乳腺钼靶检查在乳腺癌新辅助化疗疗效评估中的价值

目的对乳腺癌新辅助化疗(NAC)前后乳腺钼靶X线征象进行观察分析,以评价其在疗效评估中的应用价值。方法对比分析21例NAC后的乳癌肿块及腋窝淋巴结的大小、形态、钙化和密度等钼靶X线表现。结果 21例乳癌肿块均较NAC前缩小,4例肿块呈局限性密度减低,20例肿块形态发生改变;9例钙化的形态和数目无明显变化,但钙化的范围较前缩小;9例腋窝淋巴结缩小及密度减低。结论新辅助化疗后乳腺癌肿块的钼靶摄影X线征象均有所变化,乳腺钼靶检查可以用来评估NAC的疗效。     

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。     

数字断层融合技术对乳腺癌的诊断价值

目的探讨数字断层融合技术（DTS）对乳腺癌的诊断价值。方法应用数字断层融合和X线钼靶检查30例临床诊断或穿刺证实为乳腺癌的患者,比较检测结果准确性。结果30例乳腺癌患者中,DTS检出24例,占80．0％;X线钼靶检出20例,占66．7％,两者之间差异无统计学意义（χ^2=0．90,P〉0．05）。其中DTS检出肿块21例,钙化9例,毛刺14例,腋窝淋巴结肿大9例;X线钼靶检出肿块13例,钙化12例,毛刺10例,腋窝淋巴结肿大3例。结论数字断层融合技术在乳腺癌的影像学诊断中是可行的,其在肿块及腋窝淋巴结的检测方面较X线钼靶好。     

乳腺癌新辅助化疗疗效评价方法的比较

目的 比较查体、超声和钼靶在乳腺癌新辅助化疗(NAC)疗效评价中的差异.方法 通过查体、超声和钼靶分别测量、记录141例NAC患者肿瘤状况,分析治疗前后原发灶、淋巴结的变化.结果 全组中晚期患者居多,Ⅰ期仅占8.5%.化疗前查体的乳腺肿块较超声检查明显偏大(P＜0.01).评价疗效时,原发灶查体误判完全缓解(CR)率高达46.8%(22/47),而超声误判残留率为84.0%(21/25).43例行钼靶检查患者中,有23例(53.5%)患者困难以测量肿块大小而无法评价疗效;5例有钙化的患者,虽化疗后肿块缩小,但钙化范围无变化.在治疗中,25例有效患者行原发灶空芯针穿刺,在9例穿刺病理阴性者中,仅有3例达pCR;16例穿刺阳性者均未达pCR.超声检查怀疑腋窝淋巴结转移的患者,通过空芯针穿刺的病理阳性率为88.3%(53/60),超声检查不怀疑者仍有20.0%(1/5)为阳性.24例超声未探及腋窝肿大淋巴结患者中,有9例(37.5%)前哨淋巴结活检阳性.化疗前淋巴结病理阳性患者64例,化疗后转阴36例(56.3%).全组原发灶及淋巴结均达病理完全缓解(pCR)者21例,占14.9%(21/141).结论 乳腺癌患者化疗前对腋窝淋巴结进行空芯针穿刺或前哨淋巴结活检明确病理状态非常重要,查体、超声及铜靶检查对原发灶肿瘤大小的判断都有相当的误差,可采用病灶穿刺来评价NAC的疗效,但对结果 的判断还需综合分析.     

乳腺X线摄影在乳腺癌NAC疗效评价上的应用

摘 要：［目的］ 应用乳腺X线摄影诊断技术评价乳腺癌新辅助化疗（NAC）的疗效。［方法］ 对比分析52例乳腺癌患者行NAC前后乳腺X线摄影各主要征象的变化。［结果］ 总有效率为61.54%;肿块的变化率为85.71%;钙化的变化率为74.07%,出现范围、数目、分布上的改变;淋巴结的变化率为68.42%。［结论］ 乳腺X线摄影是乳腺癌新辅助化疗直观、经济的观察手段。     

54例乳腺浸润性导管癌的钼靶X线表现

[目的]分析乳腺浸润性导管癌钼靶X线表现，提高其影像学诊断水平。[方法]对54例经手术病理证实的乳腺浸润性导管癌进行钼靶X线征象的回顾性分析。[结果]54例乳腺浸润性导管癌的主要X线表现：肿块伴微小钙化27例，单纯肿块14例，单纯钙化9例，结构紊乱伴局部密度增高3例，结构紊乱伴钙化1例。[结论]乳腺浸润性导管癌钼靶X线表现较丰富，具有一定的特征性，大多数病例于术前可以做出正确的诊断。     

乳腺癌CT表现价值探讨

本文讨论12例乳腺癌CT表现。直接征象即肿块阴影,一般为圆形,卵圆形。肿块等于或高于腺体密度,边缘一般呈毛刺状参差不齐,有细小钙化。增强扫描CT值成倍增加为其特征性。间接征象有血管增粗增多,出现宽窄不一透亮带,皮肤增厚、收缩。乳后间隙消失,乳头内陷,腋下可见肿大淋巴结等。乳腺CT扫描适应症主要有乳腺钼靶照片的隐区部位,乳腺钼靶X线片上怀疑乳腺癌者,以及对致密型,青春期,哺乳期乳腺和乳腺癌根治术前了解肿块与周围组织关系等方面有一定意义。乳腺CT扫描也有局限性,它不适合于普查形式,对乳腺癌砂粒样钙化的特征性表现不如X线钼靶,对致密型乳腺中小于10mm的结节亦很难显示。     

乳腺内微钙化在乳腺癌诊断中的价值

目的 探讨微钙化对乳腺癌的诊断价值.方法 收集经手术病理证实并在乳腺钼靶X线摄影片中发现微钙化乳腺疾病患者80例,分析其微钙化的特征在乳腺癌诊断中的价值.结果 乳腺癌内微钙化多成簇分布,大多伴有肿块,形态大小各异,密度不一,单个区域数量大多>20个.结论 乳腺钼靶X线摄影对乳腺癌的诊断具有重要价值.     

乳腺粘液癌的钼靶X线表现

目的：探讨乳腺粘液癌的钼靶X线表现特点以提高临床诊断率。方法：对2006年3月至2008年11月我院诊断的11例乳腺粘液癌患者的X线资料进行回顾分析,11例乳腺粘液癌患者均经术后病理证实。结果：11例乳腺粘液癌中单纯型粘液癌4例,其中中等密度肿块影3例,局限性密度增高1例;混合性粘液癌7例,均为高密度肿块影,其中毛刺样肿块4例,伴有簇样砂粒样钙化2例,侵犯乳头者1例,腋窝淋巴结转移1例。结论：单纯型乳腺粘液癌钼靶X线表现常表现为边缘光滑的肿块,而混合型具有一些典型的恶性征象。     

VEGF、COX-2、MMP-9在乳腺癌组织中的表达对乳腺钼靶x线征象的影响

目的探讨乳腺癌组织中血管内皮细胞生长因子（VEGF）、环氧化酶-2（COX-2）、基质金属蛋白酶-9（MMP-9）的表达对乳腺钼靶x线征象的影响,并初步探讨乳腺钼靶x线征象与分子病理学之间的关系。方法收集经乳腺钼靶X线检查、手术和病理证实的乳腺癌患者69例,将乳腺钼靶x线征象分为毛刺征、钙化征、异常血管征、淋巴结转移征,分析VEGF、COX-2、MMP-9表达对以上征象的影响。结果乳腺钼靶x线征象有毛刺征组VEGF、COX-2、MMP-9阳性表达率明显高于无毛刺征组（P〈0．05）;钙化组与无钙化组VEGF、COX-2、MMP-9阳性表达率差异无统计学意义（P〉0．05）;有异常血管征组VEGF、COX-2、MMP-9阳性表达率明显高于无异常血管征组（P〈0．05）;有淋巴结转移征组VEGF、COX-2、MMP-9阳性表达率明显高于无淋巴结转移征组（P〈0．05）。结论VEGF、COX-2、MMP-9高表达对乳腺钼钯x线征象毛刺征、异常血管征、淋巴结转移征的出现存在影响,并可作为乳腺钼钯X线恶性征象的生物学基础。     

Method of detection of new contralateral primary breast cancer in younger versus older women

BACKGROUND: Surveillance for contralateral primary breast cancer after a diagnosis of unilateral breast cancer typically consists of yearly mammography and physical examinations at 3-6 month intervals. Mammography is known to be less sensitive in younger, dense breasts. It is unknown at this time how well mammography performs in young patients to detect a new contralateral primary breast cancer. PATIENTS AND METHODS: Patients with contralateral breast cancer diagnosed between 1980 and 2004 were identified from the British Columbia Cancer Agency's Breast Cancer Outcomes Unit database in Vancouver. Characteristics of the tumor at baseline and the contralateral tumor were recorded as well as the method of detection of the contralateral breast cancer. A subset of patients was identified based on the age at which they were diagnosed with their initial primary cancer: < 40 years (group A) and 55-59 years (group B). chi2 and independent-sample t tests were used for between-group comparisons. RESULTS: Older patients were significantly more likely to have their second primary tumor detected by routine follow-up mammography compared with the younger cohort (P < 0.001). Older patients were also more likely to have estrogen receptor-positive, lower grade second primary tumors, and there was a trend toward smaller tumors. Tumors detected by mammography were more likely to be lower grade, estrogen receptor positive, and smaller. CONCLUSION: Older patients were more likely to have a contralateral breast cancer detected by conventional mammography, whereas younger patients tended to have cancer detected by physical examinations or by self-diagnosis. Better imaging techniques are required to detect new contralateral primary breast cancer in younger patients.     

To乳腺癌的X线诊断

目的：总结Ｔｏ乳腺癌Ｘ线特征及与病理的关系。方法;对１２０例次乳腺Ｔｏ癌患者中,有乳腺Ｘ线检查的９７例次病例进行了回顾性分析。结果：Ｔｏ乳腺癌的Ｘ线检查阳性率为３２．９９％,可疑率２１．６５％,合计５４．６４％。Ｔｏ乳腺癌Ｘ线表现以局限致浸润及钙化为主,占Ｘ线阳性表现病例中６６％,以肿块为表现者罕见,仅３例。     

乳腺钼靶摄片在中老年女性乳腺癌筛查中的应用分析

目的探讨乳腺钼靶摄片在中老年女性乳腺癌筛查中的应用价值。方法抽取本地1000例中老年女性进行乳腺癌筛查,筛查方法为乳腺钼靶摄片。结果查出7例乳腺癌,占0.7%。与病理诊断符合率为100.0%,病理类型多为浸润性导管癌。所有患者摄片都可见明确肿块影,可见恶性钙化者6例。结论钼靶摄片筛查中老年女性乳腺癌作为一种无创性的检查手段,摄片肿块与钙化现象能为诊断乳腺癌提供可靠依据,可作为大规模人群筛查的主要手段。     

Should mammographic screening be done in primary ovarian cancer?

Breast cancer is a significant global health problem. It is the most common malignancy in women. Mammographic screening is recommended for women older than 40 yr for early detection of breast cancer. The aim of this study is to evaluate the role of screening mammography in ovarian cancer independent of age. Eighty-four patients with ovarian cancer were evaluated with bilateral mammography. Two hundred asymptomatic healthy controls with a similar age distribution were also imaged with screening mammography. Mammography results were classified according to the American College of Radiology criteria in five groups. The median age of the study group was 51.4 (range, 27–77) and 49.3 (range, 30–75) in the control group. Screening mammography detected four cases of malignancy (4.8%) in patients with ovarian cancer; two were the primary breast carcinomas (2.5%) and two were metastatic cancers from the ovary. Five subjects (2.5%) among healthy controls were also found to have breast cancer. Although the incidence of primary breast carcinoma was found to be similar in the two groups (2.5%), mammographic imaging detected metastatic disease to the breast from the ovaries. Mammography should therefore be considered in patients with ovarian cancer independent of age.     

A Radial Sclerosing Lesion Mimicking Breast Cancer on Mammography in a Young Woman

A spiculated mass on a mammogram is highly suggestive of malignancy. We report the case of a 32-year-old woman with a radial sclerosing lesion that mimicked breast cancer on mammography. She visited her physician after palpating a lump in her left breast. Mammography showed architectural distortion in the upper inner quadrant of the left breast. Ultrasonography showed a low echoic area with an ambiguous boundary. Core needle biopsy was performed because of the suspicion of malignancy. Histological examination did not reveal any malignant cells. After 6 months, the breast lump became larger and the patient was referred to our hospital. Mammography performed in our hospital showed a spiculated mass, and therefore mammotome biopsy was performed. Histological examination revealed dense fibroelastic stroma with a wide variety of mastopathic changes, leading to a diagnosis of a radial sclerosing lesion. One year after the biopsy, the lump on her left breast had disappeared and mammography showed no spiculated mass.Key words: Breast cancer, Radial sclerosing lesion, Mammography, Young women     

Relation between the method of detection of initial breast carcinoma and the method of detection of subsequent ipsilateral local recurrence and contralateral breast carcinoma

BACKGROUND: Mammography and physical examination are routine methods for the detection of ipsilateral local recurrence and contralateral breast carcinoma in patients initially undergoing breast conservation treatment. The current study reports the relation between the method of detection of the initial breast carcinoma and the method of detection of subsequent ipsilateral local recurrence and contralateral breast carcinoma. METHODS: A retrospective review was performed of the records of female patients with initial American Joint Committee on Cancer (AJCC) Stage I and II invasive breast carcinoma who developed ipsilateral local recurrence or contralateral breast carcinoma after breast conservation treatment. The method of detection of local recurrence in the ipsilateral breast and the method of detection of contralateral breast carcinoma were compared with the method of detection of the primary tumor. RESULTS: There were 125 ipsilateral breast local recurrences and 71 contralateral breast carcinoma cases detected. Of the 125 recurrences in the ipsilateral breast, 38% (48 recurrences) were detected by mammography only, 37% (46 recurrences) were detected by physical examination only, and 25% (31 recurrences) were detected by both methods. Of the 71 contralateral breast carcinoma cases, 53% (38 cases) were detected by mammography only, 23% (16 cases) were detected by physical examination only, and 24% (17 cases) were detected by both methods. When the primary tumors were detected by mammography only, 21% of the local recurrences (3 of 14 local recurrences) and 19% of the contralateral breast carcinoma cases (4 of 21 cases) were detected by physical examination only. When the primary tumors were detected by physical examination only, 24% of the local recurrences (14 of 58 local recurrences) and 42% of the contralateral breast carcinoma cases (8 of 19 cases) were detected by mammography only. When stratified by the interval between diagnosis of the primary tumor and ipsilateral local recurrence or contralateral breast carcinoma (< or = 5 years vs. > 5 years) or age of the patient at the time of ipsilateral breast recurrence or contralateral breast carcinoma (age < or = 49 years vs. age > or = 50 years), both breast examination and mammography were found to be important in the detection of locally recurrent tumor and contralateral breast carcinoma in each subgroup of the patients, regardless of the method of presentation of the primary tumor. CONCLUSIONS: Both mammography and physical examination were found to be significant in the detection of locally recurrent tumor in the ipsilateral breast and in the detection of contralateral breast carcinoma, regardless of the method of detection of the primary tumor.     

TBO-1型双波长乳腺肿瘤检测仪临床应用研究

目的：探讨TB（）11型检测仪对乳腺肿瘤的诊断价值。方法：选择病例200例，乳腺癌92例，乳腺良性肿瘤108例。检测肿瘤的血流及血氧含量，并常规行乳腺超声及乳腺钼靶X线摄片检查。结果：应用TB（）11型双波长乳腺肿瘤检测仪检测到乳腺癌患者中符合高血低氧者83例，诊断符合率为90．2％；乳腺良性肿瘤中符合非高血低氧者86例，诊断符合率为79．6％。乳腺钼靶X线摄片对乳腺癌及良性肿瘤的诊断符合率分别为93．5％和88．0％，乳腺超声检查的诊断符合率分别90．6％和93．3％。3种检查手段的诊断结果差异无统计学意义，P〉0．05。结论：TB（）11型检测仪可作为乳腺癌诊断的辅助方法之一。     

影像学预测乳腺癌患者预后及新辅助化疗反应的研究进展

在世界范围内,乳腺癌是女性发病率最高的恶性肿瘤,也是女性因癌症死亡的主要原因。新辅助化疗(Neoadjuvant chemotherapy,NAC)可以降低乳腺癌分期、缩小肿瘤,甚至使病灶达到病理完全缓解(Pathological complete response,pCR),在乳腺癌综合治疗中得到广泛应用。由于患者对治疗的反应各有差异,所以及时准确评估NAC疗效已成为临床医生关注并致力解决的重点。常规影像学检查手段如乳腺钼靶、超声、PET-CT和磁共振成像(MRI)已广泛用于乳腺癌NAC疗效的评估,且每种影像学检查各有优势和不足。本文就常规影像学检查用于预测乳腺癌患者预后及NAC疗效的研究进展进行综述。     

超声及钼靶对乳腺癌新辅助化疗后腋窝淋巴结状态的诊断价值评估

目的:评估乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)后腋窝淋巴结的变化,探讨超声及钼靶在NAC疗效评价中的应用价值。方法:对我院176例经穿刺病理证实为腋窝淋巴结转移的乳腺癌患者行NAC,所有患者NAC前后均行彩超与钼靶检查,对比两种检查的灵敏度、特异度及准确率。评价NAC后腋窝淋巴结的状态,并评估临床缓解与病理完全缓解（pathological complete response,pCR）的相关性。结果:NAC后超声、钼靶及两者联合评估的灵敏度分别为:79.4%、76.6%、86.5%;特异度分别为:68.6%、51.4%、71.4%;准确率分别为:77.3%、71.6%、83.5%;较NAC前超声、钼靶及两者联合评估的灵敏度、特异度及准确率明显下降,阳性预测价值最高的为两者联合检查（92.4%）。NAC后超声图像评估44例达到临床完全缓解,其中25（25/44,56.8%）例患者经病理证实达到pCR,NAC后超声检查评估pCR的灵敏度为71.4%,特异度为86.5%,准确率为83.5%。结论:超声诊断NAC后腋窝淋巴结转移较钼靶诊断灵敏度、特异度及准确率高,具有重要的临床诊断价值,但尚存局限性,对手术及术后治疗的指导性仍需进一步研究。