Evaluation of internal and shell stiffness in the differential diagnosis of breast non-mass lesions by shear wave elastography

BACKGROUND The diagnostic specificity of conventional ultrasound for breast non-mass lesions(NMLs)is low at approximately 21%-43%.Shear wave elastography(SWE)can distinguish benign from malignant lesions by evaluating the internal and peripheral stiffness.SWE has good reproducibility and high diagnostic efficacy.However,there are very few independent studies on the diagnostic value of SWE in breast NMLs.AIM To determine the value of SWE in the differential diagnosis of breast NMLs.METHODS This study enrolled a total of 118 patients with breast NMLs who underwent SWE examinations in the Beijing Shijitan Hospital Affiliated to Capital Medical University and The Second Hospital of Shandong University from January 2019 to January 2020.The internal elastic parameters of the lesions were recorded,including maximum(Emax),mean(Emean)and minimum elastic values and the standard deviation.The following peripheral parameters were noted:Presence of a“stiff rim”sign;Emax,and Emean elasticity values within 1 mm,1.5 mm,2 mm,2.5 mm and 3 mm from the edge of NMLs.The receiver operating characteristic curve of each parameter was drawn,and the areas under the curve were calculated.RESULTS Emax,Emean and elastic values,and the standard deviation of the internal elastic values in malignant NMLs were significantly higher than those in benign NMLs(P<0.05).The percentage with the“stiff rim”sign in malignant NMLs was significantly higher than that in the benign group(P<0.05),and Emax and Emean at the shell of 1 mm,1.5 mm,2 mm,2.5 mm and 3 mm in the malignant group were all higher than those in the benign group(P<0.05).Of the surrounding elasticity values,Emax of the shell at 2.5 mm in malignant NMLs had maximum areas under the curve of 0.900,and the corresponding sensitivity and specificity were 94.57%and 85.86%,respectively.CONCLUSION The“stiff rim”sign and multiple quantitative elastic values within and around the lesion had good diagnostic performance in the differential diagnosis of breast NMLs.Emax in peripheral tissue had better diagnostic efficiency than other parameters.

Breast non-mass-like lesions on contrast-enhanced ultrasonography: Feature analysis, breast image reporting and data system classification assessment

BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System(BI-RADS).Contrast-enhanced ultrasound(CEUS)can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography(US),color Doppler flow imaging(CDFI)and CEUS,and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019.All lesions were examined by US,CDFI and CEUS,and their features from those examinations were analyzed.With pathology as the gold standard,binary logic regression was used to analyze the independent risk factors for malignant breast NMLs,and a regression equation was established to calculate the efficiency of combined diagnosis.Based on the regression equation,the combined diagnostic efficiency of US combined with CEUS(US+CEUS)was determined.The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS,and the diagnostic efficiency of CEUS combined with BI-RADS(CEUS+BI-RADS)was calculated based on the results.ROC curves were drawn to compare the diagnostic values of the three methods,including US,US+CEUS,and CEUS+BI-RADS,for benign and malignant NMLs.RESULTS Microcalcification,enhancement time,enhancement intensity,lesion scope,and peripheral blood vessels were significantly different between benign and malignant NMLs.Among these features,microcalcification,higher enhancement,and lesion scope were identified as independent risk factors for malignant breast NMLs.When US,US+CEUS,and CEUS+BI-RADS were used to identify the benign and malignant breast NMLs,their sensitivity rates were 82.6%,91.3%,and 87.0%,respectively;their specificity rates were 71.4%,89.2%,and 92.9%,respectively;their positive predictive values were 70.4%,87.5%,and 90.9%,respectively;their negative predictive values were 83.3%,92.6%,and 89.7%,respectively;their accuracy rates were 76.5%,90.2%,and 90.2%,respectively;and their corresponding areas under ROC curves were 0.752,0.877 and 0.903,respectively.Z tests showed that the area under the ROC curve of US was statistically smaller than that of US+CEUS and CEUS+BI-RADS,and there was no statistical difference between US+CEUS and CEUS+BI-RADS.CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs.The adjustment of the BI-RADS classification according to the features of contrastenhanced US of NMLs enables the diagnostic results to be simple and intuitive,facilitates the management of NMLs,and effectively reduces the incidence of unnecessary biopsy.

Expression and clinical significance of E-cadherin, β-catenin and E-cadherin-catenins complex in breast cancer and precancerous lesions

Objective： The aim of our study was to observe the expressions and clinical Significance of E-cadherin, β-catenin and E-cadherin-catenins complex in breast cancer and precancerous lesions, and analyze the relationship between the expressions and clinicopathological features in breast cancer. Methods： Immunhistochemical UltraSensitiveTM S-P method was employed to detect the expression of E-cadherin, β-catenin and E-cadherin-catenins complex in 128 cases of invasive ductal carcinomas, 89 cases of ductal carcinoma in situ and 57 cases of atypical ductal hyperplasia, 53 cases of usual ductal hyperplasia breast tissues were selected as a control group. The express of E-cadherin, β-catenin and their relationship with mult biological parameters including histological grade, region lymph node metastasis, distant metastasis and recurrence on files were also assessed. Results： （1） The staining patterns character of E-cadherin, β-catenin and E-cadherin-catenins complex： In UDH breast tissues, E-cadherin and a-catenin were expressed on cell membrane of ductal and acinic cells, showing cellular contour and border among cells. The abnormal expression of the three proteins occurred in breast invasive ductal carcinomas, ductal carcinoma in situ and atypical ductal hyperplasia tissues, showing cytoplasmic or nuclear staining, decrease and loss of cytomembrane staining. （2） The abnormal expression rates of E-cadherin, β-catenin and E-cadherin-catenins complex in invasive ductal carcinomas were 53.91%, 65.63% and 81.25%, which were significantly higher than that in ductal carcinoma in situ, atypical ductal hyperplasia, usual ductal hyperplasia tissues （P 〈 0.01）. Compared with usual ductal hyperplasia breast tissues group, the abnormal expression rates of E-cadherin, β-catenin and E-cadherin-catenins complex were significantly decreased （P 〈 0.01） in the breast cancer group. However, there was no significance of the abnormal expression rate between ductal carcinoma in situ and atypical ductal hyperplasia tissues groups （X2 = 0.76, P = 0.38; x2 = 0.14, P = 0.70; x2 = 0.81, P = 0.37; X2 = 2.19, P = 0.14） （P 〉 0.05）. （3） There was a significantly difference in the mean E-cadherin, β-catenin and E- cadherin-catenins complex frequency between estrogen receptor ＆ progesterone receptor positive IDC group and negative group, epidermal growth factor receptor type 2 （HER2/neu） positive and negative groups, Ki-67 proliferation index 〈 14% and 〉 14% groups, histological grade （I ＋ II） and grade III invasive ductal carcinomas groups, with lymph node metastasis, distant metastasis and recurrence groups （P 〈 0.05） and without groups （P 〈 0.05）. However, there was no difference in the mean E-cadherin, β-catenin and E-cadherin-catenins complex frequency between age （_〈 50 years vs 〉 50 years）, tumor diameter （〈 2 cm vs 〉 2 cm） （P 〉 0.05）. Conclusion： In breast cancer, the expressions of E-cadherin, β-catenin and E-cadherin-catenins complex are abnormally decreased and are correlated with pathology grade, differentiation disturbance and metastasis. E- cadherin and β-catenin may be as the predictors for prognosis. Combined detection may improve accuracy and sensitivity of predicting metastasis and prognosis of breast Cancer.

Clinical and pathological characteristics of intraductal proliferative lesions and coexist with invasive ductal carcinomas

Objective： The purpose of this study was to study the clinical and pathological characteristics of breast intraductal proliferative lesions （IDPLs） and associated with invasive breast cancer. Methods： We reviewed 327 cases of breast intra- ductal proliferative lesions including 53 cases of usual ductal hyperplasia, 57 cases of atypical ductal hyperplasia, 89 cases of ductal carcinoma in situ, and 128 cases coexist with invasive ductal carcinomas. Cases of pure invasive cancer without intraductal proliferative lesions were excluded. The mult IDPLs biological parameters including the express of ER, PR, HER2, HIF-lo and Ki-67 detected by immunohistochemistry S-P method （n = 327） and the levels of CA153, TSGF, CA125 and CEA both in nipple discharge and serum （n = 179） measured with Electrochemiluminescence method and their relationship were studied, and 30 cases of normal pregnant women were compared with. Results： A single histologic subtype was present in 49.85% （163/327） of the cases, two subtypes in 33.03% （108/327）, and three in 17.13% （56/327）. The most common subtypes present were cribriform （43.12%, 141/327） and solid （38.53%, 126/327）, while the comedo （16.35%, 54/327）, and micropapillary （12.84%, 42/327） subtypes were less common. Comedo and solid were frequently found together for coexpres- sion as were micropapillary and papillary subtypes. However, Comedo subtype was much less likely to be found with papillary, cribriform or micropapillary subtypes. Additionally, comedo subtypes tend to be hormone receptor negative, Her2 positive and high-grade while the cribriform and solid subtype tends to be hormone receptor positive, Her2 negative and low grade. Papil- lary subtype was least likely to be associated with an invasive cancer. Furthermore, the nipple discharge and serum levels of CA153, TSGF, CA125 and CEA in coexist with invasive ductal carcinomas patients were significantly higher than those in the benign breast disease （pure intraductal proliferative lesions） and normal pregnant women （P 〈 0.01）. Additionally, the levels of CA153, TSGF, CA125 and CEA in nipple discharge were significantly higher than in the serum （P 〈 0.01）, and had a positive correlation with the Ki-67, grade, clinical stage, lymph node metastasis and tumor recurrence （P 〈 0.05）, and negative correla- tion with the level of ER and PR （P 〈 0.05）. The sensitivity of the four serum tumor markers in combination was only 69.77%, in contrast, the combined detection both in discharge and serum was 97.67%, and the negative predictive value was 99.03%. The sensitivity of combined detection both in nipple discharge and serum were significantly higher than other detection （P 〈 0.05）. Conclusion： IDPLs often present more than one histologic subtype and the most common subtypes are cribriform and solid, while comedo and micropapillary subtypes are less common. Our results suggest that the levels of CA153, TSGF, CA125 and CEA in nipple discharge were significantly higher than those in the serum, and is associated with HIF-le. The aberration of HIF-la may play a key role during oncogenesis and promote breast cellular transformation into malignancy, a finding useful for further understanding of tumorigenesis. Nipple discharge can be the earliest presenting symptom of breast cancer. The dynamic combined detection of the four tumor markers both in nipple discharge and serum are helpful to the stratification of preoperative patients and benefit to better prewarning markers for monitoring their recurrence and metastasis and clinical staging of tumors in clinic, but cannot increase the sensitivity of judging the patients with early breast cancer.

基于瘤体及瘤周多参数MRI对乳腺病变良恶性诊断列线图预测模型的构建与评价

目的:建立基于瘤体及瘤周多参数MRI的乳腺病变良恶性鉴别诊断的列线图模型,并验证其预测效能。方法:纳入经病理学检查明确乳腺病变性质的100例患者作为研究对象,所有患者均行核磁共振(MRI)检查和病理检查,根据病理检查结果分为乳腺良性病变组(n=62)和乳腺恶性病变组(n=38)。收集患者临床资料、瘤体各参数、瘤周各参数以及乳腺病变良恶性情况。多因素Logistic回归分析筛选乳腺恶性病变的危险因素并构建列线图预测模型,采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验验证模型的预测效能及拟合优度;内部验证采用Bootstrap。结果:乳腺恶性病变组病灶直径、平均扩散峰度(MK)、MDp/t、瘤周与瘤体MKp/n高于乳腺良性病变组(均P<0.05);乳腺恶性病变组表观扩散系数(ADC)值、平均扩散率(MD)、非对称磁化转移率(MTRasym)、MKp/t、MDp/n低于乳腺良性病变组(均P<0.05)。多因素分析结果显示,病灶直径、MK、MDp/t、MKp/n升高,ADC值、MD、MTRasym、MKp/t、MDp/n降低是乳腺恶性病变的独立影响因素(均P<0.05)。基于上述独立影响因素构建乳腺恶性病变的列线图预测模型,曲线下面积(AUC)为0.827。Hosmer-Lemeshow拟合优度检验显示P值为0.004。采用Bootstrap法,生成的校准曲线拟合良好。结论:瘤体及瘤周多参数MRI对乳腺病变良恶性鉴别诊断具有重要预测价值,基于乳腺恶性病变的独立影响因素构建的列线图预测效果良好,能直观预测乳腺发生恶性病变的概率。

基于磁共振多模态成像定量参数鉴别诊断乳腺良恶性病变及与临床病理特征的关系探究

目的 分析磁共振多模态成像定量参数鉴别诊断乳腺良恶性病变的价值,并探究乳腺病变性质与临床病理特征的关系。方法 纳入2015年1月-2022年12月医院120例乳腺占位性病变患者,所有患者入院时均接受磁共振多模态成像检查,包括弥散加权(DWI)、磁共振波谱成像(MRS)与磁共振动态增强(DCE-MRI),以病理检查结果为“金标准”,分析该检查方式鉴别诊断乳腺良恶性病变的价值。依据乳腺占位性病变性质将患者分为恶性组与良性组,对比两组临床病理特征,分析乳腺病变性质与临床病理特征的关系。结果 120例乳腺占位性病变患者经病理检查结果显示,乳腺癌98例(81.67%),乳腺良性病变22例(18.33%);以病理检查结果为“金标准”,DCE-MRI及联合诊断乳腺病变性质的灵敏度、准确度高于DWI(P<0.05);乳腺癌组表观扩散系数(ADC)、rADC值低于乳腺良性病变组,Ⅰ型TIC曲线占比低于乳腺良性病变组,Ⅲ型TIC曲线占比高于乳腺良性病变组(P<0.05);绘制ROC曲线,结果显示,ADC、rADC及TIC曲线类型诊断乳腺病变性质具有一定价值(AUC=0.815、0.850、0.911);乳腺癌组肿瘤形态不规则、边缘毛刺/不规则、强化不均匀占比高于乳腺良性病变组(P<0.05);经Logistic回归分析,结果显示,肿瘤临床病理特征与乳腺占位性病变密切相关,形态不规则、边缘毛刺/不规则、强化不均匀是乳腺癌的危险因素(OR>1,P<0.05)。结论磁共振多模态成像定量参数对乳腺良恶性病变具有一定鉴别诊断价值,乳腺癌的发生与肿瘤形态不规则、边缘毛刺/不规则、强化不均匀等临床病理特征密切相关。

对比增强能谱乳腺X线摄影定量强化参数对乳腺病变的诊断价值

目的 通过对比增强能谱乳腺X线摄影(CESM)减影图像强化参数定量分析,探讨其对乳腺良恶性病变的鉴别诊断价值。方法 选取2021年8月至2022年9月于成都市龙泉驿区第一人民医院及成都市妇女儿童中心医院行CESM检查并经病理确诊乳腺病变的女性患者102例为研究对象,其中1例患者双侧乳腺各1例病灶,1例患者单侧乳腺有2例病灶。研究共104例病灶,根据病理结果分为良性组78例,恶性组26例,分别测量CESM图像上乳腺病灶及背景实质的强化参数,并计算病灶相对强化值_(-CC)、病灶相对强化值_(-MLO)、△病灶强化1、△病灶强化2,对比分析两组间强化参数的差异,并采用ROC曲线评价不同强化参数对乳腺良恶性病变的鉴别诊断效能。结果 恶性组双乳头尾位(CC位)及内外斜位(MLO位)上的BPE_(-平均)指标,明显大于良性组,差异有统计学意义(P<0.05);恶性组的病灶_(-CC、)病灶_(-MLO)、病灶相对强化值_(-CC)均大于良性组,差异均有统计学意义(P<0.05)。恶性组△病灶强化_1、△病灶强化_2的数值变化大于良性组,差异均有统计学意义(P<0.05)。病灶_(-CC)的AUC值高于病灶_(-MLO),差异有统计学意义(P<0.05),△病灶强化_1的AUC值稍高于△病灶强化_2,但差异无统计学意义(P>0.05)。病灶_(-CC)、病灶_(-MLO)、病灶相对强化值_(-CC)鉴别诊断乳腺良恶性病变的敏感度分别为96.15%、96.15%、88.46%,特异度分别为42.13%、37.18%、57.69%,约登指数分别为0.38、0.33、0.46;△病灶强化_1、△病灶强化_2鉴别诊断乳腺良恶性病变的敏感度分别为65.38%、46.15%,特异度分别为89.74%、98.72%,约登指数分别为0.55、0.45。结论 CESM不同强化参数能为乳腺良恶性病变的鉴别诊断提供依据。

The value of synthetic MRI in the differential diagnosis of benign and malignant breast lesions

Objective To investigate the diagnostic value of synthetic MRI methods in the differentiation of benign and malignant breast lesions.Methods Clinical and imaging data of 93 breast patients confirmed by pathology in the Second Affifiliated Hospital of Xi’an Jiaotong University from May 2019 to April 2020 were analyzed retrospectively.

Monoexponential, biexponential and stretched-exponential models based diffusion weighted imaging: a comparative study in the differential diagnosis of benign and malignant breast lesions

Objective To investgate the value of various parameters obtained from monoexponential,biexponential,and stretched exponential diffusion-weighted imaging models in the differential diagnosis of breast lesions.Methods A retrospective study was performed in 54 patients with pathologically confirmed malignant tumors(n=30),benign lesions(n=34)and normal fibroglandular

基于不同磁共振成像技术的影像组学在乳腺病变鉴别诊断中的应用

乳腺癌是女性最常见的恶性肿瘤,在中国女性肿瘤发病中居于首位。目前乳腺磁共振成像(magnetic resonance imaging,MRI)已经被广泛应用于乳腺检查中,且较其他影像学检查具有显著优势。影像组学是近十年来研究的热点,可提取出人眼识别不了的影像特征,为乳腺病变提供定性诊断。基于MRI的影像组学在乳腺良恶性病变的鉴别中具有显著价值,本综述主要详细阐述了基于不同MRI技术的影像组学在乳腺病变中的应用,回顾了近年来基于不同MRI的影像组学研究进展,以及这些技术在乳腺病变的诊断与鉴别等方面的价值。本综述能够为乳腺病变的诊断与鉴别等提供有效信息,为乳腺病变的个性化治疗方案提供重要参考,助力尽早实现精准医学。

MRI引导下乳腺病变真空辅助旋切活检术的临床应用

目的 探讨MRI引导下真空辅助旋切活检术(vacuum-assisted biopsy, VAB)对仅MRI显示乳腺病变的可行性及诊断准确性。材料与方法 回顾性分析2019年9月至2022年12月在我院行MRI引导下VAB的患者27例,共27个病变。所有病灶BI-RADS分为4类或5类。采用3.0 T MRI扫描仪、开放式乳腺穿刺线圈、磁共振兼容活检穿刺定位架及MRI兼容耗材。记录病变的影像学特征、活检病理结果、恶性病变术后最终病理结果及术中、术后并发症情况。以手术后病理结果或良性病变至少半年后随访结果为金标准,计算VAB的诊断准确度、敏感度、特异度、阳性预测值及阴性预测值,并评估活检病变组织学低估情况。结果 所有病例均一次性成功取样并取得病理学结果,活检技术成功率100%(27/27)。平均操作时间(39.92±8.34)min。活检诊断为恶性病变7个(25.93%);非典型导管增生2个(7.41%);其余良性病变18个(66.67%),恶性病变检出率25.93%。将活检病理结果与术前MRI图像进行对照,未出现影像—病理不一致情况。所有活检诊断为恶性病变或非典型导管增生的患者进一步行外科手术切除,活检结果与术后病理结果相一致,未出现组织学低估情况;活检诊断为良性病变者,其中2个乳腺炎性病变半年随访病变缩小;其余随访未见明显变化。VAB结果显示准确度100%(27/27),敏感度100%(7/7),特异度100%(20/20),阳性预测值100%(7/7),阴性预测值100%(20/20)。1例患者在术中出现迷走神经反应症状,主要由精神紧张引起,经休息、心理安抚后很快恢复。结论 对于仅在乳腺MRI检查发现的可疑病变,MRI引导VAB能够安全、精准、有效地完成组织取样以用于病理学评估,病理诊断准确性高且并发症少,值得临床应用推广。

超声造影检查定量参数联合检测在乳腺非肿块样强化病变良恶性鉴别诊断中的应用价值

目的:观察超声造影检查定量参数联合检测在乳腺非肿块样强化病变良恶性鉴别诊断中的应用价值。方法:选取2021年4月至2023年4月该院收治的118例乳腺非肿块样强化病变患者进行前瞻性研究,患者均行超声造影检查,以术后病理结果为“金标准”,将患者分为良性组(n=49)、恶性组(n=69),比较两组超声造影检查影像学表现和定量参数(时间-强度曲线峰值强度、达峰时间、上升时间、平均通过时间、从峰值将至一半时间、曲线下面积),采用受试者工作特征(ROC)曲线分析超声造影检查定量参数中峰值强度、达峰时间、曲线下面积联合检测在乳腺非肿块样强化病变良恶性鉴别诊断中的价值。结果:恶性组不均匀增强、高增强、伴穿支血管、增强后病灶扩大、造影剂快进慢退发生率均高于良性组,差异有统计学意义(P<0.05);恶性组峰值强度高于对照组,曲线下面积大于对照组,达峰时间短于对照组,差异均有统计学意义(P<0.05);两组上升时间、平均通过时间、从峰值降至一半时间比较,差异均无统计学意义(P>0.05);ROC曲线结果显示,峰值强度、达峰时间、曲线下面积单项及联合检测鉴别诊断乳腺非肿块样强化病变良恶性的曲线下面积分别为0.774、0.748、0.818、0.935,联合检测诊断价值高于三者单项检测诊断价值。结论:超声造影定量参数中峰值强度、达峰时间、曲线下面积联合检测鉴别诊断乳腺非肿块样强化病变良恶性的价值高于三者单项检测。

MRI动态对比增强时间-信号强度曲线与弥散加权成像表观弥散系数检查对乳腺良恶性病变的鉴别诊断价值

目的 探讨MRI动态对比增强时间-信号强度曲线(DCE-TIC)与弥散加权成像表观弥散系数(DWIADC)检查对乳腺良恶性病变的鉴别诊断价值。方法 106例乳腺占位性病变患者均行DCE-TIC、DWI-ADC检查,根据检查结果分为乳腺良性病变和乳腺癌患者,比较乳腺良性病变和乳腺癌患者的ADC值、rADC、TIC分型。以病理检查结果为金标准,分析DCE-TIC、DWI-ADC单独及联合检查对乳腺癌的诊断价值。结果 病理检查结果显示,106例乳腺占位性病变患者中,乳腺癌87例,乳腺良性病变19例。乳腺良性病变患者ADC值、rADC均明显高于乳腺癌患者,差异均有统计学意义(P﹤0.01)。乳腺良性病变TIC分型Ⅰ型患者比例明显高于乳腺癌,TIC分型Ⅲ型患者比例明显低于乳腺癌,差异均有统计学意义(P﹤0.01)。乳腺良性病变与乳腺癌TIC分型Ⅱ型患者比例比较,差异无统计学意义(P﹥0.05)。DCE-TIC、DWI-ADC联合检查诊断乳腺癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于二者单独检查。结论 DCE-TIC、DWI-ADC联合检查诊断乳腺癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于二者单独检查,诊断效能良好。

基于临床及对比增强乳腺X线摄影技术构建乳腺良恶性病变评价模型

目的:基于临床及对比增强乳腺X线摄影技术,构建乳腺良恶性病变评价模型。方法:选取2021年1月—2022年12月邹平市中心医院收治的乳腺良恶性病变患者380例为研究对象,其中恶性病变151例纳入恶性组,良性病变229例纳入良性组,比较两组临床资料,对比增强乳腺X线摄影技术相关指标,分析乳腺恶性病变影响因素,构建乳腺良恶性病变评价模型。结果:经Logistic分析,病灶最大径≥2 cm、病灶固定、强化类型(Ⅱ型强化)、强化类型(Ⅲ型强化)、强化程度(重度)、强化方式(不均匀)、征象(分叶)、大导管征为乳腺恶性的危险因素(P<0.05);Hosmer-Lemeshow检验显示,χ^(2)=0.694,P=1.000,模型拟合优度较好。结论:基于临床及对比增强乳腺X线摄影技术构建的鉴别乳腺良恶性病变的评价模型效果较好,能够为乳腺良恶性病变的鉴别诊断提供参考。

多模态MRI对乳腺良恶性病变的鉴别诊断研究

目的:探讨多模态磁共振(MRI)检查对乳腺良恶性病变的诊断价值及效果。方法:选取临沂市肿瘤医院2020年6月—2023年4月收治的乳腺病变患者200例为研究对象,所有患者均采用飞利浦Ingenia 3.0T磁共振、8通道乳腺专用线圈完成患者平扫、磁共振动态增强(DCE-MRI)扫描和弥散加权成像(DWI)检查,参考ACR BI-RADS-MRI完成乳腺良恶性病变的解读、诊断及分级,并以病理结果为“金标准”,分析多模态MRI对乳腺良恶性病变患者中的诊断鉴别效果。结果:200例乳腺病变患者经“金标准”检查确诊恶性病变56例(占28.00%)、良性病变142例(占72.00%)。MRI平扫检查恶性28例,DCE-MRI检查恶性48例,DWI检查恶性53例,多模态MRI检查恶性56例;金标准下恶性患者MRI检查下DWI扫描序列ADC值、EADC值低于良性患者(P<0.05);恶性患者Tmax低于良性患者(P<0.05);MSI及SER水平高于良性(P<0.05);多模态MRI用于乳腺良恶性病变鉴别中准确度、灵敏度、阳性和阴性预测值均高于单一扫描检查结果(P<0.05)。结论:多模态MRI用于乳腺良恶性病变鉴别中效果显著,能清晰地显示病变形态、血供及细胞代谢水平差异,具有典型的影像学特点。

DCE-MRI联合DWI诊断乳腺良恶性病变的临床价值分析

目的 分析磁共振动态增强(DCE-MRI)联合弥散加权成像(DWI)诊断乳腺良恶性病变的临床价值。方法 回顾性分析2019年3月至2021年9月到我院就诊的62例乳腺病变患者的临床资料。所有患者均于术前1周行3.0 T MRI平扫,DCE-MRI及DWI检查。以病理诊断结果为金标准,比较DCE-MRI检查、DWI检查及二者联合检查对乳腺良恶性病变的诊断效能。结果 本组62例患者,共71个病灶,其中乳腺恶性病变40例(46个病灶),乳腺良性病变22例(25个病灶),恶性病灶中以浸润性导管癌(43.40%)为主,良性病灶中以纤维腺瘤(36.00%)为主;乳腺良恶性病灶的边缘状态、病灶强化程度、TIC类型及ADC值比较差异有统计学意义(P<0.05),而两种病灶的形态、乳头受累、皮肤增厚、腋窝淋巴结肿大情况比较差异无统计学意义(P>0.05);DCE-MRI及DWI单独诊断乳腺良恶性病变的灵敏度(78.26%、89.13%),特异度(76.00%、64.00%)、准确率(77.46%、80.28%)均低于二者联合诊断(灵敏度91.30%、特异度92.00%、准确率91.55%)。结论 DCE-MRI联合DWI诊断乳腺癌良恶性病变可有效降低误诊、漏诊,提高诊断准确率,临床应用效果良好。

DCE-MRI技术及ADC值对乳腺非肿块样强化病变良恶性的诊断价值

目的:探讨DCE-MRI技术及表观扩散系数(ADC)值对乳腺非肿块样强化(NMLE)病变良恶性的诊断价值。方法:回顾性分析180例在邯郸市第一医院接受手术并完成病理组织学诊断乳腺NMLE病变患者的临床资料,均行多模态3.0T MRI检查,比较良恶性病变MRI分布类型、强化特点、时间-信号曲线(TIC)类型及ADC值,描绘ROC曲线评价ADC值鉴别诊断效能。结果:恶性病变组节段型和集丛样强化比例显著高于良性病变组(P<0.05);两组TIC类型比较差异无统计学意义(P>0.05);恶性病变ADC值≤1.3×10^(-3)mm^(2)/s比例显著高于良性病变组(P<0.05);恶性病变ADC值显著小于良性病变组(P<0.05);描绘ROC曲线后分析,ADC值用于乳腺NMLE良恶性病灶鉴别诊断AUC=0.73,最佳cut-off值为1.3×10^(-3)mm^(2)/s,灵敏度和特异度分别为72.33%和79.60%。结论:DCE-MRI技术及ADC值可有效提高乳腺NMLE良恶性病灶的诊断效能,具有临床应用价值。

人工智能对乳腺影像辅助诊断的研究进展

图像分析技术和高通量计算方法的发展促进人工智能与医学影像交叉融合。人工智能的发展为从乳腺X线摄影、超声和MRI成像数据中获取有价值的信息提供了前所未有的机会。从影像数据中挖掘的关键信息,重塑了乳腺疾病患者的临床管理策略。本文对人工智能辅助乳腺影像的应用现状和发展方向进行综述。

基于人工智能深度学习算法的超声诊断系统在触诊阴性的乳腺结节良恶性鉴别中的应用

目的:探讨基于人工智能深度学习算法的超声诊断系统在触诊阴性的乳腺结节良恶性鉴别中的应用。方法:回顾性分析120例乳腺结节患者临床资料,所有纳入的病例术前触诊阴性,并行超声检查、超声弹性成像以及人工智能深度学习算法S-Detect检查,术后有完整的病理组织学报告。分别计算超声弹性成像、人工智能S-Detect以及联合诊断方法对于乳腺良恶性结节的诊断价值。结果:120例患者共检查出153个乳腺病灶,组织病理学检查中良性病灶共97个,恶性病灶共56个。超声弹性成像共检出60个恶性结节和93个良性结节,超声弹性成像诊断敏感度75.00%,特异度81.44%,阳性预测值70.00%,阴性预测值84.95%,准确度79.08%。人工智能S-Detect共检出67个恶性结节和86个良性结节,人工智能S-Detect诊断敏感度91.07%,特异度83.51%,阳性预测值76.12%,阴性预测值94.19%,准确度86.27%。二者联合诊断共检出65个恶性结节和88个良性结节,诊断敏感度94.64%,特异度87.63%,阳性预测值81.54%,阴性预测值96.59%,准确度90.20%。与单独超声弹性成像或人工智能S-Detect相比,联合诊断方案AUC(95%CI)为0.864(0.790~0.942),具有更好的诊断效果。结论:基于人工智能深度学习算法的超声诊断系统在触诊阴性的乳腺结节良恶性鉴别中的应用效果较好,有助于辅助临床诊断。

探究PET-CT定量参数对乳腺癌诊断及预后评估的价值

目的分析正电子发射计算机断层显像(PET-CT)定量参数对乳腺癌诊断及预后评估的价值。方法选取2019年5月—2022年6月诊治的乳腺癌110例纳入恶性组,另选取同期治疗的乳腺良性病变100例纳入良性组,2组术前均行PET-CT检查。乳腺癌患者根据随访1年预后情况分为预后良好组71例及预后不良组39例。对比良性组与恶性组PET-CT定量参数[最大标准摄取值(SUV_(max))、肿瘤代谢体积(MTV)及糖酵解总量(TLG)],多因素Logistic回归分析探讨影响乳腺癌患者预后的危险因素,采用受试者工作特征曲线分析PET-CT定量参数对乳腺癌诊断及预后评估的价值。结果恶性组SUV_(max)、MTV及TLG均高于良性组(P<0.01)。SUV_(max)、MTV及TLG诊断乳腺癌的曲线下面积(AUC)分别为0.824、0.747、0.859,三者联合诊断的AUC为0.918。预后不良组SUV_(max)、MTV、TLG均高于预后良好组(P<0.01);肿瘤最大径、临床分期、淋巴结转移、SUV_(max)、MTV及TLG是影响乳腺癌患者预后不良的独立危险因素(P<0.01)。SUV_(max)、MTV及TLG预测乳腺癌患者预后不良的AUC分别为0.846、0.795、0.873,三者联合预测的AUC为0.894。结论PET-CT定量参数可用于乳腺癌的临床诊断及预后评估,且三者联合检测的应用价值更高。