非腫塊型乳腺癌的鉬靶X線征象分析
發(fā)布時間：2018-08-24 12:09
【摘要】：目的通過回顧分析確診為非腫塊型乳腺癌患者的鉬靶X線的影像學表現(xiàn),研究非腫塊型乳腺癌的鉬靶X線影像學特點,以提高通過鉬靶X線診斷非腫塊型乳腺癌的水平。通過對比鉬靶X線、超聲及兩者聯(lián)合對非腫塊型乳腺癌的診斷符合率,分析各自的優(yōu)勢并探討提高非腫塊型乳腺癌檢出率的有效途徑。方法選取2015年7月-2017年1月我院收治的經手術病理證實為非腫塊型乳腺癌(即在兩個不同的掃查方向上不具備空間占位效應)患者53例。所有患者術前均行鉬靶X線及彩色多普勒超聲檢查,對53例患者的鉬靶X線表現(xiàn)進行分析,并與超聲及病理結果進行對比。所有患者行雙側乳腺頭尾位(CC位)及內外側斜位(MLO位)檢查,根據必要行側位(ML位)、腋尾位(AT位)、切線位(TAN位)或放大位(M+位)檢查,對患者的乳腺類型進行分析,脂肪型(ACR1)、少量腺體型(ACR2)、多量腺體型(ACR3)及致密型(ACR4)。鉬靶X線檢查由專業(yè)技師操作,根據乳腺大小、厚度以及致密程度來選擇不同的條件,曝光量自動控制。鉬靶X線圖像由兩名資深醫(yī)師進行解讀,主要通過密度、形狀、邊界、部位、范圍、分布、腺體結構及合并征象對病變進行綜合判定。彩色多普勒超聲由兩名資深醫(yī)師同時進行動態(tài)觀察,主要通過回聲、形態(tài)、邊緣、血流信號、后方聲影、縱橫比、部位及彈性成像等對病變進行綜合判定。鉬靶X線和彩色多普勒超聲均采用乳腺影像報告及數據系統(tǒng)(Brest Imaging Reporting and Data System,BI-RADS),結果為BI-RADS分類4B及以上者視為診斷符合。鉬靶X線、彩色多普勒超聲與兩者聯(lián)合診斷符合率比較用SPSS19.0版統(tǒng)計學軟件進行分析,各組間比較用χ2檢驗,P0.05,差異具有統(tǒng)計學意義。結果53例非腫塊型乳腺癌中,微小鈣化24例,占45.3%;結構扭曲14例,占26.4%;非對稱性局部致密13例,占24.5%;合并征象2例,占3.8%。病理結果分別是:浸潤性導管癌36例,導管原位癌9例,導管內癌5例,浸潤性小葉癌1例,粘液腺癌1例,不典型髓樣癌1例。鉬靶X線BI-RADS分類4B及以上者44例,診斷符合率83%。彩色多普勒超聲BI-RADS分類4B及以上者41例,診斷符合率77%。鉬靶X線聯(lián)合超聲檢查,BI-RADS分類4B及以上者51例,診斷符合率96%。結論1.微小鈣化在非腫塊型乳腺癌的診斷中有重要意義,特別是簇狀分布的多形性鈣化。2.鉬靶X線上,出現(xiàn)中心為低密度的星芒狀影,應考慮到乳腺癌的可能。3.鉬靶X線對于微小鈣化有優(yōu)勢,超聲對于非對稱性局部致密的病變較為敏感,兩者聯(lián)合能明顯提高非腫塊型乳腺癌的診斷符合率。
[Abstract]:Objective to study the characteristics of mammography in non-mass breast cancer by retrospectively analyzing the imaging features of mammography in patients with non-mass breast cancer, so as to improve the level of mammography in the diagnosis of non-mass breast cancer. By comparing the diagnostic coincidence rate of mammography, ultrasound and their combination in non-mass breast cancer, the advantages were analyzed and the effective ways to improve the detection rate of non-mass breast cancer were discussed. Methods from July 2015 to January 2017, 53 patients with non-mass breast cancer confirmed by surgery and pathology (i.e., no space occupying effect in two different scan directions) were selected. All the patients underwent mammography and color Doppler ultrasonography before operation. The X-ray findings of 53 patients were analyzed and compared with the results of ultrasound and pathology. All patients were examined with bilateral head and tail position (CC) and lateral oblique position (MLO). According to the necessary examination of lateral (ML), axillary caudal (AT), tangent (TAN) or magnification (M), the types of breast were analyzed. Fatty type (ACR1), small amount of glandular type (ACR2), multiple glandular type (ACR3) and dense type (ACR4). The mammography examination is operated by a professional technician. According to the size, thickness and density of the mammary gland, the exposure is automatically controlled under different conditions. The X-ray images of molybdenum target were interpreted by two senior doctors, and the lesions were judged by density, shape, boundary, location, range, distribution, structure of glands and combined signs. Color Doppler ultrasound was observed by two senior doctors simultaneously. The lesions were judged by echo, shape, edge, blood flow signal, posterior acoustic image, aspect ratio, position and elastic imaging. Mammography and color Doppler ultrasound were all performed with the mammography report and data system (Brest Imaging Reporting and Data System,BI-RADS). The results showed that BI-RADS classification 4B or above was considered to be in accordance with the diagnosis. The diagnostic coincidence rate of molybdenum target X-ray, color Doppler ultrasound and their combined diagnosis was analyzed by SPSS19.0 software. The difference was statistically significant by 蠂 2 test (P 0.05). Results among the 53 cases of non-mass breast cancer, 24 cases were microcalcification (45.3%), 14 cases were structural distortion (26.4%), 13 cases were asymmetric local density (24.5%), and 2 cases (3.8%) were associated with signs. The pathological results were as follows: invasive ductal carcinoma (36 cases), ductal carcinoma in situ (9 cases), intraductal carcinoma (5 cases), invasive lobular carcinoma (1 case), mucinous adenocarcinoma (1 case) and atypical medullary carcinoma (1 case). 44 cases were classified as 4B and above by BI-RADS with molybdenum target X-ray, the diagnostic coincidence rate was 833%. Color Doppler BI-RADS classification of 41 cases with 4 B and above, the diagnostic coincidence rate 7750. There were 51 cases with BI-RADS classification 4B and above by mammography combined with ultrasound. The diagnostic coincidence rate was 96%. Conclusion 1. Microcalcification is of great significance in the diagnosis of non-mass breast cancer, especially in the multiform calcification of cluster distribution. On the molybdenum target X-ray, the center is low density starlike shadow, should consider the breast cancer possible. 3. Molybdenum target X-ray has the advantage of micro-calcification and ultrasound is more sensitive to asymmetric local dense lesions. The combination of the two can obviously improve the diagnostic coincidence rate of non-mass breast cancer.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9;R730.44
本文編號：2200778
[Abstract]:Objective to study the characteristics of mammography in non-mass breast cancer by retrospectively analyzing the imaging features of mammography in patients with non-mass breast cancer, so as to improve the level of mammography in the diagnosis of non-mass breast cancer. By comparing the diagnostic coincidence rate of mammography, ultrasound and their combination in non-mass breast cancer, the advantages were analyzed and the effective ways to improve the detection rate of non-mass breast cancer were discussed. Methods from July 2015 to January 2017, 53 patients with non-mass breast cancer confirmed by surgery and pathology (i.e., no space occupying effect in two different scan directions) were selected. All the patients underwent mammography and color Doppler ultrasonography before operation. The X-ray findings of 53 patients were analyzed and compared with the results of ultrasound and pathology. All patients were examined with bilateral head and tail position (CC) and lateral oblique position (MLO). According to the necessary examination of lateral (ML), axillary caudal (AT), tangent (TAN) or magnification (M), the types of breast were analyzed. Fatty type (ACR1), small amount of glandular type (ACR2), multiple glandular type (ACR3) and dense type (ACR4). The mammography examination is operated by a professional technician. According to the size, thickness and density of the mammary gland, the exposure is automatically controlled under different conditions. The X-ray images of molybdenum target were interpreted by two senior doctors, and the lesions were judged by density, shape, boundary, location, range, distribution, structure of glands and combined signs. Color Doppler ultrasound was observed by two senior doctors simultaneously. The lesions were judged by echo, shape, edge, blood flow signal, posterior acoustic image, aspect ratio, position and elastic imaging. Mammography and color Doppler ultrasound were all performed with the mammography report and data system (Brest Imaging Reporting and Data System,BI-RADS). The results showed that BI-RADS classification 4B or above was considered to be in accordance with the diagnosis. The diagnostic coincidence rate of molybdenum target X-ray, color Doppler ultrasound and their combined diagnosis was analyzed by SPSS19.0 software. The difference was statistically significant by 蠂 2 test (P 0.05). Results among the 53 cases of non-mass breast cancer, 24 cases were microcalcification (45.3%), 14 cases were structural distortion (26.4%), 13 cases were asymmetric local density (24.5%), and 2 cases (3.8%) were associated with signs. The pathological results were as follows: invasive ductal carcinoma (36 cases), ductal carcinoma in situ (9 cases), intraductal carcinoma (5 cases), invasive lobular carcinoma (1 case), mucinous adenocarcinoma (1 case) and atypical medullary carcinoma (1 case). 44 cases were classified as 4B and above by BI-RADS with molybdenum target X-ray, the diagnostic coincidence rate was 833%. Color Doppler BI-RADS classification of 41 cases with 4 B and above, the diagnostic coincidence rate 7750. There were 51 cases with BI-RADS classification 4B and above by mammography combined with ultrasound. The diagnostic coincidence rate was 96%. Conclusion 1. Microcalcification is of great significance in the diagnosis of non-mass breast cancer, especially in the multiform calcification of cluster distribution. On the molybdenum target X-ray, the center is low density starlike shadow, should consider the breast cancer possible. 3. Molybdenum target X-ray has the advantage of micro-calcification and ultrasound is more sensitive to asymmetric local dense lesions. The combination of the two can obviously improve the diagnostic coincidence rate of non-mass breast cancer.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9;R730.44
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