AIM: To determine whether contrast-enhanced ultrasound(CEUS) can improve the precision of breast imaging reporting and data system(BI-RADS) categorization. METHODS: A total of 230 patients with 235 solid breast lesion...AIM: To determine whether contrast-enhanced ultrasound(CEUS) can improve the precision of breast imaging reporting and data system(BI-RADS) categorization. METHODS: A total of 230 patients with 235 solid breast lesions classified as BI-RADS 4 on conventional ultrasound were evaluated. CEUS was performed within one week before core needle biopsy or surgical resection and a revised BI-RADS classification was assigned based on 10 CEUS imaging characteristics. Receiver operating characteristic curve analysis was then conducted to evaluate the diagnostic performance of CEUS-based BI-RADS assignment with pathological examination as reference criteria. RESULTS: The CEUS-based BI-RADS evaluation classified 116/235(49.36%) lesions into category 3, 20(8.51%), 13(5.53%) and 12(5.11%) lesions into categories 4A, 4B and 4C, respectively, and 74(31.49%) into category 5. Selecting CEUS-based BI-RADS category 4A as an appropriate cut-off gave sensitivity and specificity values of 85.4% and 87.8%, respectively, for the diagnosisof malignant disease. The cancer-to-biopsy yield was 73.11% with CEUS-based BI-RADS 4A selected as the biopsy threshold compared with 40.85% otherwise, while the biopsy rate was only 42.13% compared with 100% otherwise. Overall, only 4.68% of invasive cancers were misdiagnosed.CONCLUSION: This pilot study suggests that evaluation of BI-RADS 4 breast lesions with CEUS results in reduced biopsy rates and increased cancer-to-biopsy yields.展开更多
AIM: To build and evaluate predictive models for contrast-enhanced ultrasound(CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system(B...AIM: To build and evaluate predictive models for contrast-enhanced ultrasound(CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system(BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve(ROC). RESULTS: Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant(P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively. CONCLUSION: The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BIRADS classification.展开更多
BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment...BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.展开更多
BACKGROUND Malignant adenomyoepithelioma(AME)of the breast is a rare tumor in which malignancy can arise from either epithelial or myoepithelial components,or from both cell types.The incidence and prognosis of malign...BACKGROUND Malignant adenomyoepithelioma(AME)of the breast is a rare tumor in which malignancy can arise from either epithelial or myoepithelial components,or from both cell types.The incidence and prognosis of malignant AME of the breast are difficult to assess due to its rarity.Therefore,the optimal treatment for this disease is still controversial.CASE SUMMARY We present two middle-aged women(48 and 56 years old)with malignant AME of the breast.Core needle biopsy was performed before surgery.However,breast adenoma and malignant tumors were observed.The preoperative diagnosis of malignant AME of the breast is still challenging for pathologists and clinicians.Both patients underwent mastectomy and sentinel lymph node biopsy,both of which were negative,followed by adjuvant chemotherapy.CONCLUSION The follow-up duration of the two patients was two years and four months,respectively.No signs of relapse or metastasis have been observed thus far.展开更多
自2013年美国放射学会出版第二版乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)后,乳腺超声的临床实践与科学研究均从中获益。本文总结了2013年版超声BI-RADS出版这10年间,乳腺超声影像技术临床应用与革...自2013年美国放射学会出版第二版乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)后,乳腺超声的临床实践与科学研究均从中获益。本文总结了2013年版超声BI-RADS出版这10年间,乳腺超声影像技术临床应用与革新、存在的问题与面临的挑战及未来的发展机遇,以期为临床诊治、指南推广与应用提供帮助。展开更多
目的探讨超声微血流成像联合剪切波弹性成像在鉴别甲状腺超声影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)4类结节良恶性的应用价值。方法回顾性选取2021年11月至2022年12月在杭州市中医院诊断为美国放射学...目的探讨超声微血流成像联合剪切波弹性成像在鉴别甲状腺超声影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)4类结节良恶性的应用价值。方法回顾性选取2021年11月至2022年12月在杭州市中医院诊断为美国放射学会(American College of Radiology,ACR)TI-RADS 4类的114个甲状腺结节,所有结节均行超声微血流成像及剪切波弹性成像检查,并与手术病理结果对比,评估微血流成像、剪切波弹性成像及二者联合应用的诊断效能。结果114例甲状腺TI-RADS 4类结节中,良性结节35例,恶性结节79例,恶性结节微血流成像模式多为聚集中断征及穿支血管征,剪切波弹性成像Emax值对鉴别良恶性差异有统计学意义(P<0.05),并且恶性结节SWE Emax≥41.6 kPa;超声微血流成像联合剪切波弹性成像诊断甲状腺TI-RADS 4类结节的敏感度、特异性和准确性分别为96.20%、65.72%、86.84%,曲线下面积为0.810,敏感度、准确性均高于单一诊断模式,差异有统计学意义(P<0.05)。结论超声微血流成像联合剪切波弹性成像能提高甲状腺TI-RADS 4类结节的良恶性诊断效能,具有较高的诊断敏感度及准确性,有助于此类结节的无创性鉴别诊断,避免不必要的穿刺活检。展开更多
目的分析基于超声乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类对不同病理类型乳腺肿块诊断的结果。方法方便选取2022年3月—2023年8月在枣庄市台儿庄区人民医院和济南市平阴县中医医院进行检查的74...目的分析基于超声乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类对不同病理类型乳腺肿块诊断的结果。方法方便选取2022年3月—2023年8月在枣庄市台儿庄区人民医院和济南市平阴县中医医院进行检查的74例女性患者为研究对象。以病理检查为金标准,经病理证实乳腺肿块共80个,采用kappa检验分析超声检查与病理结果的一致性。结果病理结果显示,良性肿块61个,恶性肿块19个(kappa值为0.710,P<0.01)。超声BI-RADS分类诊断的灵敏度、特异度、准确度分别为96.72%、84.21%、93.75%。超声BI-RADS对良性肿瘤的诊断符合率均≥85.71%,而对恶性肿瘤诊断中,符合率最低时为75.00%。结论虽然不同病理类型乳腺肿块的超声诊断符合率较高,但在实际操作过程中仍然存在漏诊误诊等情况,故需要临床医师了解超声检查的不足,对超声诊断质量做好把控。展开更多
文摘AIM: To determine whether contrast-enhanced ultrasound(CEUS) can improve the precision of breast imaging reporting and data system(BI-RADS) categorization. METHODS: A total of 230 patients with 235 solid breast lesions classified as BI-RADS 4 on conventional ultrasound were evaluated. CEUS was performed within one week before core needle biopsy or surgical resection and a revised BI-RADS classification was assigned based on 10 CEUS imaging characteristics. Receiver operating characteristic curve analysis was then conducted to evaluate the diagnostic performance of CEUS-based BI-RADS assignment with pathological examination as reference criteria. RESULTS: The CEUS-based BI-RADS evaluation classified 116/235(49.36%) lesions into category 3, 20(8.51%), 13(5.53%) and 12(5.11%) lesions into categories 4A, 4B and 4C, respectively, and 74(31.49%) into category 5. Selecting CEUS-based BI-RADS category 4A as an appropriate cut-off gave sensitivity and specificity values of 85.4% and 87.8%, respectively, for the diagnosisof malignant disease. The cancer-to-biopsy yield was 73.11% with CEUS-based BI-RADS 4A selected as the biopsy threshold compared with 40.85% otherwise, while the biopsy rate was only 42.13% compared with 100% otherwise. Overall, only 4.68% of invasive cancers were misdiagnosed.CONCLUSION: This pilot study suggests that evaluation of BI-RADS 4 breast lesions with CEUS results in reduced biopsy rates and increased cancer-to-biopsy yields.
文摘AIM: To build and evaluate predictive models for contrast-enhanced ultrasound(CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system(BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve(ROC). RESULTS: Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant(P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively. CONCLUSION: The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BIRADS classification.
文摘BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.
基金Supported by National Natural Science Foundation of China,No.81902675the Medical Science and Technology Foundation of Guangdong,No.A2018069。
文摘BACKGROUND Malignant adenomyoepithelioma(AME)of the breast is a rare tumor in which malignancy can arise from either epithelial or myoepithelial components,or from both cell types.The incidence and prognosis of malignant AME of the breast are difficult to assess due to its rarity.Therefore,the optimal treatment for this disease is still controversial.CASE SUMMARY We present two middle-aged women(48 and 56 years old)with malignant AME of the breast.Core needle biopsy was performed before surgery.However,breast adenoma and malignant tumors were observed.The preoperative diagnosis of malignant AME of the breast is still challenging for pathologists and clinicians.Both patients underwent mastectomy and sentinel lymph node biopsy,both of which were negative,followed by adjuvant chemotherapy.CONCLUSION The follow-up duration of the two patients was two years and four months,respectively.No signs of relapse or metastasis have been observed thus far.
文摘自2013年美国放射学会出版第二版乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)后,乳腺超声的临床实践与科学研究均从中获益。本文总结了2013年版超声BI-RADS出版这10年间,乳腺超声影像技术临床应用与革新、存在的问题与面临的挑战及未来的发展机遇,以期为临床诊治、指南推广与应用提供帮助。
文摘目的探讨超声微血流成像联合剪切波弹性成像在鉴别甲状腺超声影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)4类结节良恶性的应用价值。方法回顾性选取2021年11月至2022年12月在杭州市中医院诊断为美国放射学会(American College of Radiology,ACR)TI-RADS 4类的114个甲状腺结节,所有结节均行超声微血流成像及剪切波弹性成像检查,并与手术病理结果对比,评估微血流成像、剪切波弹性成像及二者联合应用的诊断效能。结果114例甲状腺TI-RADS 4类结节中,良性结节35例,恶性结节79例,恶性结节微血流成像模式多为聚集中断征及穿支血管征,剪切波弹性成像Emax值对鉴别良恶性差异有统计学意义(P<0.05),并且恶性结节SWE Emax≥41.6 kPa;超声微血流成像联合剪切波弹性成像诊断甲状腺TI-RADS 4类结节的敏感度、特异性和准确性分别为96.20%、65.72%、86.84%,曲线下面积为0.810,敏感度、准确性均高于单一诊断模式,差异有统计学意义(P<0.05)。结论超声微血流成像联合剪切波弹性成像能提高甲状腺TI-RADS 4类结节的良恶性诊断效能,具有较高的诊断敏感度及准确性,有助于此类结节的无创性鉴别诊断,避免不必要的穿刺活检。
文摘目的分析基于超声乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类对不同病理类型乳腺肿块诊断的结果。方法方便选取2022年3月—2023年8月在枣庄市台儿庄区人民医院和济南市平阴县中医医院进行检查的74例女性患者为研究对象。以病理检查为金标准,经病理证实乳腺肿块共80个,采用kappa检验分析超声检查与病理结果的一致性。结果病理结果显示,良性肿块61个,恶性肿块19个(kappa值为0.710,P<0.01)。超声BI-RADS分类诊断的灵敏度、特异度、准确度分别为96.72%、84.21%、93.75%。超声BI-RADS对良性肿瘤的诊断符合率均≥85.71%,而对恶性肿瘤诊断中,符合率最低时为75.00%。结论虽然不同病理类型乳腺肿块的超声诊断符合率较高,但在实际操作过程中仍然存在漏诊误诊等情况,故需要临床医师了解超声检查的不足,对超声诊断质量做好把控。
