乳腺肿瘤的钼靶X线诊断及其摄影技术探讨

目的探讨乳腺肿瘤的钼靶X线特征及钼钯X线摄影技术要求。方法收集分析200例经手术、穿刺活检证实的乳腺肿瘤的钼靶X线摄影资料。结果乳腺良性肿瘤138例,X线征象多为圆形、椭圆形肿块,临床触诊质地较软。62例乳腺癌钼靶X线征象为不规则形肿块37例,占59.7%;类圆形25例,占40.3%。有微小钙化32例,占51.6%;局部浸润4例,占6.5%。触诊质地较硬,X线测量比值小于临床。结论X线钼靶摄影是乳腺肿瘤首选检查方法,显示乳腺癌的主要直接征象和间接征象,在乳腺癌的早期诊断及鉴别诊断中很有价值。     

乳腺肿瘤性病变的钼靶X线征象分析

目的 明确乳腺肿瘤性病变的钼靶X线征象,评价钼靶在乳腺肿瘤性病变的诊断及鉴别诊断中的价值.资料与方法 总结分析本院从2008年6月至2010年1月共1330例乳腺疾病钼靶X线摄影中检出并经手术和病理证实为乳腺肿瘤患者176例,其中乳腺良性肿瘤103例,乳腺癌70例,交界性叶状肿瘤3例.常规摄乳腺X线片,怀疑乳腺导管内乳头状瘤者,行溢液乳管造影.结果 (1)乳腺良性肿瘤钼靶X线多表现为圆形、椭圆形肿块,边界清楚,周边有或无透明"晕征",导管内乳头状瘤造影多表现为导管内单个或多个充盈缺损.(2)70例乳腺癌的钼靶X线征象,表现为肿块者56例(80%),砂粒状或簇状微钙化46例(66%),肿块伴微钙化42例(60%),结构扭曲、紊乱5例(7%),局灶性致密影3例(4%),血管影增粗24例(34%).(3)叶状肿瘤的钼靶X线表现为圆形或浅分叶状肿块,密度高而均匀,肿块体积较大.结论 乳腺不同良恶性肿瘤具有较为特征性的X线征象,钼靶X线在乳腺良恶性肿瘤的诊断及鉴别诊断中具有重要意义,结合临床病史,可进一步提高诊断准确率.     

钼靶X线摄片在乳腺癌诊断中的应用价值

目的讨论钼靶X线对诊断乳腺癌的应用价值。方法回顾性分析17例经手术病理证实的乳腺癌X线表现,包括直接征象和间接征象。结果17例乳腺癌患者的X线征象:肿块见于15例,占88.24%,钙化8例,占47.06%,乳腺导管扩张2例,占11.7%,乳晕增厚7例,占41.18%,乳头凹陷8例,占47.06%,乳后间隙肿块3例,占17.65%,液下淋巴结肿大8例,占47.06%。结论钼靶X线摄影是诊断乳腺癌的首选方法。     

乳腺癌钼靶X线征象分析(附114例报告)

目的探讨乳腺癌钼靶X线表现、X线分型和病理关系,以提高乳腺癌诊断水平。方法收集经手术病理证实、有完整影像资料的乳腺癌114例,回顾分析其钼靶X线征象及与病理关系。结果乳腺癌分5型:肿块型34例,肿块伴钙化型27例,钙化型28例,结构异常型21例,隐匿型4例。浸润性导管癌最多,占61.4%,其次是单纯癌,占20.1%。结论肿块型、肿块伴钙化型和钙化型乳腺癌钼靶X线表现具有特征性,乳腺钼靶X线摄影能明确诊断。结构异常型乳腺癌X线表现不典型,认识其X线征象,可明显提高乳腺癌的影像诊断率。     

乳腺肿瘤X线摄影临床价值分析

目的探讨乳腺X线摄影在乳腺肿瘤鉴定与诊断中的应用价值。方法分析70例X线摄影的乳腺肿块患者的影像学资料,X线诊断结果与病理结果进行对比分析。结果乳腺X线摄影结果与金标准病理诊断的符合率为80.00%。70例腺肿块患者的肿块及结构扭曲、钙化等征象23例,仅表现微钙化征象11例,毛刺样肿块21例,伴乳头凹陷8例,乳腺皮肤增厚10例,肿块周围粗大血管征5例。6例良性病变误诊为恶性病变:3例为右乳外上象限肿块影,边缘清晰,呈浅分叶状,未见明显钙化,术后病理结果为乳腺结核;2例为左乳外上象限大片状致密影,其内大片成簇状微小钙化,病理结果为乳腺囊肿;1例为左乳头深部肿块影,边缘模糊欠规整,病理结果为乳腺囊肿。8例良性病变因钼靶表现为边缘模糊,未见明显毛刺征象,术前误诊为乳腺癌。乳腺肿瘤钼靶X线诊断乳腺肿瘤的敏感性、特异性及准确性分别为79.49%、80.65%、80.00%。结论肿块及微小钙化是乳腺癌最直接、最主要的X线征象,乳腺X线摄影对乳腺组织结构显示清晰,特别是对微小钙化有很高的诊断价值。     

数字钼靶X线摄影形态及边缘征象对乳腺良、恶性病变的诊断价值

目的 探讨数字钼靶X线摄影形态及边缘征象对乳腺肿块性病变的定性诊断价值.资料与方法 180例乳腺肿块患者,均为女性,均经手术与病理证实,其中良性48例,恶性132例,对其数字钼靶X线摄影形态及边缘征象进行回顾性分析.将数字钼靶X线摄影形状呈深分叶或不规则形、边缘毛糙或毛刺者归为恶性组;表现为类圆形、浅分叶、边缘光整者归为良性组.结果 采用形态及边缘征象诊断乳腺癌的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为88.64%、77.08%、85.56%、91.41%及73.33%.恶性病变表现为类圆形、分叶状、不规则形呈依次递增趋势;良性病变表现为类圆形、分叶状、不规则形依次递减;恶性病变边缘以毛刺、毛糙及模糊为主(84.85%),良性病变以光整及部分光整为主(72.91%).恶性病变约85.61%≥加岁,14.39%＜40岁;良性病变约39.58%≥加岁,60.42%＜40岁.以40岁为分界,依靠良、恶性形态及边缘征象对乳腺病变定性的准确率≥40岁组(88.64%)高于＜40岁组(77.08%).结论 数字钼靶X线摄影乳腺肿块形态及边缘征象可作为乳腺肿块性病变良、恶性定性诊断的一种参考,其简单易行,具有重要的临床价值,患者年龄结合形态及边缘征象对乳腺病变定性诊断有一定帮助.     

钼靶X线摄影与1.5T MRI对乳腺良恶性肿块的诊断价值

目的 探讨钼靶X线摄影与MRI对乳腺良恶性肿块的诊断价值.方法 收集临床资料完整,经手术病理结果证实并于术前1～2周进行过临床触诊、钼靶X线摄影乳腺肿块138例,对48例X线表现不典型病例行MRI平扫及动态增强检查,并与手术病理结果做对照分析. 结果本组中恶性病变71例,良性病变67例.钼靶X线摄影的敏感性、特异性及准确性分别为81.69%、76.12%及78.99%.MRI结合平扫、DCE-MRI早期强化率及时间-密度曲线诊断,MRI检查的敏感性、特异性及准确性分别为87.50%、83.33%及85.42%. 48例患者MRI与钼靶X线摄影对病变的符合情况准确性比较具有统计学意义(χ2=4.063,P0.05).结论 钼靶X线摄影与1.5T MRI二者结合可明显提高乳腺良恶性肿块的诊断准确率.     

乳腺良恶性肿瘤的钼靶X线鉴别诊断

目的　分析乳腺良恶性肿瘤的钼靶X线表现特征 ,以提高鉴别诊断水平。方法　对经术后病理检查证实的 98例乳腺肿瘤钼靶X线表现特征进行对照分析 ,其中恶性 67例 ,良性 3 1例。结果　毛刺状肿块、细微簇样钙化是乳腺恶性肿瘤特异性X线征象。良恶性肿瘤X线诊断准确率分别为 84%和 89.6%。结论　乳腺钼靶X线摄影是鉴别良恶性肿瘤的有效影像学方法     

乳腺癌X线表现与P53、CerbB-2、Ki-67表达的相关性研究

目的:探讨乳腺癌的钼靶X线表现与P53、CerbB-2、Ki-67表达的关系,旨在为乳腺癌的早期诊断及预测预后提供依据.方法:97例乳腺癌患者术前行乳腺钼靶摄影,术后测定乳腺癌组织中P53、CerbB-2、Ki-67的表达水平,分析其表达与X线表现的关系.结果:97例乳腺癌中,肿块62例,占63.91%;单纯钙化8例,占0.82%;结构紊乱27例,占27.84%.P53阳性表达56例,占57.73%;CerbB-2 63例,占64.95%.肿块组Ki-67增殖指数为29.64±3.15,并随肿瘤体积增大而增高.局部密度增高伴钙化组P53、CerbB-2、Ki-67表达高于不伴钙化组, P53表达差异有显著性意义(χ2＝5.571,P<0.05).结论:乳腺癌的一些重要钼靶X线征象与P53、CerbB-2、Ki-67之间存在密切的关系,从一定程度上反映了癌细胞的生物学行为和预后,对早期诊断和治疗有一定的意义.     

CR钼靶征象对乳腺癌的诊断价值

目的探讨乳腺癌CR钼靶X线征象的特点,以提高乳腺癌的诊断水平。方法回顾性分析经手术病理证实的37例乳腺癌的CR钼靶X线表现。结果37例乳腺癌表现为肿块29例;无肿块8例;钙化性改变15例;异常血管影7例;乳头回缩6例;皮肤增厚3例;塔尖征3例,漏斗征1例;乳腺局部结构紊乱和小灶性密度增高影3例。结论肿块和钙化是乳腺癌的主要X线征象,CR钼靶X线摄影可以充分显示乳腺癌的表现特征,是诊断乳腺癌的首选方法之一。     

Image-guided core breast biopsy of ductal carcinoma in situ presenting as a non-calcified abnormality

Objective: Ductal carcinoma in situ (DCIS) typically presents as calcifications which are detected mammographically. Our aim was to evaluate the less common presentations of ductal carcinoma in situ diagnosed by image-guided core biopsy and correlate with histopathologic diagnoses. Methods and Material: Imaging and histopathologic findings were retrospectively reviewed in 11 patients with ductal carcinoma in situ diagnosed at core biopsy that presented as noncalcified radiographic abnormalities. Results: Mammography showed non-calcified, circumscribed nodules, ill-defined nodules and architectural distortion. In two patients, no mammographic abnormality was detected. Sonography showed circumscribed, round or oval, solid masses; irregular, heterogeneous masses; and a tubular structure. Histopathologic diagnoses included multiple architectural subtypes and ranged from low to high nuclear grade. Conclusion: Although image-guided core biopsy diagnosis of ductal carcinoma is typically made when sampling calcifications, DCIS can be diagnosed following biopsy of non-calcified masses or distortion. There is no correlation between histopathologic subtype and radiologic appearance.     

Dose to contralateral breast—A comparative study

Radiation, especially subtherapeutic doses, has been proven to be carcinogenic. During therapeutic irradiation, normal tissue is exposed to some dose due to internal and external scatter from the primary beam. The dose to the contralateral breast during primary irradiation may cause secondary breast malignancies. For example, studies have shown that half-beam block techniques can dramatically increase the opposite breast dose. An attempt has been made to calculate the dose delivered during primary breast irradiation. Materials used will include previously published articles in medical and science journals. Preliminary results from a study currently being done by Marilyn Stovall will also be utilized. Isodose distributions demonstrating various treatment techniques will be shown.     

Stereotactic and sonographic large-core biopsy of nonpalpable breast lesions: results of the Radiologic Diagnostic Oncology Group V study

RATIONALE AND OBJECTIVES: To determine the diagnostic accuracy of stereotactically and sonographically guided core biopsy (CB) for the diagnosis of nonpalpable breast lesions. MATERIALS AND METHODS: Twenty-two institutions enrolled 2,403 women who underwent imaging-guided fine needle aspiration followed by imaging-guided large-CB of nonpalpable breast abnormalities. All mammograms were reviewed for study eligibility by one of two breast imaging radiologists. The protocol for image-guided biopsy, using either ultrasound (USCB) or stereotactic (SCB) guidance, was standardized at all institutions and all biopsy specimens were over-read by one of three expert pathologists. Patients with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, or lobular neoplasia on CB underwent surgical excision. Those with negative CB but suspicious ("discordant") pre-biopsy mammography also underwent surgical excision. Patients having a negative CB that was concordant with the pre-biopsy mammography suspicion were assigned to follow-up mammography at 6, 12, and 24 months following CB. RESULTS: A gold standard diagnosis based on definitive histopathologic diagnosis, mammography follow-up, or an imputed gold standard diagnosis was established for 1,681 patients. Of 310 cases with a gold standard diagnosis of invasive breast carcinoma, 261 (84.2%) were invasive carcinoma, 31 (10%) were ductal carcinoma in situ (DCIS), four (1.3%) were ADH, one (0.3%) was a non-breast cancer, and 13 (4.2%) were benign on CB. For 138 cases with a gold standard diagnosis of DCIS, 113 (81.9%) were DCIS, 20 (14.5%) were ADH, and five (3.6%) were benign on CB. For 57 cases (13 masses, 44 calcifications) with an initial CB diagnosis of ADH, atypical lobular hyperplasia or lobular neoplasia, 20 (35.1%) had a gold standard diagnosis of DCIS (4 masses, 16 calcifications) and four (7.0%) had a gold standard diagnosis of invasive cancer (4 calcifications). Of 144 cases (22 masses, 122 calcifications) with an initial CB diagnosis of DCIS, 31 (21.5%) had a gold standard diagnosis of invasive cancer (10 masses, 21 calcifications). The sensitivity, specificity and accuracy for CB by either imaging guidance method in this trial were .91, 1.00, and .98, respectively. The sensitivity, predictive value negative, and accuracy of CB for diagnosing masses (.96, .99, and .99, respectively) were significantly greater (P < .001) than for calcifications (.84, .94, and .96, respectively). The sensitivity (.89) of SCB for diagnosing all lesions was significantly lower (P = 0.029) than that of USCB (.97) because of the preponderance of calcifications biopsied by SCB versus USCB. There was no difference between USCB and SCB in sensitivity, predictive value negative, or accuracy for the diagnosis of masses (97.3, 98.9, and 99.2, respectively for USCB; 95.6, 98.5, and 98.9 respectively for SCB). CONCLUSION: Percutaneous, imaged-guided core breast biopsy is an accurate diagnostic alternative to surgical biopsy in women with mammographically detected suspicious breast lesions.     

Quantification of background enhancement in breast magnetic resonance imaging

Purpose:

To present a novel technique for measuring tissue enhancement in breast fibroglandular tissue regions on contrast‐enhanced breast magnetic resonance imaging (MRI) aimed at quantifying the enhancement of breast parenchyma, also known as “background enhancement.”

Materials and Methods:

Our quantitative method for measuring breast MRI background enhancement was evaluated in a population of 16 healthy volunteers. We also demonstrate the use of our new technique in the case study of one subject classified as high risk for developing breast cancer who underwent 3 months of tamoxifen therapy.

Results:

We obtained quantitative measures of background enhancement in all cases. The high‐risk patient exhibited a 37% mean reduction in background enhancement with treatment.

Conclusion:

Our quantitative method is a robust and promising tool that may allow investigators to quantify and document the potential adverse effect of background enhancement on diagnostic accuracy in larger populations. J. Magn. Reson. Imaging 2011;33:1229–1234. © 2011 Wiley‐Liss, Inc.     

The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions

AIM: To determine the accuracy and therapeutic success of localisation of impalpable breast lesions by hookwire with additional lesion marking with carbon suspension to mark screen detected abnormalities requiring surgical excision. MATERIALS AND METHODS: Retrospective review of all breast localisation procedures performed in our unit on women with a screen detected abnormality requiring excision over a 7 year period. RESULTS: One hundred and thirty eight women underwent breast localisation procedures. All of the mammographic abnormalities were excised at the initial surgical procedure. The benign to malignant ratio was 1:2. Pre-operative cytology was used to guide the extent of surgical excision, with clear margins in 70 of the 92 patients (75 percent) with malignancy. Twenty patients had further surgery: mastectomy in 7 and further local excision in 14. The localisation procedure was a therapeutic success in the local excision of malignancy in 73 of the 92 patients (79 percent) with malignancy. CONCLUSION: This method of localisation biopsy is an accurate technique for surgical excision of mammographically detected impalpable abnormalities. The surgeon is able to choose the site of surgical incision to give the best cosmetic result, the lesion is easier to identify at operation and the confidence that the abnormality has been excised is improved.     

Optimal post-contrast timing of breast MR image acquisition for architectural feature analysis

PURPOSE: To define a post-contrast imaging time span during which diagnostic accuracy of breast magnetic resonance (MR) architectural feature analysis is maintained. MATERIALS AND METHODS: Seventy-five patients with mammographically-visible or palpable findings underwent MR examination. Three sequential post-contrast, fat-saturated, three-dimensional gradient-echo imaging runs were acquired spanning 0-90, 90-180, and 180-270 seconds after contrast injection. Five readers independently predicted the malignant potential of the MR abnormalities. RESULTS: Receiver-operator characteristics (ROC) curves were our primary measure of diagnostic accuracy. The accuracy of four readers was unchanged over the three post-contrast runs. One reader was slightly more accurate using the second and third runs than using the first. CONCLUSION: For most readers, a single post-contrast run performed at any point during the first four minutes and 30 seconds following injection should yield an equivalent diagnostic accuracy. If any time period is less optimal, it is that of our first run, performed between 0-90 seconds after contrast injection.     

乳腺癌X线表现分析

目的分析乳腺癌典型及不典型X线征象,提高对乳腺癌不典型X线表现的认识。方法对61例经手术病理证实的乳腺癌资料进行回顾性分析。结果61例乳腺癌主要X线征象:肿块39例;微小钙化30例;不伴肿块及微小钙化的乳腺局部结构紊乱4例、星芒征3例、非对称性密度增高3例。结论肿块及微小钙化是乳腺癌最主要、最直接的X线征象,但部分乳腺癌X线上缺乏上述2种表现,单纯以结构紊乱、非对称性密度增高或星芒征为主要表现。提高对此类乳腺癌不典型X线表现的认识,有利于防止误、漏诊。     

动态光学乳腺成像技术诊断乳腺癌指标初探

目的：动态光学乳腺成像技术（dynamic optical breast imaging,DOBI）对乳腺癌诊断指标进行初步探讨。材料和方法：接受DOBI及乳腺活检的患者共52例,均为女性。乳腺癌组19例,非乳腺癌组33例。结果：非乳腺癌感兴趣区内的“蓝色病灶”85．42％为漂移或发散,而乳腺癌68．42％为聚焦;非乳腺癌的“蓝色病灶”代谢曲线86．46％为平缓下降或呈波浪状,而乳腺癌以直线下降为多,达57．37％;64．58％非乳腺癌感兴趣区内的“蓝色病灶”代谢曲线与非蓝区代谢曲线相同,78．95％乳腺癌患者的代谢曲线与非蓝区代谢曲线不同;乳腺癌患者“蓝色病灶”代谢值（平均值为-5．77&#177;2．13）的绝对值明显高于非乳腺癌患者（平均值为-3．34&#177;0．87;P〈0．05）。结论：DOBI空间特征的局限、聚焦且稳定、代谢曲线呈陡直下降对恶性或可疑恶性病变诊断价值更大,其次为代谢值的绝对值较大（多大于｜-5｜）。     

The role of MRI in assessment of asymmetrical breast densities

This study included 86 women presented with asymmetric breast densities, seen on either routine screening or diagnostic mammogram.