成簇样钙化对乳腺癌的诊断价值

目的：探讨乳腺癌成簇样钙化在乳腺X线片中的特征性表现，提高诊断和鉴别诊断的水平。方法：经手术病理证实并在乳腺X线片中成簇样钙化的病例54例，分析成簇样钙化的形态、大小、密度等特征及其在诊断乳腺癌中的价值。结果：乳腺癌常见的钙化形态为细沙型和混合型；良性病变的成簇样钙化的整体形状多呈类圆形或椭圆形，而且钙化颗粒较大、密度较高、大小较均匀，而乳腺癌的钙化簇的整体形状多呈不规则形；87．5％乳腺癌的钙化点密度不均、大小不一；81．3％乳腺癌的每平方厘米钙化数目（N／S）〉15个。结论：乳腺X线片中成簇样钙化形态学表现和数目、密度、大小对乳腺癌的诊断具有重要价值。     

超声与钼靶摄影诊断乳腺导管内癌的对照研究

目的评价超声、钼靶摄影以及二者综合对乳腺导管内癌的诊断准确性。 方法分析经病理证实的83例乳腺导管内癌的钼靶摄影和超声表现，并比较其诊断准确性。 结果（1）超声表现腺体内低回声实性病变52例（62．7％），导管内实性结节16例（19．3％），囊性病变或乳腺导管扩张7例（8．4％），阴性8例（9．6％）；（2）钼靶摄影表现簇状微小钙化53例（63．9％），软组织结节或局部密度增高50例（60．2％），未发现明确病变者9例（10．8％）；（3）分类比较超声、钼靶摄影和二者综合分类为可能恶性者分别为47例、53例、67例，2种方法准确率差异无统计学意义（56．6％和63．9％，P=0．169）；综合2种方法后诊断准确率高于钼靶摄影（80．7％和63．9％，P〈0．001）。 结论超声和钼靶摄影诊断导管内癌的准确率较低。综合应用2种检查方法可提高诊断准确率。     

低剂量乳腺钼靶x线摄影技术的探讨

目的:探讨低剂量乳腺钼靶X线摄影技术,提高影像质量,降低被检者的曝光量.材料与方法:利用SIEMENS公司MAMMOMAT 1000型乳腺摄影机,对30例志愿者双侧乳腺对其一侧乳腺CC位和MLO位用50kV摄影,另一侧乳腺CC位和MLO位用35kV摄影,其它参数均相同,获得CC位和MLO位各60幅影像,分析对比影像质量,记录曝光量(mAs)值,并对其结果进行统计学分析.结果:35kV比30kV摄影曝光量值平均降低约2.2倍,且影像质量高;对CC位和MLO位30kV、35kV摄影时的曝光量值分别进行配对t检验,CC位t=4.03,p＜0.05,MLO位t=3.78,p＜0.05,均具有统计学意义.对2组影像质量进行X2检验,X2=10.8,P＜0.05,具有统计学意义.结论:低剂量乳腺钼靶X线摄影千伏应用35kV为宜,能够提高影像质量降低被检者的曝光量.     

对比分析高频超声与X线诊断乳腺髓样癌

目的观察乳腺髓样癌的高频超声和X线检查特征,比较超声、X线检查或超声联合X线检查对乳腺髓样癌的诊断价值。方法回顾性分析25例手术病理证实为乳腺髓样癌患者的术前超声与X线检查结果,分析其影像学特征,统计诊断符合率。结果乳腺髓样癌超声表现多为形态较规则的低回声肿块,边界较清楚、内部回声较均匀,伴后方回声增强,但钙化较少见,血供多较丰富,呈高阻动脉血流,部分患者腋窝可检测到淋巴结肿大,超声诊断符合率为80.00%(20/25)。X线检查对乳腺髓样癌微小钙化的检出率明显高于超声(P<0.01),但对诊断腋窝淋巴结转移的敏感度明显低于超声检查。超声联合X线检查诊断乳腺髓样癌的符合率达92.00%(23/25)。结论联合超声与X线检查诊断乳腺髓样癌可优势互补,提高诊断符合率。     

Effect of false-positive mammograms on return for subsequent screening mammography

There has been concern that false-positive mammograms may deter women from future screening mammograms. We sought to determine whether false-positive mammograms affected follow-up for rescreening.We studied a cohort of 41,844 women in the Vermont Mammography Registry. We measured the proportion of women returning for the next screening mammogram for 30 months following an initial screening mammogram, and compared rates of follow-up screening at 18 and 30 months in women with false-positive and true-negative initial mammograms. We adjusted for potential confounders using multivariable logistic regression models.Of the 2469 women aged 50 years or older with false-positive mammograms, 67.2% (n = 1660) returned at 18 months for rescreening, compared with 63.9% (16,948/26,521) of the women with true-negative mammograms (P = 0.001). Similarly, 86.8% (2143/2469) of the women with false-positive mammograms returned at 30 months for rescreening, compared with 84.7% (22,466/26,521) of the women with true-negative mammograms (P = 0.005). After adjusting for age, use of hormone replacement therapy, prior mammography, prior false-positive mammography, and education, women with false-positive mammograms were more likely to return at 18 months (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.30 to 1.51) and at 30 months (OR = 1.30; 95% CI: 1.18 to 1.44).Despite previous concerns, false-positive screening mammograms did not discourage women from returning for subsequent screening mammography. However, other deleterious effects of false-positive results still warrant improvements in the accuracy of breast cancer screening.     

Dosimetric and Contrast Noise Ratio Comparison of Three Different Digital Imaging Technologies in Mammography

PurposeThe purpose of the study was to compare the three most common technologies available in digital mammography based in the evaluation of average glandular dose and contrast noise ratio (CNR).MethodThe average glandular dose was estimated with a direct digital detector (aSe) with a pixel size of 0.85 μm, a photon counter with a pixel size of 50 μm and a computerized radiography (CR) system. A semiconductor detector was used to measure the input kerma to the detector, and the average glandular dose was calculated from the conversion factors dependent on the anode filter combination, half value layer and breast glandularity.ResultsThe average glandular dose obtained with polymethyl methacrylate and CNR of mean thickness 4.5 cm using direct digital equipment was 1.02 mGy and CNR = 7.4; using the photon counter it was 0.43 mGy and CNR = 4.7 in C100 mode, and 0.64 mGy and CNR = 5.7 in C120 mode; and using the photostimulable CR, the estimated value was 1.65 mGy and CNR = 5.1.ConclusionsThe photon counter offers a lower average glandular dose than the other two devices with adequate image quality (CNR). The CR equipment offers a similar CNR value but delivers a higher dose than the new generations of available mammograms.     

Comparison of Diffuse Optical Tomography,Ultrasound Elastography and Mammography in the Diagnosis of Breast Tumors

Previous studies have reported the usefulness of diffuse optical tomography (DOT), ultrasound elastography (UE) and mammography in differentiating breast tumors. This study was aimed at evaluating and comparing DOT, UE and mammography with respect to their diagnostic performance in differentiating benign and malignant breast tumors. Of the 67 tumors, 45 were histopathologically benign, and 22 were malignant. UE was the most specific (93.33%) of the three diagnostics modalities. DOT and UE were both more accurate (80.60% and 89.55%, respectively) than mammography (63.08%). UE + mammography (93.33% and 91.04%) and DOT + mammography (77.78% and 82.09%) exhibited higher specificity and accuracy, respectively, than mammography alone (57.78% and 63.08%). Receiver operating characteristic (ROC) curves were constructed to assess the performance of the modalities. In conclusion, UE and DOT were superior to conventional mammography in terms of both specificity and accuracy. DOT and UE improve the specificity and accuracy of breast cancer diagnosis, and combining the two modalities improves the diagnostic value.     

动态增强MRI在乳腺癌行保乳术的术前评估价值研究

目的探讨动态增强MRI在乳腺癌行保乳术的术前评估准确性。方法分析106例经手术和病理证实的乳腺癌患者术前的动态增强MRI及钼靶X线摄影资料,观测动态增强MRI及钼靶X线摄影片上乳腺癌病灶的数目、位置、大小、形态、侵犯范围和淋巴结转移情况,按乳腺癌术前行保乳术（breastconservingsurgery,BCS）所需条件,并与术后大体解剖标本及镜下病理结果相对照,分析动态增强MRI、钼靶X线对乳腺癌术前行保乳术治疗的评估准确性。结果动态增强MRI能够较准确评价乳腺癌灶的位置、大小、浸润范围、数目、乳腺皮肤、胸壁和腋窝淋巴结状态,MRI判断40例（37.8％）可行BCS,判定准确性为96．2％。钼靶X线摄影判断37例（34．9％）可行BCS．准确性为89．6％。结论动态增强M砒能为乳腺癌患者行BCS的筛选提供比较全面和准确的信息,术前运用动态增强MIU评价乳腺癌行BCS是可行的。     

乳腺黏液癌的影像学特征分析

目的 评价乳腺黏液癌的超声、X线等影像学特征及其与病理组织类型的相关性.方法 回顾性分析21例经手术病理证实的乳腺黏液癌患者(22个病灶)的超声、X线特征及与病理组织类型之间的关系.结果 病理组织学分类包括14个单纯型(6个富细胞型,8个少细胞型)和8个混合型病灶.超声:所有病例均存在实性肿块,85.71％(12/14)的单纯型肿块境界清晰,回声等或略低于皮下脂肪,92.86％(13/14)的单纯型病灶后方回声增强;75.00％(6/8)的混合型和14.29％(2/14)的单纯型肿块边界较模糊并细小毛刺,内部回声较脂肪回声低.超声和X线片术前怀疑恶性的比例均为63.64％(14/22).恶性X线表现包括肿块(10个)、局限性不对称致密影(2个)、结构扭曲并恶性钙化和单纯不定性钙化(各1个).肿块主要为高密度,单纯型边界清楚或呈浅分叶状,混合型边界不规则和毛刺改变.81.82％(18/22)的病灶被超声或X线之一疑诊恶性,45.45％(10/22)的病灶术前超声和X线均疑为恶性.结论 乳腺黏液癌尤其单纯型影像学特征不典型,超声和X线诊断均可能诊断为良性病变;肿块边缘特征是鉴别良恶性的重要依据,混合型肿块较单纯型更具有浸润性特征;超声和X线联合诊断有利于避免误诊,两者之一怀疑恶性时,即应行穿刺活检以明确诊断.     

X线立体定位活检在乳腺微小病变的临床应用

目的　探讨应用乳腺摄片结合立体定位穿刺活检对不可触及的乳腺微小病变的诊断价值。方法　回顾性总结对 3 0例乳腺摄片发现微小病变的病人进行立体定位穿刺活检。结果　 3 0例病人中发现早期乳腺癌 9例 ,其中原位癌 3例 ,临床I期 6例 ,另外 ,乳腺纤维瘤 6例 ,不典型增生 9例 ,纤维腺病 4例 ,囊肿 2例 ,而乳腺癌、纤维瘤、不典型增生及囊肿均有明确的手术指征。结论　对不可触及的乳腺微小病变应积极活检 ,X线立体定位活检术是提高早期乳腺癌诊断率首选而有效的方法。