三维容积成像在乳腺肿块诊断中的临床应用
摘要
目的:探讨三维超声容积成像在乳腺肿块中的应用。方法:57例乳腺肿块在二维超声检查的基础上,用容积探头进行三维成像,并与手术病理结果对照。结果:超声三维与二维相比,克服二维超声仅能对与超声束平行的平面成像的限制。它获得的病变信息更接近实际解剖结构;应用三维容积成像乳腺肿块的主要声像特征的检出有了提高,特别是对肿块边缘的阳性检出,二维和三维的差异有统计学意义(P<0.05);三维超声图像清晰、逼真、能够显示肿块的内部细微结构,冠状断面上可以清晰观察到恶性病灶对周边组织浸润的特殊征像“太阳征”,(汇聚征)并且三维彩色血流能量成像(3D-CDE)清晰显示肿块血供的空间分布,对鉴别乳腺肿块提供了帮助。结论:三维容积成像对诊断乳腺肿块,提供了一个有价值的方法。
Objective: TO explore the clinical value in the diagnosis of breast masses of three- dimensional (3D) volume Ultrasound. Methods: A total 57 breast masses were examined with three-dimensional volume ultrasound based on in the informations of Two-dimensional(2D) .All cases were comfirmed by pathology . Results: The images of Breast masses on 3D demonstrated characterstics of stereosocopic visually and clearly. The detection rate of boundary echo discordant on 3D is higher than 2D, it was statistically difference(P<0.05).A sign of maligancy on the coronal plane was observed by 3D .Ultasonograph named“sun-like symptom”(confluence spmptom ).Additionally,3D color Doppler energy imaging displayed the features of color flow distribution visually, which was helped in differentiating breast masses.Conclusions: Three-dimensional volume ultrasound is a valuable method in differentiating breast masses.
Objective: TO explore the clinical value in the diagnosis of breast masses of three- dimensional (3D) volume Ultrasound. Methods: A total 57 breast masses were examined with three-dimensional volume ultrasound based on in the informations of Two-dimensional(2D) .All cases were comfirmed by pathology . Results: The images of Breast masses on 3D demonstrated characterstics of stereosocopic visually and clearly. The detection rate of boundary echo discordant on 3D is higher than 2D, it was statistically difference(P<0.05).A sign of maligancy on the coronal plane was observed by 3D .Ultasonograph named“sun-like symptom”(confluence spmptom ).Additionally,3D color Doppler energy imaging displayed the features of color flow distribution visually, which was helped in differentiating breast masses.Conclusions: Three-dimensional volume ultrasound is a valuable method in differentiating breast masses.
引文
[1]张嘉庆,王殊,乔新民.乳腺癌的现状与远景[J].中华外科杂志, 2002, 40(3 ):161-163.
[2]田家玮,陈宇,刘宇杰。高频超声与X线钼靶联合应用对早期乳腺癌的诊断价值[J].中国医学影像技术,2006,22:557-559.
[3]沈德娟,杨斌.乳腺癌的超声诊断及其新进展[J].医学研究生学报,2007,20:203-206.
[4]周世崇,常才,陈敏,等.实时三维超声鉴别乳腺良恶性肿块的价值[ J].中华超声影像学杂志.2006,15(12),906-909.
[5]韩增辉,王建宏,钱蕴秋,等.小乳癌的高频声像图及能量多普勒血流特征[J].中国超声医学杂志,2001,17(7):500.
[6] Shukunami K,Nishijima K,Orisaka M,Tajima K,Kotsuji F.Galactocele of the breast in a postmenopausal woman[J].CurrSurg,2004,61:319.
[7] Ibitoye B O,Adetiloye V A,Aremu A A.The appearances of benign breast diseases on ultrasound [J].Niger J Med,2006,15:421-426.
[8]尤淑艳,杨光,黄欣.乳汁淤积60例超声诊断[J]..实用医技杂志2008,15(34).31.
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[11]许良中,乳腺病理学[M].上海:上海医科大学出版社,1998:45.
[12]Stavros AT,Thickman D,Rapp CL,et al.Solid breast nodules:use of sonographyto distinguish Between benign and malignant lesions.[J]Radiology,1995,196:123-124.
[13]李建初,袁光华等.血管和浅表器官彩色多普勒超声诊断学[J].北京医科大学、中国协和医科大学联合出版,1999.335.
[14]盘丽娟,肖萤,刘芳.超声弹性成像与彩色多普勒超声在乳腺占位性病变诊断中的对比研究[J].中国超声医学杂志.2010,26(2),124-127.
[15]白志勇,张武,苗立英等.三维超声重建冠状断面检查诊断乳腺良恶性肿物的探讨[J].中国医学影像技术.2002,18(4)355-357.
[16]董晓秋,邵小慧,胡成乙等.超声像素亮化处理技术在乳腺良恶性肿块诊断中的应用价值[J].中华超声影像学杂志.2009,18(4),329-331.
[17]江泉,赵玉华,俞颂革,等.乳腺肿块三维超声成像的临床应用[J].上海医学影像2005,14:104-106.
[18]Nariya C,Woo KM,Joo HC,et al.Differentiating benign from malignant solid breast masses:comparison of two-dimensional and three-dimensional[ J]. US.Radiology,2006,240(1):26-32.
[19]Levin M. Biology, eraly diagnosis ,prevention and management of eraly and Advanced breast cancer[J].Drug News Perspect Drug news &perspectives,2005, 18(3): 215-221.
[20]徐庆华,谭咏韶,朱广兴,等.二维彩色多普勒超声及三维超声成像对乳腺肿块的诊断价值[J].医学临床研究,2003,20:271-274.
[21]钱超文,徐栋,边晔萍,等.应用三维超声重建成像诊断乳腺癌[J].肿瘤防治,2005,17(6):374-376.
[22]李颖嘉,张云昆,周宴梅,等.超声造影微血管成像对乳腺良恶性肿瘤微血管构筑的评价[J].中国超声医学杂志.2009,25(6):559-563.
[23]Todd D,Btian J,Davia A,et al.Evaluation of palpable breast masses with color Dopple sonography and grau scale imaging[J]. UltrosoundMed, 1998,17:110-111.
[24]Orre M,Royers PA.Reduced vascular base-membrane immunstaining in mucinous tumors of the ovary[J] .Int J Cancer,1998,79:2139-2143.
[25] Schoenfeld A,Levavi H,Breslavski D,et al.Three-dimensional of tumor-induced ovarian angiogenesis[J].Cancer Lett,1994,87:79-84.
[26]O ffersen BV, Borre M, Overgaard J. Quantification of angiogenesis as a prognostic marker in human carcinomas: a critical evaluation of histopmethods for estimation of vascular density[J]. Eur J Cancer, 2003, 39 ( 7 ): 881-890.
[27]Ahlgren J, Risberg B, Villman K,et al. Angiogenesis in invasive breast Carcinoma a prospective study of tumor hetero-geneity[J]. Eur J Cancer, 2002, 38 ( 14 ): 64-69.
[28]Rizzatto GJ.Towards a more sophisticated use of breast ultrasound[ J]. EurRadiol,2001,11 (12):2425-2435.
[29]李春海,李克勤.肿瘤微血管生成的机制与肿瘤侵袭和转移[ J]..中华肿瘤杂志,2000,22:181-183.
[30]Folman J.The role of angiogenesis in tumor growth[J].Semin Cancer Biol,1992,3 (2):65-71.
[31]Fox SB,Gatter KC,Bickman R.Et,al. Relationship of endothelial cell proliferatirn to tumor Vascularity in human breast cancer[J].Cancer Res 1993,53:4161-4163.
[32]殷平,李文巨,李波,蒋晶.三维彩色血管能量成像诊断乳腺肿瘤的应用价值[J].中国肿瘤2006,15(5):335-337.
[33]Pezzella F.Evidence for novel non-angiogenic pathway in breast cancer tastasis[J]. Breast Cancer Progression Working Party Lancet.2000,355:1787-1788.
[34]Jay R.Horris,Marc E.Lippman,Monica,Morrow,C.Kent Osborne.Diseases of theBreast[M].The thirdedition. Shang dong:Shangdong Science and Technoligy Press. 2006: 405.
[1] Burbank F, Parker SH, Fogarty TJ. Stereotactic breast biopsy:improved tissue harvesting with the Mammotome[J].AmSurg,1996,62(9):738-744.
[2]王建东,黄利虹,杨敬春,等.Mammotome真空辅助旋切系统在乳腺良性肿块微创切除中的应用[J].中国肿瘤临床与康复,2007,14(3):239-241.
[3] Sperber F,Blank A,Metser U,et a1.Diagnosis and treatment of breast fibroadeno-mas by ultrasound-guided vacuum-assisted biopsy[J].Arch surg,2003,138:796-800.
[4]谢衡辉,章乐虹,杨学伟,等.Mammotome旋切术在乳腺良性疾病中的应用[J].国际医药卫生导报,2008,14(1):24-26.
[5]陈杏初,谢笃英,元国荣,等.Mammotome微创旋切乳腺肿块的临床思考[J].中国肿瘤防治杂志,2007,14(3):218-219.
[6] Kopas DS the positive predictive value of mammography .Am J Roentgenol 1992,158(3):521-526.
[7]肖丽周平李瑞珍,等.麦默通与Tru-cut活检针对乳腺肿块活检的对比分析[J],中南大学学报(医学版),2006, 31(3)417-419.
[8] Margolin FR,Leung JW,Jacobs RP,et al.Percutaneous im aging-guided core breast biopsy:5years' experience in a community hospital[J].AJR Am J Roentgenol, 2001 , 177:559-564.
[9] Lai JT, Burrowes P, MacGregor JH,et al.Vacuum-assisted large-core breast biopsy:complications and their incidence[J].Can Assoc RadiJ, 2000, 51 (4) :232-236.
[10]Fine RE,Whitw Orth PW,Kim JA,et al. Low-risk palpable breast masses rem oved using a vacuum-assisted hand-hold device[J].Am J Surg,2003,186(4):362-367.
[11]Iwuagwu OC, Calvey TA, Ilsley D, et al. Ultrasound guided minimally invasive breast surgery (UMIBS): a superior technique for gynecomastia [J].Ann Plast Surg,2004, 52(2 ): 131-133.
[12]张树平,邹燕鹏,邓素华,等.Mammotome微创手术与开放手术切除乳腺良性肿瘤75例分析[J].中国现代医生,2008,46(7):18-20.
[13]张林,吴亚群,王立平,等. Mammotome术诊断隐匿性病灶和非典型增生[J].中国现代医学医学杂志,2004,14(9):110-112.
[14]Weber WP,Zanetti R,Langer I,et al.Mammotome:less invasive than ABBI with similar ccuracy for early breast cancer detection[J].Worl J Surg,2005,29(4):495-499.
[15]LindforsKK, OC' onnor J,AcredoloCR, eta.l Short-interval follow-up ammo-graphyversus immediate core biopsy of benign breast lesions: assessment of patient stress [J].Am J Roentgeno,l 1998,171(1): 55-58.
[16]续哲莉,边学海,王瑞庆,等,Mammotome微创旋切系统治疗乳腺脓肿:附53例报告[J],中国普通外科杂志,2007,16(11):1063-1065.
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[2]田家玮,陈宇,刘宇杰。高频超声与X线钼靶联合应用对早期乳腺癌的诊断价值[J].中国医学影像技术,2006,22:557-559.
[3]沈德娟,杨斌.乳腺癌的超声诊断及其新进展[J].医学研究生学报,2007,20:203-206.
[4]周世崇,常才,陈敏,等.实时三维超声鉴别乳腺良恶性肿块的价值[ J].中华超声影像学杂志.2006,15(12),906-909.
[5]韩增辉,王建宏,钱蕴秋,等.小乳癌的高频声像图及能量多普勒血流特征[J].中国超声医学杂志,2001,17(7):500.
[6] Shukunami K,Nishijima K,Orisaka M,Tajima K,Kotsuji F.Galactocele of the breast in a postmenopausal woman[J].CurrSurg,2004,61:319.
[7] Ibitoye B O,Adetiloye V A,Aremu A A.The appearances of benign breast diseases on ultrasound [J].Niger J Med,2006,15:421-426.
[8]尤淑艳,杨光,黄欣.乳汁淤积60例超声诊断[J]..实用医技杂志2008,15(34).31.
[9]周永昌,郭万学主编.超声医学[M].第5版.北京:科学技术文献出版社,2006.149.
[10]Juan Rosai,外科病理学[M],第9版,北京:北京大学医学出版社,2006:1776-1777.
[11]许良中,乳腺病理学[M].上海:上海医科大学出版社,1998:45.
[12]Stavros AT,Thickman D,Rapp CL,et al.Solid breast nodules:use of sonographyto distinguish Between benign and malignant lesions.[J]Radiology,1995,196:123-124.
[13]李建初,袁光华等.血管和浅表器官彩色多普勒超声诊断学[J].北京医科大学、中国协和医科大学联合出版,1999.335.
[14]盘丽娟,肖萤,刘芳.超声弹性成像与彩色多普勒超声在乳腺占位性病变诊断中的对比研究[J].中国超声医学杂志.2010,26(2),124-127.
[15]白志勇,张武,苗立英等.三维超声重建冠状断面检查诊断乳腺良恶性肿物的探讨[J].中国医学影像技术.2002,18(4)355-357.
[16]董晓秋,邵小慧,胡成乙等.超声像素亮化处理技术在乳腺良恶性肿块诊断中的应用价值[J].中华超声影像学杂志.2009,18(4),329-331.
[17]江泉,赵玉华,俞颂革,等.乳腺肿块三维超声成像的临床应用[J].上海医学影像2005,14:104-106.
[18]Nariya C,Woo KM,Joo HC,et al.Differentiating benign from malignant solid breast masses:comparison of two-dimensional and three-dimensional[ J]. US.Radiology,2006,240(1):26-32.
[19]Levin M. Biology, eraly diagnosis ,prevention and management of eraly and Advanced breast cancer[J].Drug News Perspect Drug news &perspectives,2005, 18(3): 215-221.
[20]徐庆华,谭咏韶,朱广兴,等.二维彩色多普勒超声及三维超声成像对乳腺肿块的诊断价值[J].医学临床研究,2003,20:271-274.
[21]钱超文,徐栋,边晔萍,等.应用三维超声重建成像诊断乳腺癌[J].肿瘤防治,2005,17(6):374-376.
[22]李颖嘉,张云昆,周宴梅,等.超声造影微血管成像对乳腺良恶性肿瘤微血管构筑的评价[J].中国超声医学杂志.2009,25(6):559-563.
[23]Todd D,Btian J,Davia A,et al.Evaluation of palpable breast masses with color Dopple sonography and grau scale imaging[J]. UltrosoundMed, 1998,17:110-111.
[24]Orre M,Royers PA.Reduced vascular base-membrane immunstaining in mucinous tumors of the ovary[J] .Int J Cancer,1998,79:2139-2143.
[25] Schoenfeld A,Levavi H,Breslavski D,et al.Three-dimensional of tumor-induced ovarian angiogenesis[J].Cancer Lett,1994,87:79-84.
[26]O ffersen BV, Borre M, Overgaard J. Quantification of angiogenesis as a prognostic marker in human carcinomas: a critical evaluation of histopmethods for estimation of vascular density[J]. Eur J Cancer, 2003, 39 ( 7 ): 881-890.
[27]Ahlgren J, Risberg B, Villman K,et al. Angiogenesis in invasive breast Carcinoma a prospective study of tumor hetero-geneity[J]. Eur J Cancer, 2002, 38 ( 14 ): 64-69.
[28]Rizzatto GJ.Towards a more sophisticated use of breast ultrasound[ J]. EurRadiol,2001,11 (12):2425-2435.
[29]李春海,李克勤.肿瘤微血管生成的机制与肿瘤侵袭和转移[ J]..中华肿瘤杂志,2000,22:181-183.
[30]Folman J.The role of angiogenesis in tumor growth[J].Semin Cancer Biol,1992,3 (2):65-71.
[31]Fox SB,Gatter KC,Bickman R.Et,al. Relationship of endothelial cell proliferatirn to tumor Vascularity in human breast cancer[J].Cancer Res 1993,53:4161-4163.
[32]殷平,李文巨,李波,蒋晶.三维彩色血管能量成像诊断乳腺肿瘤的应用价值[J].中国肿瘤2006,15(5):335-337.
[33]Pezzella F.Evidence for novel non-angiogenic pathway in breast cancer tastasis[J]. Breast Cancer Progression Working Party Lancet.2000,355:1787-1788.
[34]Jay R.Horris,Marc E.Lippman,Monica,Morrow,C.Kent Osborne.Diseases of theBreast[M].The thirdedition. Shang dong:Shangdong Science and Technoligy Press. 2006: 405.
[1] Burbank F, Parker SH, Fogarty TJ. Stereotactic breast biopsy:improved tissue harvesting with the Mammotome[J].AmSurg,1996,62(9):738-744.
[2]王建东,黄利虹,杨敬春,等.Mammotome真空辅助旋切系统在乳腺良性肿块微创切除中的应用[J].中国肿瘤临床与康复,2007,14(3):239-241.
[3] Sperber F,Blank A,Metser U,et a1.Diagnosis and treatment of breast fibroadeno-mas by ultrasound-guided vacuum-assisted biopsy[J].Arch surg,2003,138:796-800.
[4]谢衡辉,章乐虹,杨学伟,等.Mammotome旋切术在乳腺良性疾病中的应用[J].国际医药卫生导报,2008,14(1):24-26.
[5]陈杏初,谢笃英,元国荣,等.Mammotome微创旋切乳腺肿块的临床思考[J].中国肿瘤防治杂志,2007,14(3):218-219.
[6] Kopas DS the positive predictive value of mammography .Am J Roentgenol 1992,158(3):521-526.
[7]肖丽周平李瑞珍,等.麦默通与Tru-cut活检针对乳腺肿块活检的对比分析[J],中南大学学报(医学版),2006, 31(3)417-419.
[8] Margolin FR,Leung JW,Jacobs RP,et al.Percutaneous im aging-guided core breast biopsy:5years' experience in a community hospital[J].AJR Am J Roentgenol, 2001 , 177:559-564.
[9] Lai JT, Burrowes P, MacGregor JH,et al.Vacuum-assisted large-core breast biopsy:complications and their incidence[J].Can Assoc RadiJ, 2000, 51 (4) :232-236.
[10]Fine RE,Whitw Orth PW,Kim JA,et al. Low-risk palpable breast masses rem oved using a vacuum-assisted hand-hold device[J].Am J Surg,2003,186(4):362-367.
[11]Iwuagwu OC, Calvey TA, Ilsley D, et al. Ultrasound guided minimally invasive breast surgery (UMIBS): a superior technique for gynecomastia [J].Ann Plast Surg,2004, 52(2 ): 131-133.
[12]张树平,邹燕鹏,邓素华,等.Mammotome微创手术与开放手术切除乳腺良性肿瘤75例分析[J].中国现代医生,2008,46(7):18-20.
[13]张林,吴亚群,王立平,等. Mammotome术诊断隐匿性病灶和非典型增生[J].中国现代医学医学杂志,2004,14(9):110-112.
[14]Weber WP,Zanetti R,Langer I,et al.Mammotome:less invasive than ABBI with similar ccuracy for early breast cancer detection[J].Worl J Surg,2005,29(4):495-499.
[15]LindforsKK, OC' onnor J,AcredoloCR, eta.l Short-interval follow-up ammo-graphyversus immediate core biopsy of benign breast lesions: assessment of patient stress [J].Am J Roentgeno,l 1998,171(1): 55-58.
[16]续哲莉,边学海,王瑞庆,等,Mammotome微创旋切系统治疗乳腺脓肿:附53例报告[J],中国普通外科杂志,2007,16(11):1063-1065.
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