非肿块型乳腺癌的钼靶X线征象分析

发布时间：2018-08-24 12:09

【摘要】：目的通过回顾分析确诊为非肿块型乳腺癌患者的钼靶X线的影像学表现,研究非肿块型乳腺癌的钼靶X线影像学特点,以提高通过钼靶X线诊断非肿块型乳腺癌的水平。通过对比钼靶X线、超声及两者联合对非肿块型乳腺癌的诊断符合率,分析各自的优势并探讨提高非肿块型乳腺癌检出率的有效途径。方法选取2015年7月-2017年1月我院收治的经手术病理证实为非肿块型乳腺癌(即在两个不同的扫查方向上不具备空间占位效应)患者53例。所有患者术前均行钼靶X线及彩色多普勒超声检查,对53例患者的钼靶X线表现进行分析,并与超声及病理结果进行对比。所有患者行双侧乳腺头尾位(CC位)及内外侧斜位(MLO位)检查,根据必要行侧位(ML位)、腋尾位(AT位)、切线位(TAN位)或放大位(M+位)检查,对患者的乳腺类型进行分析,脂肪型(ACR1)、少量腺体型(ACR2)、多量腺体型(ACR3)及致密型(ACR4)。钼靶X线检查由专业技师操作,根据乳腺大小、厚度以及致密程度来选择不同的条件,曝光量自动控制。钼靶X线图像由两名资深医师进行解读,主要通过密度、形状、边界、部位、范围、分布、腺体结构及合并征象对病变进行综合判定。彩色多普勒超声由两名资深医师同时进行动态观察,主要通过回声、形态、边缘、血流信号、后方声影、纵横比、部位及弹性成像等对病变进行综合判定。钼靶X线和彩色多普勒超声均采用乳腺影像报告及数据系统(Brest Imaging Reporting and Data System,BI-RADS),结果为BI-RADS分类4B及以上者视为诊断符合。钼靶X线、彩色多普勒超声与两者联合诊断符合率比较用SPSS19.0版统计学软件进行分析,各组间比较用χ2检验,P0.05,差异具有统计学意义。结果53例非肿块型乳腺癌中,微小钙化24例,占45.3%;结构扭曲14例,占26.4%;非对称性局部致密13例,占24.5%;合并征象2例,占3.8%。病理结果分别是:浸润性导管癌36例,导管原位癌9例,导管内癌5例,浸润性小叶癌1例,粘液腺癌1例,不典型髓样癌1例。钼靶X线BI-RADS分类4B及以上者44例,诊断符合率83%。彩色多普勒超声BI-RADS分类4B及以上者41例,诊断符合率77%。钼靶X线联合超声检查,BI-RADS分类4B及以上者51例,诊断符合率96%。结论1.微小钙化在非肿块型乳腺癌的诊断中有重要意义,特别是簇状分布的多形性钙化。2.钼靶X线上,出现中心为低密度的星芒状影,应考虑到乳腺癌的可能。3.钼靶X线对于微小钙化有优势,超声对于非对称性局部致密的病变较为敏感,两者联合能明显提高非肿块型乳腺癌的诊断符合率。
[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.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R730.44

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