不典型病灶超声引导下粗针活检的价值

目的评价超声引导下粗针活检术（US-CNB）对不典型乳腺病变的诊断意义。方法对女性患者的61个不典型病灶行US-CNB和手术切除活检,以切除活检病理结果为诊断标准。结果在US-CNB标本中,33个为良性,15个为可疑恶性,10个为恶性,3处取材不当。在手术切除标本中,26个病灶为恶性,32个为良性,US-CNB取材不当的3个均为良性。超声引导下粗针活检术诊断恶性肿瘤的诊断阳性率为96.15%（25/26）,特异性为100%（32/32）,正确率为98.28%（57/58）。结论US-CNB诊断不典型病灶安全、创伤小、准确率高。     

重视乳腺良性疾病与癌前病变的诊治研究

乳腺增生性疾病发病机制尚不清楚,临床诊断、治疗标准尚缺乏共识,对其可能发生癌变的临床特点和规律认识仍不清楚,对疾病进展缺乏有效的临床监测方法。乳腺纤维腺瘤外科治疗中如何关注到病人美观问题,需要探索微小纤维腺瘤的处理原则和微创手术方法,乳腺纤维腺瘤病的预防和治疗仍然存在困难。聚丙烯酰胺水凝胶类注射式隆乳后发生的哺乳期急性乳腺炎发病和治疗方法具有特殊性,而浆细胞性乳腺炎的治疗方法尚未达成共识。乳腺癌前病变的诊断和临床检测方法和乳腺原位癌的治疗仍须进一步深入研究。努力探索解决这些临床问题的方法是进一步提高乳腺良性疾病治疗效果的关键。     

麦默通旋切系统在临床触诊阴性乳腺病灶的应用

【摘要】〓目的〓探讨超声引导下麦默通旋切系统在临床触诊阴性乳腺病灶中的诊疗作用。 方法〓对62例共85个临床触诊阴性乳腺病灶进行超声引导下麦默通旋切术。结果〓85个病灶皆被准确、完整切除。术中冰冻切片病理示良性病变77例,乳腺癌8例。85例术中冰冻切片和术后石蜡切片诊断均相符。术后3个月复查B超均未见局部复发。结论〓超声引导下麦默通旋切术是确诊临床触诊阴性乳腺病灶的有效方法,在诊断的同时可完整切除良性病灶,达到治疗效果。     

Radioguided localization of clinically occult breast lesions (ROLL): a pilot study

Management of nonpalpable breast lesions requiring pathologic diagnosis has been with wire localization during the last few decades. Recently, radioguided localization (ROLL) became an alternative for this type of lesions. The objective of the present study was to evaluate the feasibility of this technique in a tertiary referral center in Mexico City. Consecutive patients requiring pathologic diagnosis from a nonpalpable breast lesion were included in the present study. On the same day of operation, all patients were injected with particles of human serum albumin. Localization of the lesion was performed in the operation theater with the aid of a hand-held gamma-probe. All lesions were identified in a control x-ray of the surgical specimen. Demographic, clinical, surgical and pathologic data were recorded. Forty patients with a mean age of 56.8 +/- 7.8 years were included. In 39 of the 40 patients (97.5%) the "hot spot" was identified easily. In all patients, the area of maximum radioactivity corresponded to the site of the lesion. Imaging confirmation of the lesion in the surgical specimen was done during the first excision in 37 patients (92.5%). In the remaining cases (7.5%), a wider excision was performed during the same procedure, finding the suspected lesion in all cases. Diagnosis of cancer was made in seven patients, (17.5%). There were no significant surgical complications. Our data suggest that ROLL offer a simple and reliable method to localize occult breast lesions, allowing complete removal of the lesion in 100% of the patients. Because of the small quantity of radioactivity, the procedure is safe for both patients and the medical staff, producing less discomfort in patients than wire localization.