全数字化乳腺摄影在乳腺病变中的临床应用价值

目的探讨全数字化乳腺摄影(FFDM)在乳腺病变中的临床应用价值。资料与方法搜集经手术病理证实有完整临床资料的乳腺病变共102例,所有患者均行FFDM,结合病理进行影像学分析。结果 102例乳腺病变中乳腺癌31例,乳腺良性病变71例。临床触及肿块者63例,未触及肿块者39例。影像表现为肿块80例,单纯成簇微小钙化4例,结构紊乱并粗长毛刺2例,结构紊乱并微小钙化1例,局部片状致密影14例,无明显影像表现1例。FFDM对乳腺癌诊断敏感性为90.3%,特异性为94.4%,准确性为93.1%。结论 FFDM能清晰显示乳腺病变的X线征象,尤其能够显示乳腺癌的主要X线征象,为临床早期诊断乳腺病变创造了条件,尤其对临床未触及肿块的早期乳腺癌具有重要的临床价值。     

全数字化乳腺X线摄影对乳腺导管原位癌的诊断价值

目的探讨全数字化乳腺X线摄影(full-field digital mammography,FFDM)对乳腺导管原位癌的诊断价值。方法回顾性分析52例经穿刺或手术病理证实的乳腺导管原位癌的X线摄影表现。结果以恶性钙化为主要征象32例,钙化表现为微细、多形性,呈簇状、群集或段性分布,其中单纯钙化24例,钙化合并局灶性致密8例;表现为肿块8例,其中3例肿块边缘见毛刺;单纯局灶性致密3例;结构扭曲2例;导管造影显示导管内占位性病变3例;X线无异常发现4例。结论 FFDM可以清晰显示微小钙化、小结节、局灶致密及结构扭曲等征象,尤其对微小钙化敏感,对乳腺导管原位癌的诊断具有重要价值。     

The Clinical Application of Full Field Digitalization Mammography in Breast Diseases

目的 探讨全数字化乳腺摄影(FFDM)在乳腺病变中的临床应用价值.资料与方法 搜集经手术病理证实有完整临床资料的乳腺病变共102例,所有患者均行FFDM,结合病理进行影像学分析.结果 102例乳腺病变中乳腺癌31例,乳腺良性病变71例.临床触及肿块者63例,未触及肿块者39例.影像表现为肿块80例,单纯成簇微小钙化4例,结构紊乱并粗长毛刺2例,结构紊乱并微小钙化1例,局部片状致密影14例,无明显影像表现1例.FFDM对乳腺癌诊断敏感性为90.3％,特异性为94.4％,准确性为93.1％.结论 FFDM能清晰显示乳腺病变的X线征象,尤其能够显示乳腺癌的主要X线征象,为临床早期诊断乳腺病变创造了条件,尤其对临床未触及肿块的早期乳腺癌具有重要的临床价值.     

全数字化乳腺摄影在非肿块型乳腺癌诊断中的应用

目的 探讨全数字化乳腺摄影(full-field digital mammography,FFDM)对非肿块型乳腺癌的诊断价值.方法 回顾性分析67例经手术病理证实的非肿块型乳腺癌及癌前病变患者的FFDM表现,总结其特征.全部病例采用GE平板2000D全数字化乳腺摄影机检查,体位常规采用头尾位(CC位)、内外斜位(MLO位),必要时加摄侧位及局部点片.对临床未触及包块而FFDM发现可疑乳腺癌及癌前病变者均行术前定位.对乳头溢血者行乳导管造影.结果 67例非肿块型乳腺癌及癌前病变中,临床触及肿块者50例,未触及肿块者17例.影像表现为微钙化28例,结构扭曲19例,致密影11例,全乳密度增高伴皮下水肿3例,未见异常6例.合并异常血管增粗20例,皮肤增厚收缩9例,乳头凹陷12例,大导管相2例,淋巴结肿大10例.病理类型以浸润性导管癌最多,占71.6 %,其次是导管原位癌,占13.4%,4例癌前病变均为不典型增生.结论 FFDM对非肿块型乳腺癌具有重要价值.     

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。     

全视野数字化乳腺摄影对乳腺导管原位癌的诊断价值

目的 :探讨全视野数字化乳腺摄影(full-field digital mammography,FFDM)对乳腺导管原位癌(ductal carcinoma in situ,DCIS)的诊断价值。方法 :选择经手术病理证实的DCIS患者36例,分析其X线表现。患者术前均行FFDM检查。诊断标准采用美国放射学院(ACR)推荐的乳腺影像报告和数据系统(BI-RADS)。结果:病灶出现钙化23例;肿块16例,其中肿块伴钙化5例;局灶性致密伴钙化11例;结构扭曲伴钙化7例;阴性1例;致密乳腺建议其他检查1例。BI-RADS诊断:5类11例,4类19例,3类3例,2类、1类、0类各1例。FFDM诊断的敏感性91.67%,符合率83.33%。结论:DCIS的常见X线表现为恶性钙化、肿块,FFDM对乳腺DCIS有重要的诊断价值。     

乳腺癌的全数字化乳腺摄影表现与癌基因表达的相关性研究

目的：探讨乳腺癌全数字化乳腺摄影（FFDM）表现与C-erbB-2、ER、PR表达之间的相关性。方法：回顾性分析100例经手术病理证实为乳腺癌患者的FFDM表现,患者术前皆未行化疗或放疗,术后标本行免疫组织化学染色测定肿瘤细胞C-erbB-2、ER、PR的表达情况,并分析其与相应病灶FFDM表现的关系。结果：乳腺癌的FFDM主要征象表现为边缘形态不规则呈浅分叶或毛刺状边缘的肿块,边界模糊,瘤内或瘤旁有成簇细砂砾样钙化。乳腺癌病灶的大小、微钙化与C-erbB-2阳性表达呈正相关（P〈0.01）,毛刺状边缘与ER阳性表达呈正相关（P〈0.05）。结论：乳腺癌的FFDM表现与分子生物学指标C-erbB-2、ER之间存在一定的相关性。乳腺癌的FFDM表现在一定程度上反映了乳腺癌细胞的生物学行为,对乳腺癌的预后评估具有重要的价值。     

全数字化乳腺摄影对临床未触及肿块乳癌的诊断价值

目的　探讨全数字化乳腺摄影对临床未触及乳癌的诊断价值。方法　收集 2 0 0 3 -0 4～ 0 7门诊及体检 412例中遇到的 3 4例乳癌 ,其中临床触及肿块的 2 2例 ,未触及肿块的 12例。全部病例采用全数字化乳腺摄影机检查 ,并经病理证实 ,检查体位常规采用CC位 (头尾位 )、MLO位 (内外斜位 ) ,必要时加照侧位及局部点片。对临床未触及包块的乳癌 ,均行术前定位。结果　 2 2例临床触及肿块的乳癌中 ,髓样癌 4例 ,硬癌 2例 ,浸润性导管癌 16例。 12例临床未触及包块的乳癌中 ,X线呈现微小钙化 6例 ,其中癌前病变 1例、导管原位癌 2例、导管浸润性癌 3例 ;呈现微小结节 2例 ,其中 1例导管原位癌、1例导管浸润癌 ;呈现微小结节半结节内微小钙化 2例 ,1例导管原位癌、1例导管浸润癌 ;呈现结构紊乱区 1例 ,为小叶原位癌 ,结构紊乱区伴微小钙化 1例 ,为浸润导管癌。结论　全数字化乳腺摄影能清晰显示乳腺癌的直接及间接征象 ,尤其对临床未触及包块的乳癌具有更重要的诊断价值     

乳腺未触及肿块的良恶性微小钙化临床X线——病理对照研究

本文报告50例乳腺未触及肿块的良恶性微小钙化,乳腺癌21例,早期微小乳癌占90.4％,钙化灶大多2mm以下,密度较高,呈局部密集线状排列,以细断针状为主。乳腺良性病变29例,乳腺病25例,纤维腺瘤4例,钙化灶大多3mm以上,密度较高,散在分布,以粗短折状为主。     

乳腺导管原位癌的全数字化钼靶X线诊断

目的探讨乳腺导管原位癌（BDCIS）的全数字化乳腺钼靶X线征象。方法回顾分析30例经手术及病理检查证实为BDCIS的全数字化乳腺钼靶X线表现。常规摄影双侧乳腺轴位（CC位）及侧斜位（MLO位）摄片。结果 30例中26例有病灶内钙化,其中单纯钙化18例,肿块伴钙化3例,结构扭曲伴钙化5例;3例为单纯肿块,其中,边缘光滑、密度均匀的圆形肿块2例,边缘有毛刺、密度不均匀的类圆型肿块1例;1例为单纯结构扭曲。结论 BDCIS全数字化乳腺钼靶X线表现以钙化为主,还应重视肿块、结构扭曲以及局部非对称致密影等征象。     

Sensitivity of a Direct Computer-aided Detection System in Full-field Digital Mammography for Detection of Microcalcifications Not Associated with Mass or Architectural Distortion

Purpose

The purpose of this study was to evaluate the sensitivity of a direct computer-aided detection (CAD) system (d-CAD) in full-field digital mammography (FFDM) for the detection of microcalcifications not associated with mass or architectural distortion.

Materials and Methods

A database search of 1063 consecutive stereotactic core biopsies performed between 2002 and 2005 identified 196 patients with Breast Imaging-Reporting and Data System (BI-RADS) 4 and 5 microcalcifications not associated with mass or distortion detected exclusively by bilateral FFDM. A commercially available CAD system (Second Look, version 7.2) was retrospectively applied to the craniocaudal and mediolateral oblique views in these patients (mean age, 59 years; range, 35–84 years). Breast density, location and mammographic size of the lesion, distribution, and tumour histology were recorded and analysed by using χ², Fisher exact, or McNemar tests, when applicable.

Results

When using d-CAD, 71 of 74 malignant microcalcification cases (96%) and 101 of 122 benign microcalcifications (83%) were identified. There was a significant difference (P < .05) between CAD sensitivity on the craniocaudal view, 91% (68 of 75), vs CAD sensitivity on the mediolateral oblique view, 80% (60 of 75). The d-CAD sensitivity for dense breast tissue (American College of Radiology [ACR] density 3 and 4) was higher (97%) than d-CAD sensitivity (95%) for nondense tissue (ACR density 1 and 2), but the difference was not statically significant. All 28 malignant calcifications larger than 10 mm were detected by CAD, whereas the sensitivity for lesions small than or equal to 10 mm was 94%.

Conclusions

D-CAD had a high sensitivity in the depiction of asymptomatic breast cancers, which were seen as microcalcifications on FFDM screening, with a sensitivity of d-CAD on the craniocaudal view being significantly better. All malignant microcalcifications larger than 10 mm were detected by d-CAD.     

不典型乳腺癌全数字化乳腺摄影X线表现规律探讨

目的 探讨不典型乳腺癌全数字化(FFDM)乳腺x线摄影表现规律.方法 从2003年4月至2007年7月对门诊及体检者中影像表现不典型的134例乳腺癌或癌前病变进行分析,探讨其FFDM影像表现规律.全部病例采用GE平板2000D全数字化乳腺摄影机检查,体位常规采用头尾位(CC位)、内外斜位(MLO位),必要时加摄侧位及局部点片.对临床未触及包块的乳腺癌均行术前定位.结果 (1)影像表现为边界光整的肿块以浸润性导管癌(22/106,20.8%)、黏液腺癌(8/10)及髓样癌(5/6)最多;边界光整的肿块表现随年龄的增加而增多,30～40岁年龄段占其病例总数的13.3%(4/30),81 和90岁的2例均为此类型;边界光整的肿块表现随病变局部腺体致密程度减少而增多,依次分别占各自病例总数的14.0%(12/86)、34.5%(10/29)、84.2%(16/19).(2)粗乱条索影、结构紊乱、结构紊乱伴条索影及伴片状高密度主要见于浸润性导管癌(65例),并主要见于30～40岁(22例)及41-50岁(34例)两个年龄段和病变局部为致密型的腺体组织(55例),其中粗乱条索影最多见于30～40岁,占其病例总数的33.3%(10/30).(3)全乳房密度增高伴皮下水肿及类肿块影主要见于浸润性导管癌(均为7/8)及41～50岁(5/8)年龄段;全乳房密度增高伴皮下水肿(8例)及未见异常表现(4例)仅见于致密型腺体.结论 不典型乳腺癌FFDM影像表现类型与乳腺癌的病理类型、患者的年龄及病变区腺体的致密度有关.     

Performance of computer-aided detection applied to full-field digital mammography in detection of breast cancers

Objective

The aim of this retrospective study was to evaluate performance of computer-aided detection (CAD) with full-field digital mammography (FFDM) in detection of breast cancers.

Materials and Methods

CAD was retrospectively applied to standard mammographic views of 127 cases with biopsy proven breast cancers detected with FFDM (Senographe 2000, GE Medical Systems). CAD sensitivity was assessed in total group of 127 cases and for subgroups based on breast density, mammographic lesion type, mammographic lesion size, histopathology and mode of presentation.

Results

Overall CAD sensitivity was 91% (115 of 127 cases). There were no statistical differences (p > 0.1) in CAD detection of cancers in dense breasts 90% (53/59) versus non-dense breasts 91% (62/68). There was statistical difference (p < 0.05) in CAD detection of cancers that appeared mammographically as microcalcifications only versus other mammographic manifestations. CAD detected 100% (44/44) of cancers manifesting as microcalcifications, 89% (47/53) as no-calcified masses or asymmetries, 88% (14/16) as masses with associated calcifications, and 71% (10/14) as architectural distortions. CAD sensitivity for cancers 1-10 mm was 84% (38/45); 11-20 mm 93% (55/59); and >20 mm 97% (22/23).

Conclusion

CAD applied to FFDM showed 100% sensitivity in identifying cancers manifesting as microcalcifications only and high sensitivity 86% (71/83) for other mammographic appearances of cancer. Sensitivity is influenced by lesion size. CAD in FFDM is an adjunct helping radiologist in early detection of breast cancers.     

乳腺癌61例X线表现及病理对照分析

目的探讨和分析乳腺癌的钼靶X线影像特点及其病理基础,提高乳腺癌的X线诊断水平。方法回顾性分析研究61例经乳腺钼靶X线摄影检查、手术及病理证实的乳腺癌患者的X线表现。结果①61例患者中,单纯肿块41例,肿块伴钙化13例,单纯钙化8例,结构扭曲5例,结构扭曲伴钙化4例,局灶性致密影5例,磨玻璃样改变1例,阴性1例。②有钙化者多见于浸润性导管癌和导管原位癌,有肿块者多见于浸润性导管癌、粘液腺癌和髓样癌,结构扭曲者和局部致密性影多见于浸润性导管癌。结论①乳腺癌常见的X线表现为单纯肿块、钙化伴肿块、单纯钙化和结构扭曲。②浸润性导管癌占乳腺癌的大部分,乳腺癌的病理基础不同,导致了不同类型的X线表现。③X线摄影对乳腺癌有很高的诊断价值,尤其对临床检查阴性的患者,但对致密性乳腺还是有一定的局限性。     

Impact of breast density on computer-aided detection for breast cancer

OBJECTIVE: Our aim was to determine whether breast density affects the performance of a computer-aided detection (CAD) system for the detection of breast cancer. MATERIALS AND METHODS: Nine hundred six sequential mammographically detected breast cancers and 147 normal screening mammograms from 18 facilities were classified by mammographic density. BI-RADS 1 and 2 density cases were classified as nondense breasts; BI-RADS 3 and 4 density cases were classified as dense breasts. Cancers were classified as either masses or microcalcifications. All mammograms from the cancer and normal cases were evaluated by the CAD system. The sensitivity and false-positive rates from CAD in dense and nondense breasts were evaluated and compared. RESULTS: Overall, 809 (89%) of 906 cancer cases were detected by CAD; 455/505 (90%) cancers in nondense breasts and 354/401 (88%) cancers in dense breasts were detected. CAD sensitivity was not affected by breast density (p=0.38). Across both breast density categories, 280/296 (95%) microcalcification cases and 529/610 (87%) mass cases were detected. One hundred fourteen (93%) of the 122 microcalcifications in nondense breasts and 166 (95%) of 174 microcalcifications in dense breasts were detected, showing that CAD sensitivity to microcalcifications is not dependent on breast density (p=0.46). Three hundred forty-one (89%) of 383 masses in nondense breasts, and 188 (83%) of 227 masses in dense breasts were detected-that is, CAD sensitivity to masses is affected by breast density (p=0.03). There were more false-positive marks on dense versus nondense mammograms (p=0.04). CONCLUSION: Breast density does not impact overall CAD detection of breast cancer. There is no statistically significant difference in breast cancer detection in dense and nondense breasts. However, the detection of breast cancer manifesting as masses is impacted by breast density. The false-positive rate is lower in nondense versus dense breasts. CAD may be particularly advantageous in patients with dense breasts, in which mammography is most challenging.     

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.     

Comparative study in patients with microcalcifications: full-field digital mammography vs screen-film mammography

The goal of this prospective study was to compare a full-field digital mammography system (FFDM) to a conventional screen-film mammography system (SFM) for the detection and characterization of microcalcifications. Fifty-five patients with 57 isolated microcalcification clusters were examined using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, Wis.) and a SFM system (Senographe DMR, GE Medical Systems, Milwaukee, Wis.). A conventional screen-film mammogram and a digital contact mammogram were obtained of each cluster. The image quality and the number of calcification particles were evaluated, and a characterization (BI-RADS 1–5) of microcalcifications was given by four experienced readers. Histopathology revealed 16 benign lesions (sclerosing adenosis, dysplasia, hamartoma, radial scar) in 15 patients and 21 malignant tumors (in situ carcinoma, invasive carcinoma) in 20 patients. Twenty patients had benign changes verified by long-term follow-up. Image quality of FFDM was assessed as superior to SFM in more than 50% of the cases. The FFDM showed more calcifications in 41% of all cases. Sensitivity and specificity for FFDM vs SFM were 95.2 vs 91.9% and 41.4 vs 39.3%, respectively. Moreover, FFDM demonstrated a higher diagnostic accuracy (deviation: 0.86 BI-RADS steps) compared with FSM (deviation 0.93 BI-RADS steps). The FFDM system with a 100-μm pixel size provides better image quality than SFM in patients with mammographic microcalcifications. The FFDM has a higher sensitivity and a higher reliability in characterizing microcalcifications. Electronic Publication     

Sclerosing adenosis: mammographic and ultrasonographic findings with clinical and histopathological correlation

OBJECTIVE: To evaluate the mammographic and ultrasonographic findings of sclerosing adenosis, a relatively uncommon entity which may sometimes mimic carcinoma. MATERIALS AND METHODS: A retrospective review of the records of 33,700 women, who have undergone mammographic examination at our institution between January 1985 and July 2001 revealed 43 histopathologically proven sclerosing adenosis. The history, physical examination, mammographic and ultrasonographic findings were analyzed in all patients. In 30 patients, the nonpalpable lesions were preoperatively localized by the needle-hookwire system under the guidance of mammography (n=22) or ultrasonography (US) (n=8). Radiological features were correlated with histopathological findings. RESULTS: The age of the patients varied between 32 and 55 years (mean, 43.7 years). Only two patients had a family history of breast cancer. In six patients, the presenting complaint was mastalgia. A palpable mass was present in 13 cases. The mammographic findings were; microcalcifications in 24 (55.8%) (clustered in 22, diffuse in two), mass in five (11.6%), asymmetric focal density in three (6.9%), and focal architectural distortion in three (6.9%) patients. Four of the masses were irregularly contoured, while one was well-circumscribed. On US, focal acoustic shadowing without a mass configuration was noted in the three patients who showed asymmetrical focal density on mammography. In eight patients, who showed normal mammograms, a solid mass was detected on US. Two masses had discrete well-circumscribed oval or lobulated contours, while six showed microlobulation and irregularity. In one case, the irregularly contoured mass had marked posterior acoustic shadowing. Two of the three patients, who had focal architectural distortion on mammograms, had an irregularly contoured solid mass, while the third presented as focal acoustic shadowing without a mass configuration. CONCLUSION: Sclerosing adenosis mostly presents as a nonpalpable lesion with different mammographic and sonographic appearances. The most common finding is microcalcifications on mammograms. Awareness of the possible imaging features will enable us to consider sclerosing adenosis in the differential diagnosis. The radiological features may sometimes mimic malignancy, so histopathologic examination is mandatory for definite diagnosis.