乳腺钙化BI-RADS报告分类对乳腺病变的诊断价值

目的 分析总结钙化的X线形态、分布在乳腺良性、恶性疾病中的诊断价值.方法 以美国放射学会提出的乳腺影像报告和数据系统(BIs-RADS)为标准,对2006-09-2008-09间166例乳腺钙化性疾病进行BI-RADS分类,同时利用数字化乳腺X线摄影技术(二维导丝定位、三维立体导丝定位及三维立体定位穿刺技术),对其中不能扪及的乳腺病变进行术前定位或穿刺活检术,术后标本摄影并与病理结果对照研究,总结分析乳腺良性、恶性钙化的X线形态和分布特点.结果 166例乳腺钙化病变中,良性74例,恶性92例.良性钙化中以簇状、弥漫分布的点状钙化占多数,均为17.57%(13/74);而恶性钙化中以节段样分布的分支杆状钙化为主,为16.30%(15/92).结论 钙化的形态、分布对鉴别乳腺良性及恶性病变具有一定的价值.     

BI-RADS分级在临床不可触及的乳腺病变活检中的应用

目的:探讨乳腺影像报告及数据系统(BI-RADS)分级对影像学发现的亚临床乳腺病变的诊断及治疗价值.材料和方法:50例乳腺X线发现异常而临床不可触及肿块的患者,运用BI-RADS分级系统为乳腺影像评分,为所有患者行乳腺X线引导下导丝定位病灶活检术,对比影像诊断与病理结果,分析影像学对病理结果的预测价值.结果:2例BI-RADS 5级,5例BI-RADS 4级与1例BI-RADS 3级病变证实为恶性,13例BI-RADS 4级和1例BI-RADS 3级病灶诊断为癌前病变,22例BI-RADS 4级和6例BI-RADS 3级病灶最终诊断为良性病变.结论:BI-RADS 3～5级的亚临床病变,通过导丝引导下病灶定位切除活检术,能够帮助发现早期乳腺癌.     

术前三维导丝定位对乳腺不可触及病变的诊断价值

目的探讨术前三维导丝定位技术对临床不可触及病变的诊断价值。方法 87例经乳腺X线检查发现的临床不可触及的可疑病变,采用术前三维导丝立体定位,留置导丝于病变区,引导外科手术进行切除活检,术后行病理学检查。结果经三维导丝立体定位术后病变切除率为100%。87例病例中,恶性病例8例,其中浸润性导管癌2例,导管原位癌6例;良性病变79例,其中包括癌前病变14例(不典型增生9例,导管内乳头状瘤4例,放射状瘢痕1例)。结论乳腺三维导丝定位术定位准确,较精确的确定乳腺不可触及病变的部位,利于活检,可有效提高早期乳腺癌的诊断率。     

乳腺钙化的X线影像评价

乳腺X线摄影经常发现钙化,但判断其性质是诊断难点。本文重点从钙化的形态和与之关联的密度、钙化的分布特点等方面系统评价乳腺钙化,并对乳腺钙化产生的原因和对钙化的诊断技巧进行探讨。     

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.     

乳腺内钙化在乳腺癌中的诊断价值

目的:探讨乳内钙化灶在诊断乳腺癌中的价值。方法:搜集乳腺X线片中出现钙化并经手术病理或穿刺活检证实的乳腺癌116例,良性病变40例,通过8项指标分析钙化在乳腺良、恶性病变中的差异。结果:乳腺良、恶性病变的钙化在形态、颗粒大小、数量、平均密度、密度是否均匀、密集度及分布7个方面均存在显著差异(P0.05),其中以密集度、形态、平均密度及颗粒大小差异最显著(P0.001);而大小是否一致无显著差异(P0.05)。结论:乳腺钙化的X线表现对乳腺癌的诊断具有重要价值。     

超声弹性成像在不可触及的乳腺病灶中的作用

该研究的目的是评估超声弹性成像鉴别不可触及的乳腺病灶良恶性的诊断效用。278例女性,共293个BI-RADS（乳腺影像报告和数据系统）,3～5级不可触及的乳腺病灶,在进行超声引导活检之前先用B超而后使用弹性成像进行评估。在293个病灶中（体积大至2cm）110个（37．5％）组织学表现是恶性的,183个（62．5％）是良性的。     

X线立体定位细针活检诊断不可触及的乳腺病变

目的 :探讨乳腺X线立体定位细针活检技术诊断不可触及的乳腺病灶的价值。材料和方法 :对 2 7例临床不能触及 ,而X线片上显示的乳腺微小病变 ,通过X线立体定位穿刺 ,放入钢丝定位后指导外科切检 ,进行组织病理学检查。结果 :2 7个乳腺病变 ,恶性病变 7例 ,其中T0 期 3例 ,T1期 4例 ;良性病变 2 0例 ,含慢性囊性乳腺病 10例 (其中合并导管上皮异型增生及上皮增生活跃各 3例 ) ,小叶增生 3例 ,慢性炎症 3例 ,腺纤维瘤 2例 ,导管内乳头状瘤 1例 ,错钩瘤 1例。结论 :立体定位细针活检对不可触及的乳腺病变的定位定性诊断以及对早期乳腺癌的诊断有重要价值。     

乳腺钙化的X线特征及其诊断乳腺疾病的价值

目的 :探讨X线影像对乳腺钙化在不同乳腺疾病中的诊断价值。材料和方法 :经手术、B超、穿刺活检或随访证实的 ,乳腺X线摄影确认的 15 0例钙化病例 ,回顾性分析其钙化形态、大小、密度、分布等特点。结果 :乳腺钙化可分成七型 ,即棍棒型、精盐型、沙石型、融合型、圆弧型、轨道型和圆孔型。棍棒型 3 0例 ,其中恶性 2 9例 (97% ) ;精盐型 40例 ,恶性 3 4例 (85 % ) ;沙石型 2 2例 ,良性 19例 (90 % ) ;融合型 2 5例 ,良性 2 3例 (92 % ) ;圆弧型、轨道型和圆孔型 ,均为乳腺良性病变。结论 :棍棒型及精盐型钙化是乳腺恶性病变钙化的主要类型 ;沙石型、融合型、圆弧型、轨道型和圆空型钙化是良性病变钙化的主要类型。乳腺钙化在诊断不同乳腺疾病及鉴别良恶性肿瘤中具有重要作用。     

Assessing the degree of collinearity among the lesion features of the MRI BI-RADS lexicon

Purpose

To retrospectively assess collinearity among lesion feature of the MRI BI-RADS lexicon. Collinearity denotes a situation in which two or more (independent) variables are correlated to some degree, thus partly conveying the same information. Collinearity may cause problems in the interpretation of logistic regression models.

Materials and methods

We analysed the BI-RADS features of 351 lesions in 325 consecutive patients. Patients with biopsy proven breast disease or treated with chemotherapy were excluded. All lesion features were dichotomised into “present” or “not present”. Correlation matrices were generated for mass and non-mass lesions separately, focus lesions were omitted. The phi coefficient was used as measure for correlation.

Results

There were 253 mass (175 malignant, 78 benign), 66 non-mass (21 malignant, 45 benign) and 32 focus (5 malignant, 27 benign) lesions among the study population. The strongest inter-subgroup correlations among mass lesion features were: slow initial enhancement with persistent kinetics, phi = 0.64 (0.56–0.71), rapid initial enhancement with washout kinetics, phi = 0.52 (0.43–0.61) and rapid initial enhancement with persistent kinetics, phi = −0.43 (−0.53 to −0.32). The strongest inter-subgroup correlation among non-mass lesion features were: rapid initial enhancement with washout kinetics, phi = 0.51 (0.30–0.67), slow initial enhancement with persistent kinetics, phi = 0.43 (0.21–0.61) and rapid initial enhancement with persistent kinetics, phi = −0.41 (−0.18 to −0.60).

Conclusion

There is a noticeable overlap of information, especially between kinetic features and initial enhancement types for both, mass and non-mass lesions. This should be considered when generating logistic regression models with the MRI BI-RADS lesion features.     

3.0‐T MR‐guided focused ultrasound for preoperative localization of nonpalpable breast lesions: An initial experimental ex vivo study

Purpose

To compare the accuracy of magnetic resonance‐guided focused ultrasound (MRgFUS) with MR‐guided needle‐wire placement (MRgNW) for the preoperative localization of nonpalpable breast lesions.

Materials and Methods

In this experimental ex vivo study, 15 turkey breasts were used. In each breast phantom an artificial nonpalpable “tumor” was created by injecting an aqueous gel containing gadolinium. MRgFUS (n = 7) was performed with the ExAblate 2000 system (InSightec). With MRgFUS the ablated tissue changes in color and increases in stiffness. A rim of palpable and visible ablations was created around the tumor to localize the tumor and facilitate excision. MRgNW (n = 8) was performed by MR‐guided placement of an MR‐compatible needle‐wire centrally in the tumor. After surgical excision of the tumor, MR images were used to evaluate tumor‐free margins (negative/positive), minimum tumor‐free margin (mm), and excised tissue volume (cm³).

Results

With MRgFUS localization no positive margins were found after excision (0%). With MRgNW two excision specimens (25%) had positive margins (P = 0.48). Mean minimum tumor‐free margin (±SD) with MRgFUS was significantly larger (5.5 ± 2.4 mm) than with MRgNW (0.9 ± 1.4 mm) (P < 0.001). Mean volume ± SD of excised tissue did not differ between MRgFUS and MRgNW localization, ie, 44.0 ± 9.4 cm³ and 39.5 ± 10.7 cm³ (P = 0.3).

Conclusion

The results of this experimental ex vivo study indicate that MRgFUS can potentially be used to localize nonpalpable breast lesions in vivo. J. Magn. Reson. Imaging 2009;30:884–889. © 2009 Wiley‐Liss, Inc.     

Accuracy of assigned BI-RADS breast density category definitions

RATIONALE AND OBJECTIVES: Quantitative criteria for the Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories have recently been defined as <25% dense for almost entirely fatty, 25%-50% dense for scattered fibroglandular densities, 51%-75% for heterogeneously dense, and >75% dense for the extremely dense category. The purpose of this study is to compare the range of percent mammographic densities with radiologist-assigned BI-RADS mammographic density categories and compare with the recently issued definitions. MATERIALS AND METHODS: In this study, 200 consecutive negative analog screening mammograms were assigned BI-RADS mammographic density categories independently by three radiologists blinded to the other readers' density assignment. Quantitative assessment of percent mammographic density was performed using previously validated software. RESULTS: All three readers agreed on BI-RADS mammographic density categories in 98 cases (49%), and two of three readers agreed in all 200 cases. Using two reader's consensus, median mammographic density (range) was 6.0% (0.5%-19.2%) for fatty, 14.8% (1.2%-52.7%) for scattered densities, 51.2% (15.9%-82.2%) for heterogeneously dense, and 78.4% (60.1%-87.9%) for extremely dense breasts. The percent mammographic density ranges for fatty and extremely dense breasts correlated well with BI-RADS definitions, whereas the ranges of densities in the scattered and heterogeneously dense categories were considerably broader. CONCLUSION: Fatty and extremely dense BI-RADS categories compare relatively well to defined criteria, and therefore may be helpful in breast cancer risk models. Scattered fibroglandular densities and heterogeneously dense categories have broad percent mammographic density ranges and may not function well in breast cancer risk models.     

Tissue Doppler and strain imaging for evaluating tissue elasticity of breast lesions

RATIONALE AND OBJECTIVES: Sonoelastography depicts the intrinsic elastic properties of a tissue which are characterized by the strain applied to achieve tissue deformation and the velocity at which tissue deformation occurs. The present study served to investigate whether the specificity of B-mode ultrasound (US) can be improved by combining B-mode imaging with tissue Doppler imaging (TDI) and offline analysis of tissue strain imaging (TSI). MATERIALS AND METHODS: Fifty women, 25 with malignant and 25 with benign focal breast lesions, were examined by US with a linear transducer (9 MHz, Aplio, Toshiba, Otawara, Japan). B-mode US views of the lesions were overlaid with color-coded TDI information and area quotients (AQ = area B-mode view/area TDI) were calculated. TSI views were reconstructed offline from the source data. This was done by placing a region of interest (ROI) in the target lesion and color-encoded display of the information. In addition, tissue elasticity was evaluated using a scale of 1-5 corresponding to the BI-RADS categories. Maximum strain (strain factor, SF) was determined in the ROI. All patients also underwent mammography. Sensitivities and specificities were calculated and statistical analysis was performed using Wilcoxon's test. RESULTS: Sensitivity/specificity was 96%/68% for B-mode US, 100%/40% for combined B-mode US and mammography, and 96%/80% for TSI. The AQ of benign and malignant lesions was significantly different (p = .00008) as was the difference in SF (p = .0004). The readers considered TSI a feasible technique. CONCLUSION: Evaluation of elasticity based on the quantification of strain factors improves characterization of focal breast lesions, especially the differentiation of BI-RADS 3 and 4 lesions. Surprisingly, significant results in characterizing breast lesions were obtained with the simple technique of TDI, showing a lower tissue displacement in malignant cases.     

钼靶X线引导下定位FNAC或CNB及其对乳腺微小病变的诊断价值

目的探讨钼靶X线引导下定位细针穿刺抽吸细胞学检查(fineneedleaspirationcytology,FNAC)或针芯组织学活检术(coreneedlebiopsy,CNB)及其对乳腺微小病变的诊断价值。方法经病理证实的34例35个乳腺微小病变均先行常规钼靶X线摄片,再在钼靶X线引导下定位FNAC或CNB。以手术病理为金标准回顾性分析35个乳腺微小病变的初期钼靶X线诊断率和中期钼靶X线诊断率。随机抽取经手术病理证实的30例30个未行钼靶X线引导下定位FNAC或CNB的乳腺微小病变作为对照。结果钼靶X线引导下35个病变FNAC或CNB均定位成功。2组初步钼靶X线的正确诊断率分别为60%和53.3%(P>0.5),无明显差异。研究组中期钼靶X线的正确诊断率与对照组初步钼靶X线的正确诊断率分别为82.9%和53.3%(P<0.05),有明显差异。结论钼靶X线引导下定位FNAC或CNB操作过程简便、经济、安全,定位准确率高。中期钼靶X线正确诊断率明显提高。     

钼靶乳腺摄影与高频超声诊断乳腺隐匿性病变的可行性及其互补作用

目的探讨钼靶摄片和超声影像对乳腺隐匿性病变的诊断价值以及互补作用。方法收集69例乳腺隐匿性病变的临床资料,所有病例均同时接受了全数字乳腺钼靶摄片和高频超声影像检查,其中至少有一种诊断结果为BI-RADS4～5级,并且均有细针立体定位手术活检病理诊断结果。结果 69例中分别有63例和22例被钼靶和超声诊断为BI-RADS4～5级,而两种诊断均为4～5级的有16例。69例中32例活检病理证实为乳腺癌。63例乳腺钼靶诊断为4～5级病例中有31例病理证实为乳腺癌,而6例诊断为0～3级的病例中仅有1例病理证实为乳腺癌,该病例被超声诊断为5级;超声诊断为4～5级的22例病例有14例为乳腺癌,而另外47例超声诊断为0～3级的病例中有18例病理证实为乳腺癌,两种检查方法对乳腺癌的检出率之间存在显著的统计学差异(χ2=11.19,P=0.004)。结论钼靶摄片对诊断乳腺隐匿性病变是否为癌的可靠性要显著优于超声影像,但是两者联合则能提高其检出率。     

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.     

Frequency of malignancy in lesions classified as probably benign after dynamic contrast-enhanced breast MRI examination

PURPOSE: To determine the chance of malignancy in lesions classified as "probably benign" by dynamic magnetic resonance imaging (MRI), in a heterogeneous population. MATERIALS AND METHODS: Reports from 473 patients, from March 1994 to March 2002, who underwent breast MRI were retrospectively reviewed. A total of 79 patients (17%) had lesions classified as probably benign after the MRI, which required further imaging follow-up. We evaluated subsequent MRI, mammographic reports, and clinical follow-up in these patients and established the frequency of malignancy in this group. RESULTS: MRI classified probably benign lesion were diagnosed in 79 women because of focal or diffuse mild enhancement and benign dynamic enhancement curves in the area of the mammographic abnormality, or because of the presence of microcalcifications on the mammogram, or because of incidental enhancing lesions. Two-year radiographic and/or clinical follow-up was available in 68 women. On follow-up, four women (6%) were diagnosed with cancer between 14 and 18 months after the initial MRI. CONCLUSION: Patients with a lesion assessed as probably benign by dynamic contrast enhanced MRI have a higher chance of malignancy than patients with probably benign lesions (Breast Imaging Reporting and Data System category 3, BI-RADS 3) seen on mammography. These patients should be informed of the increased risk of cancer and be given the option of biopsy or close follow-up.