彩色超声联合 X 线钼靶摄影在乳腺癌诊断中的价值

目的：研究彩色超声联合X线钼靶摄影在乳腺癌诊断中的价值。方法回顾性分析270例乳腺癌患者的彩色超声、X线钼靶摄影以及二者联合的检查结果,并与术后或者是病理学分析结果进行对比。从阳性诊断符合率、乳腺类型、恶性肿瘤的肿块粒径、癌的类型4个方面的结果进行分析。结果单用彩色超声、单用X线钼靶摄影和彩色超声联合X线钼靶摄影的阳性诊断符合度分别为86．1％、87．9％和96．5％,单用彩色超声和单用X线钼靶摄影的阳性诊断符合度均明显低于彩色超声联合X线钼靶摄影,差异具有统计学意义（P＜0．05）;对于不同的乳腺类型,则单用彩色超声、单用X线钼靶摄影和彩色超声联合X线钼靶摄影的正确诊断率分别为72．2％、77．1％和91．1％,单用彩色超声、单用X线钼靶摄影的正确诊断率明显低于彩色超声联合X线钼靶摄影,差异具有统计学意义（ P＜0．05）;对于不同的肿块粒径,单用彩色超声、单用X线钼靶摄影和彩色超声联合X线钼靶摄影的正确诊断率分别为79．2％、74．4％、92．6％,彩色超声联合X线钼靶摄影诊断准确率明显高于单用彩色超声和单用X线钼靶摄影,差异具有统计学意义（ P＜0．05）;在不同类型的癌方面,单用彩色超声、单用X线钼靶摄影和彩色超声联合X线钼靶摄影的正确诊断率分别为77．2％、76．3％、93．1％,彩色超声联合X线钼靶摄影的准确率均明显高于单用彩色超声、单用X线钼靶摄影的诊断准确率,差异具有统计学意义（P＜0．05）。结论彩色超声和X线钼靶摄影在检查乳腺癌过程中,都具有各自的优势和劣势,二者联合之后能显著提高乳腺癌的诊断准确率,提高对乳腺肿瘤的早期发现率,具有较大实用价值。     

钼靶 X 线摄影联合彩色多普勒超声( CDFI) 检查在乳腺癌中的诊断价值

目的：探讨钼靶X线摄影联合彩色多普勒超声（CDFI）检查对乳腺癌的诊断价值.方法：回顾性分析我院2009年-2012年189例乳腺肿瘤患者的钼靶X线与CDFI检查结果,并与手术病理结果进行比较.结果：189例患者中139例病理证实为乳腺癌,单独应用钼靶X线及CDFI 对乳腺肿瘤诊断符合率分别为 74.6%和68.2%,而联合诊断符合率达 89.4%,明显高于单用任一种检查方法（P＜0.05）,联合诊断乳腺癌的准确率为 92.1 %.对最大径小于 1.0cm的乳腺癌的检出率,单用CDFI、单用钼靶X线摄影和联合检查诊断符合率分别为50.0%、67.7%和82.1%,三者之间的差异具有统计学意义（P＜0.05）.而对于肿瘤最大径大于1.0cm的乳腺癌,三种方法的检出率之间无统计学差异.对于40岁及以上患者,单用CDFI、单用钼靶X线摄影以及两者联合检查其诊断符合率分别为64.7%、81.3%和90.6%,有明显差异,而对于40岁以下患者,三者的诊断符合率分别为80.0%、68.0%和88.0%,三者差异也具有统计学意义.结论：钼靶X摄影联合 CDFI在乳腺癌检查中具备优势,联合应用能明显提高乳腺癌的检出率.     

钼靶X线假阴性乳腺癌的临床病理及分子生物学研究进展

在众多影像学检查方法中，钼靶X线摄影是首选检查方法，技术成熟，具有诊断准确性高，早期、快速、方便、价廉的优点，对早期乳腺癌具有较高的敏感性。     

钼靶X线假阴性乳腺癌的临床病理及分子生物学研究进展

在众多影像学检查方法中,钼靶X线摄影是首选检查方法,技术成熟,具有诊断准确性高,早期、快速、方便、价廉的优点,对早期乳腺癌具有较高的敏感性. 1 钼靶X线的作用原理及临床意义 乳腺组织有腺体组织、导管、脂肪及少量结缔组织组成,这些软组织密度相似,对普通X线的衰减无明显差别,而钼靶所放射的软X线波长适用于乳腺组织投照最佳波长(0.63-0.90A),对乳腺组织投照具有独特的优越性,能将乳腺组织内病变清晰地显示于胶片上.     

超声和钼靶X线诊断乳腺癌的临床价值比较

[目的]探讨年龄和肿块大小对超声和钼靶X线在乳腺癌筛查及检查中的影响。[方法]所有受检者在同一天接受超声和钼靶X线检查,检查中详细记录病变位置、大小及声像图特征,由超声专业和放射专业的高年资医师在双盲情况下,独立作出诊断。[结果]共1090例乳腺病例1132个病灶,其中病理诊断乳腺癌301例314个病灶,良性病变789例818个病灶。早期乳腺癌诊断率为53.50%。超声检查乳腺癌的灵敏度为95.22%,特异性为65.16%,假阴性率为4.78%;钼靶X线检查乳腺癌的灵敏度为90.13%,特异性为86.31%,假阴性率为9.87%,二者之间的差异具有统计学意义(P<0.05)。超声与钼靶X线联合检查的灵敏度为97.77%,特异性为92.42%。对于<50岁女性,钼靶X线的灵敏度低于超声,二者间差异具有统计学意义(P<0.05)。≥50岁女性的超声和钼靶X线的灵敏度相似,其差异无统计学意义(P>0.05)。在肿块直径6～10mm组中钼靶X线灵敏度最低,与超声的灵敏度比较差异有统计学意义(P<0.05)。[结论]在乳腺癌检查中,对于≥50岁女性,超声和钼靶X线具有相同的检查效果,而<50岁女性,超声检查乳腺癌的灵敏度优于钼靶X线。当肿块直径在6～10mm时钼靶X线灵敏度最低。     

乳腺癌钼靶X线21例误诊分析

乳腺癌是危害妇女健康的常见恶性肿瘤,乳腺钼靶X线检查在乳腺癌的诊断中占重要地位。但由于乳腺癌的X线表现较复杂,特别是部分病例临床表现不典型,容易造成误诊。现收集本院21例钼靶X线片误诊的乳腺癌病例,重新阅片,分析总结如下。1临床资料对我院2002年12月~2005年12月钼靶X线片误诊经病理证实为乳腺癌21例资料进行分析。患者均为女性,未婚4例,已婚17例;年龄24~65岁,平均47.5岁;病程1周~1年,平均7个月。21例中14例因自觉无痛性乳房肿块就诊,4例伴有乳房局部压痛,2例乳晕区触及粟粒大小肿块并伴有乳头溢液,1例为常规体检就诊。所有患者临…     

钼靶X线在评价乳腺癌腋窝淋巴结转移中的应用价值

目的:评价X线钼靶片术前评估乳腺癌腋窝淋巴结转移的应用价值.方法: 对77例乳腺癌患者进行术前钼靶X线检查, 观察肿块及腋窝淋巴结的形态、大小,与术后病理进行对照分析.结果: 77例中46例片内检出有淋巴结, 敏感度为59.7%,共显示淋巴结94枚,短径在0.6cm-2.8cm,平均1.1cm.其中30例所显示58枚淋巴结病理证实无转移,直径均在2.0cm以下,形态呈圆形或椭圆形,边缘光滑,边界清楚,密度不均匀,中心呈稍低密度,周边密度高,呈壳状改变;16例所见36枚淋巴结病理证实有转移,直径均在0.8cm以上,边缘不规则有分叶、边界不清楚,淋巴结密度均匀呈实性无脂肪浸润.并且对淋巴结直径进行统计学分析,转移组与非转移组之间有差别.结论: 肿瘤直径对判定乳腺癌淋巴结是否有转移无意义.淋巴结的大小与是否转移有一定关系,当淋巴结最小径大于0.8cm时,参考其边缘、形态、密度的相应改变综合考虑淋巴结转移可能.     

CT钼靶X线对乳腺癌早期发现的价值研究

目的探讨CT检查结合钼靶X线检查对乳腺癌早期发现的临床价值。方法手术并经病理检查证实为乳腺癌的80例患者,术前均行CT和钼靶X线检查,回顾性分析其影像学及病理学资料。结果单纯钼靶X线检查检出乳腺癌64例(80.0%),单纯CT检查检出乳腺癌72例(90.0%),CT与钼靶X线联合检查检出乳腺癌77例(96.3%),3种方法检出乳腺癌的诊断符合率及误诊率比较差异有统计学意义(P<0.05)。单纯CT发现钙化45例(56.3%),单纯钼靶X线发现钙化63例(78.8%),CT与钼靶X线对钙化灶检出率比较差异有统计学意义(P<0.05)。单纯CT发现腋窝淋巴结转移49例(89.1%),单纯钼靶X线发现腋窝淋巴结转移40例(72.7%)。CT与钼靶X线淋巴结转移检出率比较差异有统计学意义(P<0.05)。结论 CT结合钼靶X线检查能够明显提高乳腺癌的早期诊断率。     

不同钼靶X线阳性标准对乳腺癌筛查成本效果的影响

  目的  根据乳腺癌筛查数据, 比较不同钼靶X线阳性判定标准对其筛查成本效果的影响, 为国家制定乳腺癌筛查方案提供参考。  方法  在2008年7月到2009年9月, 对天津、南昌、肥城和沈阳4个城市开展了一个横断面多中心的乳腺癌筛查研究项目。其中21 986例45~69岁年龄组的妇女进行了乳腺钼靶X线检查, 经过1年随访, 最后65例乳腺癌新发病例被确诊。根据不同钼靶X线检查阳性判定标准计算其各自的灵敏度和特异度。利用马尔科夫模型模拟整个筛查过程, 计算各自的成本效果比值并对其进行敏感性分析。模拟筛查过程时, 对其进行了3%的折扣。成本效果比值用挽救每个生命年所花的费用来表示, 即: ￥/ LYs（life years saved）。  结果  将BIRADS分级0级（需进一步影像检查或与前次影像资料比较才能得出结论）归为阴性, 筛查出55例乳腺癌, 灵敏度为84.6%, 特异度为98.6%, 成本效果比值为45 632￥/LYs; 若0级为阳性, 筛查出56例乳腺癌, 灵敏度为86.2%, 特异度为93.9%, 成本效果比值为52 392￥/LYs。  结论  不同的钼靶X线阳性判定标准对其灵敏度影响较小, 对特异度和成本效果影响较大。      

超声和钼靶X线对乳腺癌患者腋窝淋巴结转移的诊断价值

目的探讨超声和钼靶X线对乳腺癌患者腋窝淋巴结转移的诊断价值,为临床是否选择前哨淋巴结活检(SLNB)提供指导。方法选择532例行SLNB并经术后病理检查确诊的原发性乳腺癌患者,所有患者术前均接受乳腺超声和乳腺钼靶X线检查,分析乳腺超声、乳腺钼靶X线征象与腋窝淋巴结转移的关系。以病理诊断结果为金标准,分析乳腺超声、乳腺钼靶X线及SLNB对腋窝淋巴结转移的诊断价值。结果532例患者中,腋窝淋巴结转移272例,未转移260例。乳腺超声检查结果显示,腋窝淋巴结转移和未转移乳腺癌患者的肿块直径、边界情况、淋巴结长短径之比、乳腺影像报告及数据系统(BI-RADS)分级比较,差异均有统计学意义(P﹤0.01)。乳腺钼靶X线检查结果显示,腋窝淋巴结转移的乳腺癌患者恶性钙化的发生率明显高于腋窝淋巴结未转移的患者,差异有统计学意义(P﹤0.01)。以病理诊断结果为金标准,SLNB诊断腋窝淋巴结转移的灵敏度和特异度最高,分别为93.01%和97.31%,其次是乳腺超声,其灵敏度和特异度分别为84.93%和92.69%,乳腺钼靶X线诊断腋窝淋巴结转移的灵敏度和特异度最低,分别为49.63%和71.54%。结论腋窝淋巴结转移和未转移乳腺癌患者的乳腺超声和乳腺钼靶X线征象具有一定的差异。乳腺超声和乳腺钼靶X线对腋窝淋巴结转移具有一定的诊断价值,且对是否选择SLNB具有指导意义。     

The value of risk factors in screening for breast cancer

The value of risk factors in selecting women for repeat screening for the detection of early breast cancer is considered. The screening methods used are a detailed history, clinical examination, thermography and mammography. The risk factors assessed are the effect of a personal and family history and thermography. There are 11 240 women in the series. The incidence of cancer in the no risk group is 24/5825 (0.4%), the group with one risk factor 127/3881 (3.3%) and in those with more than one factor 263/1534 (17.1%). It is suggested that the use of risk factors is sufficiently discriminating to select women for further screening over the next 10 years after an initial negative test.     

Harms of screening mammography for breast cancer in Japanese women

Background

The US Preventative Services Task Force assesses the efficacy of breast cancer screening by the sum of its benefits and harms, and recommends against routine screening mammography because of its relatively great harms for women aged 40–49 years. Assessment of the efficacy of screening mammography should take into consideration not only its benefits but also its harms, but data regarding those harms are lacking for Japanese women.

Methods

In 2008 we collected screening mammography data from 144,848 participants from five Japanese prefectures by age bracket to assess the harms [false-positive results, performance of unnecessary additional imaging, fine-needle aspiration cytology (FNA), and biopsy and its procedures].

Results

The rate of cancer detected in women aged 40–49 years was 0.28%. The false-positive rate (9.6%) and rates of additional imaging by mammography (5.8%) and ultrasound (7.3%) were higher in women aged 40–49 years than in the other age brackets. The rates of FNA (1.6%) and biopsy (0.7%) were also highest in women aged 40–49 years. However, they seemed to be lower than the rates reported by the Breast Cancer Surveillance Consortium (BCSC) and other studies in the US.

Conclusions

The results, although preliminary, indicate the possibility that the harms of screening mammography for Japanese women are less than those for American women.     

《中国女性乳腺癌筛查指南》解读（精简版）

乳腺癌是中国女性最常见的恶性肿瘤，早期筛查是提高乳腺癌早诊早治最佳途径。中国女性乳腺癌发病高峰年龄与欧美国家乳腺癌发病高峰年龄明显不同，制定适合中国女性特点的群体性乳腺癌筛查指南势在必行。中国抗癌协会与国家肿瘤临床医学研究中心（天津医科大学肿瘤医院）组织专家在分析总结中国女性乳腺癌筛查数据的基础上，参考欧美及东亚等国家的最新乳腺癌筛查指南或共识，分别从筛查起始年龄、筛查方法、筛查时间间隔3个方面，针对中国女性乳腺癌一般风险人群和高危风险人群制定以人群为基础的《中国女性乳腺癌筛查指南》，本文对该指南进行解读以供乳腺癌筛查相关人士参考。      

Developing a breast cancer screening program for Chinese-American women

The Chinese, like other minority groups, often underuse cancer screening services because of language, cultural, and economic barriers. Nonattendance reduces the probability that cancer will be detected in its earliest and often most curable form. To improve use of cancer screening services among Chinese-Americans, a community-based coalition organized a one-day demonstration cancer awareness and screening program--the Breast Cancer Screening Day for Chinese Women. More than 100 women, many of whom did not speak English, attended the program. Six abnormal mammograms required follow-up and one breast cancer was detected. The planning process used to develop this successful project is described as are suggestions to improve future screening programs for ethnic minorities.     

Cost-effectiveness of breast cancer screening programme for women in rural China

In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35–64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost-effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality-adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.     

绝经前和围绝经期乳腺癌辅助内分泌治疗

回顾绝经前和围绝经期早期乳腺癌术后辅助内分泌治疗,综述第3代芳香化酶抑制剂(AI)联合药物性卵巢去势在术后辅助治疗中的应用.