Emory University, Atlanta, Georgia, USA.
J Am Coll Radiol. 2010 Dec;7(12):920-30. doi: 10.1016/j.jacr.2010.07.006.
Screening mammography can detect breast cancer before it becomes clinically apparent. However, the screening process identifies many false-positive findings for each cancer eventually confirmed. Additional tools are available to help differentiate spurious findings from real ones and to help determine when tissue sampling is required, when short-term follow-up will suffice, or whether the finding can be dismissed as benign. These tools include additional diagnostic mammographic views, breast ultrasound, breast MRI, and, when histologic evaluation is required, percutaneous biopsy. The imaging evaluation of a finding detected at screening mammography proceeds most efficiently, cost-effectively, and with minimization of radiation dose when approached in an evidence-based manner. The appropriateness of the above-referenced tools is presented here as they apply to a variety of findings often encountered on screening mammography; an algorithmic approach to workup of these potential scenarios is also included. The recommendations put forth represent a compilation of evidence-based data and expert opinion of the ACR Appropriateness Criteria(®) Expert Panel on Breast Imaging.
乳腺 X 线筛查能够在乳腺癌临床症状出现之前检测出肿瘤。然而，筛查过程会发现许多假阳性结果，最终被证实为假阳性。目前有多种其他的辅助工具可以帮助鉴别假阳性与真实肿瘤，并且有助于判断何时需要进行组织取样，何时进行短期随访，或者该发现是否可以被判断为良性。这些工具包括附加的诊断性乳腺 X 线摄影、乳腺超声、乳腺 MRI 检查，以及当需要进行组织学评估时，经皮穿刺活检。采用基于证据的方法，对筛查性乳腺 X 线摄影发现的病灶进行影像学评估，可以使评估过程最有效、最具成本效益，并且辐射剂量最小。本文将介绍上述工具的适用性，适用于在筛查性乳腺 X 线摄影中经常遇到的各种病灶；还包括这些潜在情况的检查方法的算法。提出的建议是基于基于证据的数据和 ACR 适宜性标准(®)乳腺成像专家小组的专家意见综合而成。
