Observer variability in screen-film mammography versus full-field digital mammography with soft-copy reading

Full-field digital mammography (FFDM) with soft-copy reading is more complex than screen-film mammography (SFM) with hard-copy reading. The aim of this study was to compare inter- and intraobserver variability in SFM versus FFDM of paired mammograms from a breast cancer screening program. Six radiologists interpreted mammograms of 232 cases obtained with both techniques, including 46 cancers, 88 benign lesions, and 98 normals. Image interpretation included BI-RADS categories. A case consisted of standard two-view mammograms of one breast. Images were scored in two sessions separated by 5 weeks. Observer variability was substantial for SFM as well as for FFDM, but overall there was no significant difference between the observer variability at SFM and FFDM. Mean kappa values were lower, indicating less agreement, for microcalcifications compared with masses. The lower observer agreement for microcalcifications, and especially the low intraobserver concordance between the two imaging techniques for three readers, was noticeable. The level of observer agreement might be an indicator of radiologist performance and could confound studies designed to separate diagnostic differences between the two imaging techniques. The results of our study confirm the need for proper training for radiologists starting FFDM with soft-copy reading in breast cancer screening. Presented at ECR, Wien 2006.     

Screen film vs full-field digital mammography: image quality,detectability and characterization of lesions

The objective of this study was to compare screen-film mammography (SFM) to full-field digital mammography (FFDM) regarding image quality as well as detectability and characterization of lesions using equivalent images of the same patient acquired with both systems. Two mammography units were used, one with a screen-film system (Senographe DMR) and the other with a digital detector (Senographe 2000D, both GEMS). Screen-film and digital mammograms were performed on 55 patients with cytologically or histologically proven tumors on the same day. Together with these, 75 digital mammograms of patients without tumor and the corresponding previous screen-film mammograms not older than 1.5 years were reviewed by three observers in a random order. Contrast, exposure, and the presence of artifacts were evaluated. Different details, such as the skin, the retromamillary region, and the parenchymal structures, were judged according to a three-point ranking scale. Finally, the detectability of microcalcifications and lesions were compared and correlated to histology. Image contrast was judged to be good in 76%, satisfactory in 20%, and unsatisfactory in 4% of screen-film mammograms. Digital mammograms were judged to be good in 99% and unsatisfactory in 1% of cases. Improper exposure of screen-film system occurred in 18% (10% overexposed and 8% underexposed). Digital mammograms were improperly exposed in 4% of all cases but were of acceptable quality after post-processing. Artifacts, most of them of no significance, were found in 78% of screen-film and in none of the digital mammograms. Different anatomical regions, such as the skin, the retromamillary region, and dense parenchymal areas, were better visualized in digital than in screen-film mammography. All malignant tumors were seen by the three radiologists; however, digital mammograms allowed a better characterization of these lesions to the Breast Imaging Reporting and Data System (BI-RADS;) [corrected] categories (FFDM better than SFM in 23 of 165 vs 9 of 165 judged cases in SFM). In conclusion, digital mammography offers a consistent, high image quality in combination with a better contrast and without artifacts. Lesion detection in digital images was equal to that in screen-film images; however, categorization of the lesions to the BI-RADS classification was slightly better.     

全数字化乳腺X线摄影对乳腺炎性疾病的诊断价值

目的:分析乳腺炎性疾病的全数字化乳腺X线摄影(FFDM)表现,提高该病与乳腺癌的鉴别诊断水平。方法:回顾性分析39例经穿刺或手术病理证实的乳腺炎性疾病的FFDM表现。结果:39例患者中,26例为慢性乳腺炎,5例为浆细胞性乳腺炎,8例为肉芽肿性乳腺炎。X线表现为肿块影17例,局部腺体非对称性致密影20例,结构扭曲2例。伴同侧腋下淋巴结致密影7例,局部或乳晕区皮肤增厚12例,乳头凹陷7例。结论:结合临床资料并细致分析乳腺炎性疾病的FFDM表现,有助于提高该病诊断与鉴别诊断水平。     

全数字乳腺摄影机最佳曝光条件的探讨

目的 探讨并找出全数字乳腺摄影机(FFDM)的最佳曝光条件。方法 用全数字乳腺X 线摄影机对Fluke NA 18-220 乳腺模体进行自动曝光控制(AEC)摄影,记录曝光条件为29kV、40mAs,用手动调整不同的mAs值(24、28、32、36和45mAs)和kV (22、23、25、27和31kV)对模体曝光,由4位影像学家在相同条件下进行软阅读,并按照美国放射学会(ACR)的评分标准对模体中的钙化点、尼龙纤维、肿块灶进行打分,对所得数据进行方差分析(ANOVA)。结果 在相同的摄影电压29 kV下,手动曝光条件下32mAs和AEC的40mAs的影像信息的评价分值差异没有统计学意义(P>0.05),说明这2种摄影条件对乳腺摄影体模内容物的显示基本相同,但二者的辐射剂量确有明显的不同。在相同的摄影电流40mAs下,27kV和29kV的影像信息的评价分值没有统计学意义(P>0.05),说明这2种摄影条件对乳腺摄影体模内容物的显示基本相同,但二者的辐射剂量不相同。结论 在保证影像质量的前提下,自动曝光控制摄影条件初始设定水平的合理性应进行必要的检测来验证。     

全数字乳腺X线3种摄影模式的影像质量和辐射剂量比较

目的 探讨全数字乳腺X线摄影(FFDM)不同摄影模式影像质量与辐射剂量的比较研究.方法 用全数字乳腺X线摄影的对比度优先模式(CNT)、标准模式(STD)及辐射剂量优先模式(DOSE)对FLUKE NA 18-220乳腺模体进行摄影,摄影采用自动曝光模式(AEC),记录摄影条件和辐射剂量.由4位影像学医师在相同条件下进行软阅读,并按照美国放射学会(ACR)的评分标准对模体中的钙化点、尼龙纤维、肿块灶进行评分.结果 标准模式、辐射剂量优先模式及对比度优先模式的模体影像评分值分别是11.5、11.0和14.5,标准模式及辐射剂量优先模式与对比度优先模式的影像质量差异有统计学意义(F=41.321,P＜0.05).标准模式与辐射剂量优先模式之间影像质量差异无统计学意义,但两种模式的辐射剂量却不相同,其表面入射剂量分别是4.5和3.15 mGy,腺体平均剂量(AGD)分别是1.18和0.78 mGy.结论 全数字乳腺摄影的辐射剂量优先模式和标准模式适合大多数被检者,特别是辐射剂量优先模式.对比度优先模式应严格控制使用.

Abstract：

Objective To study the difference of image quality and radiation dose between different exposure modes with full-field digital mammography (FFDM).Methods The Fluke18-220mammographic phantom was exposed by FFDM system with different exposure modes at automatic exposure control ( AEC ) ,including contrast mode,standard mode and dose mode,and the exposure factors and radiation dose were recorded.The images on monitor with the best window width and window level were read by four independent radiologists.The images of specks groups,nylon fibers and masses was assessed by the four experienced readers at the criterion of American College of Radiology.Results The detection of specks groups,nylon fibers and masses were statistically different at the contrast mode and standard mode (F =41.321,P ＜ 0.05),further at the contrast mode and dose mode.The detection of specks groups、nylon fibers and masses were not statistically different( P ＞ 0.05 ) at standard mode and dose mode,but the radiation doses were different.The ESD at standard mode and dose mode was 4.5 and 3.15 mGy,respectively.The AGD of standard mode and dose mode was 1.18 mGy and 0.78 mGy,respectively.Conclusions The standard mode and dose mode of FFDM might be fit for most patients,especially at the dose mode.Contrast mode of FFDM should be strictly controled in use.     

全数字化乳腺摄影与MRI对乳腺恶性病变诊断的对比分析

目的 探讨乳腺癌全数字化乳腺摄影(full-field digital mammography,FFDM)与乳腺MRI的影像学表现,评价其对乳腺癌的诊断价值.方法 收集68例经穿刺或手术病理证实的乳腺癌病例,对比分析其X线摄影及MRI表现.全数字化乳腺摄影采用常规方法摄片,MRI采用自旋回波T1WI,T2WI序列及动态增强扫描等.结果 68例乳腺恶性肿瘤中,浸润性导管癌57例,浸润性小叶癌3例,叶状囊肉瘤1例,血管肉瘤1例,导管内癌2例,炎性乳癌2例,印戒细胞癌1例,Paget's病1例.乳腺X线摄影诊断正确61例,诊断准确率89.7％.MRI诊断正确66例,诊断准确率97.1％.结论 乳腺X线摄影是乳腺恶性病变的首选检查方法,MRI能更多的显示乳腺病灶的内部特征,二者联合应用对乳腺癌的临床诊断具有重要意义.     

全数字乳腺摄影系统与双面阅读CR乳腺摄影系统的比较

目的 对比研究全数字乳腺摄影系统(FFDM)与双面阅读CR乳腺摄影成像系统(DSCRM)辐射剂量与成像质量的关系.方法 在相同的辐射剂量下用FFDM和DSCRM对ALVIM统计学乳腺摄影模体TRM进行曝光,记录摄影条件和模体表面入射剂量,然后固定此摄影条件kV值,选用不同mAs值用DSCRM对模体进行曝光,记录表面入射剂量,并将所获取的影像在图像诊断工作站显示器上由3位放射学专家进行视读打分,按照5分值判断法评判,绘制ROC曲线,计算出每种信号的判断概率值Pdet,对所得数据进行统计学分析.结果 在辐射剂量为1.36 mGy时,FFDM所摄取模体影像内容物中不同直径钙化点和肿块灶的Pdet值分别是0.730 ～0.925和0.670～0.945,DSCRM所得模体影像内容物中不同直径钙化点和肿块灶的Pdet值分别是0.632～0.815和0.575～0.785.二者在1.35 mm肿块灶和0.40 mm钙化点用双因素方差分析(ANOVA)进行处理,(F=37.1,P＜0.05).在相同的判断概率值Pdet下,DSCRM所用表面入射剂量为1.63 mGy,腺体平均剂量为0.65 mGy,FFDM所用的表面入射剂量为1.36 mGy,腺体平均剂量为0.56 mGy,FFDM较DSCRM表面入射剂量减少了19.8％,腺体平均剂量减少16.0％.结论 在相同曝光条件下,FFDM对模体内容物的检出率高于DSCRM;在获得相似图像质量时,FFDM的辐射剂量明显低于DSCRM.     

Two-modality mammography may confer an advantage over either full-field digital mammography or screen-film mammography

RATIONALE AND OBJECTIVES: We sought to compare the cancer detection rate and receiver operating characteristic (ROC) area under the curve of full-field digital mammography, screen-film mammography, and a combined technique that allowed diagnosis if a finding was suspicious on film mammography, on digital mammography, or both. MATERIALS AND METHODS: We used the data originally analyzed by Lewin and associates in 2002. In that trial, 6,736 paired full-field and digital mammograms were performed in 4,489 women. We used parametric and nonparametric tests to compare the area under the curve for ROC scores of film-screen only, digital mammography only, and the combined test. We used McNemar's test for paired proportions to compare the cancer detection rates. RESULTS: With the parametric test, neither the difference in the area under the curve between the film and combined nor the difference between the digital and combined ROC curves was significant at the Bonferroni-corrected 0.025 alpha level (film versus combined difference = 0.0563, P = .0712; digital versus combined difference = 0.0894, P = .0455). The nonparametric test showed that there was a significant difference between both film and combined (difference = 0.073, P = .008) and digital versus combined ROC curves (difference = 0.1164, P = .0008). The continuity-corrected McNemar's test showed a significant increase in the proportion of cancers detected by the combined modality over film (chi(2) = 7.111, df = 1, P = .0077), and over digital (chi(2) = 12.071, df = 1, P = .0005). CONCLUSION: Using two mammograms, one film and one digital, significantly increases the detection of breast cancer.     

Follow-up and final results of the Oslo I Study comparing screen-film mammography and full-field digital mammography with soft-copy reading

Purpose: To compare cancer detection rates of screen-film (SFM) and full-field digital mammography (FFDM) with soft-copy reading in a screening program including the initial positive scores for interval cancers and cancers in the subsequent screening round, and to analyze the false-negative FFDM interpretations.

Material and Methods: Using a paired study design, 3683 women underwent SFM and FFDM in a population-based screening program. Two standard views of each breast were acquired. The images were interpreted without previous films for comparison. Independent double reading using a 5-point rating scale for probability of cancer was used for each modality. An examination was defined as positive if at least one of the two independent readers scored 2 or higher on the 5-point rating scale. SFM-positive cases were discussed in a SFM consensus meeting and FFDM-positive cases in a separate FFDM consensus meeting before recall. The study population was followed for more than 2 years so that interval cancers and screen-detected cancers in the subsequent screening round could be included. Cancer detection rates were compared using the McNemar test for paired proportions. The kappa statistic and Wilcoxon signed-rank test for matched pairs were used for comparing rating scores. The reading time was recorded for all FFDM interpretations.

Results: A total of 31 cancers (detection rate 0.84%) were diagnosed initially, of which SFM detected 28 and FFDM 23 (McNemar test P = 0.23, discordant pair 8 and 3). Two cancers with a positive score at initial SFM reading and three with a positive score at initial FFDM reading were dismissed at SFM and FFDM consensus meetings, respectively. The difference in cancer detection after recall (discordant pair 11 and 5) was not significant (McNemar test, P = 0.21). Of the 10 interval cancers and 16 screen-detected cancers in the subsequent round, 3 had true-positive SFM scores while 4 had true-positive FFDM scores in the initial reading session. A total of 38 cancers therefore had a positive result at double reading at one or both modalities, 31 at SFM and 27 at FFDM (McNemar test, P = 0.48). Comparison of SFM and FFDM interpretations using the mean score for each case revealed no statistically significant difference between the two modalities (Wilcoxon signed-rank test for matched pairs; P-value = 0.228). Two initial round cancers (one tumor found incidentally at work-up for a mass proved to be a simple cyst with a positive score at FFDM but a negative score at SFM, and one tumor with positive score at SFM but negative score at FFDM due to positioning failure) were excluded from the further analysis. Excluding these two cancers from comparison, there were 31% (22 of 72) false-negative SFM and 47% (34 of 72) false-negative FFDM individual interpretations. The overall mean interpretation time for normal FFDM examinations was 45 s. For most false-negative FFDM results, the reading time was shorter or longer than for normal examinations. The recorded FFDM interpretation time was noticeably short for several overlooked cancers manifesting as microcalcifications (ductal carcinoma in situ).

Conclusion: There is no statistically significant difference in cancer detection rate between SFM and FFDM with soft-copy reading in a mammography screening program. Analysis of cancers missed at FFDM with soft-copy reading indicates that close attention has to be paid to systematic use of image display protocols.     

Computer-aided detection in direct digital full-field mammography: initial results

For the first time, full-field digital mammography (FFDM) allows computer-aided detection (CAD) analysis of directly acquired digital image data. The purpose of this study was to evaluate a CAD system in patients with histologically correlated breast cancer depicted with FFDM. Sixty-three cases of histologically proven breast cancer detected with FFDM (Senographe 2000D, GE Medical Systems, Buc, France) were analyzed using a CAD system (Image Checker V2.3, R2 Technology, Los Altos, Calif.). Fourteen of these malignancies were characterized as microcalcifications, 37 as masses, and 12 as both. The mammographic findings were categorized as BI-RADS 3 (n=5), BI-RADS 4 (n=17) and BI-RADS 5 (n=40). The sensitivity for malignant lesions and the rate of false-positive marks per image were calculated. The sensitivity and its 95% confidence interval (CI) were estimated. The sensitivity of the CAD R2 system in breast cancer seen on FFDM was 89% for microcalcifications [CI_95%=(70%; 98%)] and 81% for masses [CI_95%=(67%; 91%)]. As expected, the detection rate was higher in lesions categorized as BI-RADS 5 (37 of 40) compared with lesions categorized as BI-RADS 4 (11 of 17). In the group categorized as BI-RADS 3 the detection rate was 4 of 5 lesions; however, this group was very small. The rate of false-positive marks was 0.35 microcalcification marks/image and 0.26 mass marks/image. The overall rate of false-positive marks was 0.61 per image. CAD based on FFDM provides an optimized work flow. Results are equivalent to the results reported for CAD analysis of secondarily digitized image data. Sensitivity for microcalcifications is acceptable and for masses is low. The number of false-positive marks per image should be reduced. Electronic Publication     

两种数字乳腺X射线摄影系统的比较

目的探讨比较全视野数字乳腺X射线摄影系统(FFDM)与计算机乳腺X射线摄影系统(CRM)在影像质量与辐射剂量方面的差异。方法用FFDM对ALVIM乳腺摄影体模TRM进行自动曝光控制(AEC)摄影,再用CRM专用成像板(IP)在同一摄影机上用相同条件对体模摄影。固定AEC摄影时的kV值,选用曝光量数值14、16、18、22和24 mAs,在FFDM机上对模体摄影,记录上述摄影条件和入射皮肤剂量(ESD)及平均腺体剂量(AGD)。由5位影像科资深医师分别在相同条件下对所得影像进行软阅读,按照5分值判断法评判,然后绘制受试者工作特征曲线(ROC)曲线,计算出每种信号的判断概率值(P_det),对所得数据进行统计学分析。结果在辐射剂量均为1.36 mGy时,FFDM对模体内钙化点和肿块灶P_det值比CRM高,尤其是微小钙化点和小肿块灶,微小钙化点最大差值为0.215,小肿块灶最大差值为0.245。在相同的P_det值下,FFDM的辐射剂量比CRM低,ESD的值降低了26%,腺体平均剂量降低了41%。在使用FFDM摄影时,当mAs值超过AEC值时,P_det值没有明显改变。结论在相同曝光条件下,FFDM对乳腺钙化点和肿块灶的检出率高于CRM;在获得相似图像质量时,FFDM的辐射剂量明显低于CRM。     

Analysis of patient dose in full field digital mammography

Now, full field digital mammography (FFDM) is widely used in diagnosis of breast cancer. With the development of FFDM, the radiation dose delivered to the patients involved in an imaging protocol is of utmost concern. Here, we analyzed the average glandular dose (AGD) and entrance surface exposure (ESE) of 1397 patients (6008 images) who underwent mammographic examinations by FFDM in three modes with automatic optimization of parameters (AOP), namely STD for standard mode, CNT for contrast mode and DOSE for dose mode. In addition, exposure factors including kVp, tube loading (mAs), and target/filter combination were evaluated. As a result, the patient dose was sorted as CNT>STD>DOSE. The dose difference among the three AOP modes was mainly attributed to the selection of mAs. The AGD and breast compressed thickness were well correlated in STD and DOSE modes. However, the correlation between CNT-delivered AGD and breast compressed thickness was dependent on the range of the breast thickness and patient age. The findings on dose and exposure characteristics of the three AOP modes get useful message of patient dose in the acquisition of FFDM.     

乳腺导管癌的乳腺钼靶与磁共振增强扫描的对比研究

目的比较全数字化乳腺摄影(full-field digital mammography,FFDM)、磁共振(MRI)增强扫描对乳腺导管癌的诊断价值。方法回顾性分析经手术病理证实的30例乳腺导管癌,所有病例均行FFDM、MRI增强检查。观察X线特征,根据美国放射学会乳腺影像报告和数据系统(breast imaging reporting and data system,BI-RADS)进行分级,3级及以下的级别考虑为良性,4A级及以上的为恶性;MRI根据病灶增强表现,绘制时间-信号强度曲线诊断病灶的良、恶性。影像诊断与病理结果对照,比较二者对导管癌的检出情况及诊断准确率。结果 30例乳腺导管癌中,FFDM检出13例肿瘤呈单纯结节或肿块,肿块伴有的钙化12例,5例病灶表现为单纯簇状钙化,同侧腋下淋巴结肿大7例。FFDM诊断4A以上病例26例,3级及以下的病例4例;MRI增强扫描检出肿块或结节27例,发现钙化5例,同侧腋下淋巴结肿大10例。时间-信号强度曲线8例呈Ⅱ型曲线,22例呈Ⅲ型曲线。FFDM正确诊断乳腺导管癌24例,MRI增强扫描正确诊断为26例,二者结合正确诊断27例。FFDM、增强MRI及FFDM+增强MRI对导管癌的诊断符合率分别为80%、86.7%、90%。结论 FFDM操作简单,对导管癌的簇状钙化检出率高于增强MRI,诊断敏感性较高,是筛查乳腺导管癌,尤其导管原位癌的首选,增强MRI对乳腺导管癌肿块及同侧腋下淋巴结检出情况高于FFDM,在乳腺导管癌定性方面有重要作用,是乳腺导管癌进行术前评价的有效方法。二者结合应用可以提高乳腺导管癌的诊断正确率。     

Population-based mammography screening: comparison of screen-film and full-field digital mammography with soft-copy reading--Oslo I study

PURPOSE: To compare screen-film and full-field digital mammography with soft-copy reading in a population-based screening program. MATERIALS AND METHODS: Full-field digital and screen-film mammography were performed in 3,683 women aged 50-69 years. Two standard views of each breast were acquired with each modality. Images underwent independent double reading with use of a five-point rating scale for probability of cancer. Recall rates and positive predictive values were calculated. Cancer detection rates determined with both modalities were compared by using the McNemar test for paired proportions. Retrospective side-by-side analysis for conspicuity of cancers was performed by an external independent radiologist group with experience in both modalities. RESULTS: In 3,683 cases, 31 cancers were detected. Screen-film mammography depicted 28 (0.76%) malignancies, and full-field digital mammography depicted 23 (0.62%) malignancies. The difference between cancer detection rates was not significant (P =.23). The recall rate for full-field digital mammography (4.6%; 168 of 3,683 cases) was slightly higher than that for screen-film mammography (3.5%; 128 of 3,683 cases). The positive predictive value based on needle biopsy results was 46% for screen-film mammography and 39% for full-field digital mammography. Side-by-side image comparison for cancer conspicuity led to classification of 19 cancers as equal for probability of malignancy, six cancers as slightly better demonstrated at screen-film mammography, and six cancers as slightly better demonstrated at full-field digital mammography. CONCLUSION: There was no statistically significant difference in cancer detection rate between screen-film and full-field digital mammography. Cancer conspicuity was equal with both modalities. Full-field digital mammography with soft-copy reading is comparable to screen-film mammography in population-based screening.     

Magnification mammography: a comparison of full-field digital mammography and screen-film mammography for the detection of simulated small masses and microcalcifications

The objective of this study was a comparison of a full-field digital mammography (FFDM) system and a conventional screen-film mammography (SFM) system with respect to the detectability of simulated small masses and microcalcifications in the magnification mode. All images were obtained using 1.8 times magnification. The FFDM images were obtained at radiation dose levels of 1.39, 1.0, 0.7, 0.49 and 0.24 times that of the SFM images. A contrast-detail phantom was used to compare the detection of simulated lesions using a four alternative forced-choice reader study with three readers. The correct observation ratio (COR) was calculated as the fraction of correctly identified lesions to the total number of simulated lesions. Soft-copy reading was performed for all digital images. Direct magnification images acquired with the digital system showed a lower object contrast threshold than those acquired with the conventional system. For equal radiation dose, the digital system provided a significantly increased COR (0.95) compared with the screen-film system (0.82). For simulated microcalcifications, the corresponding difference was 0.90 to 0.72. The digital system allowed equal detection to screen-film at 40% of the radiation dose used for screen film. Digital magnification images are superior to screen-film magnification images for the detection of simulated small masses and microcalcifications even at a lower radiation dose.     

数字乳腺断层摄影及其合成二维影像技术在乳腺癌筛查中的研究进展

目前乳腺X线检查仍是乳腺癌早期诊断的有效检查方法之一,主要包括全视野数字化乳腺摄影（FFDM）、数字乳腺断层摄影（DBT）、合成乳腺X线摄影（SM）以及3种技术的联合应用（FFDM联合DBT、SM联合DBT）。对DBT、SM和SM联合DBT在乳腺筛查中诊断效能、影像质量及辐射剂量等进行比较。SM联合DBT可有效平衡辐射剂量和诊断效能,但仍然在判读时间、信息的存储与传输和检查成本方面存在局限性。就以上3种检查技术在乳腺癌筛查中的研究进展予以综述。     

全数字化乳腺X线三维定位创新技术在不可触及性病变术前定位的应用

目的 探讨全数字化乳腺X线引导下的三维立体定位创新技术对不可触及性乳腺病变术前定位的临床价值.方法 回顾性分析乳腺不可触及性病变并行术前定位的106例患者,根据乳房X线片(0°及90°)人工计算进针深度,定位时利用全数字化乳腺X线三维立体定位系统(GE Senogrphe DS)自动计算进针深度,将此值与人工计算的进针深度值相结合,再结合患者,定位前皮肤弹性以及腺体结构情况,调整进针深度,置入定位针,临床根据定位导丝位置对病变进行切除,术后再行X线摄影与术前对比,判断病变是否被完整切除.结果 全数字化乳腺X线引导下的三维立体定位系统对不可触及性乳腺病变的定位准确率达到100%,手术均能完整切除,11例出现不良反应,主要表现为晕厥,经休息、心理安抚及输液处理后均能较快恢复.结论 术前行乳腺X线引导下的三维立体定位可以提高乳腺不可触及性病变切除的准确性,简单易行,具有推广价值.     

全数字化乳腺摄影对乳腺疾病的诊断价值

目的 评价全数字化乳腺摄影在临床中对乳腺疾病的诊断价值.方法 回顾215例经手术或活检的术前全数字化乳腺摄影资料,对比影像诊断与最终病理诊断异同.分析不同疾病的误诊原因,初步分析及探讨全数字化乳腺摄影对乳腺疾病的诊断价值.结果 215例经手术或活检的病例中,132例被病理确诊为乳腺癌,83例被诊断为良性病变.在被病理证实为乳腺癌的132例乳腺癌病例中,14例被全数字化乳腺摄影诊断漏诊或误诊.而同时被影像诊断为恶性病变可能的130例(BI-RADS大于4级)的病例中,12例最终病理诊断确定为良性病变.结论 全数字化乳腺摄影是乳腺疾病的重要检查手段,尤其对发现及筛查乳腺癌具有重要价值,但对某些乳腺良性病变,其诊断准确率较低,需要结合其他临床诊断方式.