Bassett L W, Manjikian V, Gold R H
UCLA School of Medicine.
Surg Clin North Am. 1990 Aug;70(4):775-800. doi: 10.1016/s0039-6109(16)45181-9.
Breast radiography should be performed only with film-screen mammography or xeromammography. At least two views of each breast should be obtained, and for film-screen mammography, at least one of these should be the oblique view. Quality assurance is becoming a significant concern in breast cancer screening. The ACR Mammography Accreditation Program takes into account the qualifications of the personnel, the performance of the x-ray equipment, and a peer review of the final product: the diagnostic image. The mammographic signs of malignancy can be divided into primary, secondary, and indirect. The accuracy of mammography depends on several factors, but the greatest limitation is the density of the breast tissue. Very dense tissue makes detection of breast cancer difficult, and a negative mammogram should never deter one from a biopsy of a clinically suspect mass. New consensus guidelines for breast cancer screening were developed to bring uniformity to the recommendations of the American Cancer Society, the National Cancer Institute, and various professional medical societies. These new guidelines reflect the encouraging results from recent clinical trials, as well as some discouraging reports on breast self-examination and the baseline mammogram. The underutilization of screening mammography is a problem of significant concern to both private and public health agencies. Barriers to mammographic screening include lack of awareness of the benefits of screening, physicians' misconceptions about patient compliance, concerns about radiation risk and overdiagnosis, fear of mastectomy, a perception that a mammogram involves great discomfort, and relatively high cost. Nationwide educational programs are under way to counter misconceptions about mammography, and various strategies are evolving to overcome the other barriers. Sonography is a useful adjunct to mammography for cyst-solid differentiation, but mammography is the only imaging modality effective for the early detection of breast cancer.
乳腺摄影应仅采用屏-片乳腺摄影或干板乳腺摄影。每个乳房至少应摄取两个体位的影像，对于屏-片乳腺摄影，其中至少应有一个为斜位。质量保证正成为乳腺癌筛查中的一个重要问题。美国放射学会（ACR）乳腺摄影认证项目考虑人员资质、X线设备性能以及对最终产品——诊断影像的同行评审。恶性肿瘤的乳腺摄影征象可分为直接征象、间接征象和次要征象。乳腺摄影的准确性取决于多个因素，但最大的限制是乳腺组织的密度。乳腺组织致密会使乳腺癌的检测变得困难，乳腺摄影阴性结果绝不应妨碍对临床可疑肿块进行活检。新的乳腺癌筛查共识指南旨在使美国癌症协会、美国国立癌症研究所及各专业医学学会的建议趋于统一。这些新指南反映了近期临床试验的鼓舞人心的结果，以及一些关于乳房自我检查和基线乳腺摄影的令人沮丧的报告。乳腺摄影筛查的利用不足是私立和公共卫生机构都非常关注的一个问题。乳腺摄影筛查的障碍包括对筛查益处缺乏认识、医生对患者依从性的误解、对辐射风险和过度诊断的担忧、对乳房切除术的恐惧、认为乳腺摄影会带来极大不适以及费用相对较高。全国范围内正在开展教育项目以消除对乳腺摄影的误解，并且正在制定各种策略以克服其他障碍。超声检查是乳腺摄影用于鉴别囊肿和实性病变的有用辅助手段，但乳腺摄影是早期发现乳腺癌的唯一有效成像方式。
