Bidlek Mária, Kovács Eszter, Fehér Krisztina, Gõdény Mária
Radiológiai Diagnosztikai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
Department of Postgraduate Education and Scientific Research, University of Medicine and Pharmacy, Tirgu Mures, Romania.
Magy Onkol. 2015 Mar;59(1):44-55. Epub 2014 Oct 13.
Complex tumor therapy development and new opportunities in surgery, which take into account both oncological principles as well as esthetic aspects, have set the requirements far higher for diagnostic imaging of the breast and for radiologists. Despite these new opportunities, X-ray mammography remains the basic examination. However, part of the cancers is hidden on the mammogram, which is partly a consequence of the dense glandular tissue and may also be influenced by the histological type of cancer. Besides reducing radiation dose, digital X-ray mammography improves the examination sensitivity of the dense breast. State of the art digital examination methods, such as tomosynthesis and contrast-enhanced mammography, increase the accuracy of examination. Ultrasound mammography is the most important supplementary method of X-ray mammography. Among the new applications of ultrasound mammography, US elastography, which is based on different tissue elasticity, as well as automatic 3D ultrasound, can be highlighted. Furthermore, among imaging methods that provide functional or metabolic data, MR mammography is the most appropriate non-invasive, non-ionising method for the detection of malignancy and for structure examination. MR mammography is the most sensitive method for the detection of breast cancer and in 20-30% of cases, results in changes of the therapy, and it is also effective in the examination of the dense breast. High level of evidence proves that MR mammography is very useful in the screening of women at risk of breast cancer. Promising results prove that MR mammography will play more considerable role in the evaluation of the effectiveness of the therapy. Diffusion-weighted MR imaging is based on the different diffusion of tissue water, qualitative analysis and quantitative evaluation can be performed. DCE-MR examines that contrast enhancement over time, which can mainly be useful for the qualitative and quantitative evaluation of perfusion changes which may indicate the biological response to tumor therapy. The MR spectroscopic (MRSI) biochemical analysis increases the characterization of the lesions. Multimodal imaging techniques provide more accurate analysis, which is confirmed by more and more evidence, but none of the imaging methods are sufficiently specific to provide histological diagnosis. However, imaging-guided biopsies enable precise histological or cytological confirmation. Technical development, new imaging methods, experienced radiologists and multi-disciplinary cooperation increase the accuracy of the diagnosis and the effectiveness of personalized therapy.
复杂肿瘤治疗的发展以及兼顾肿瘤学原则和美学方面的外科手术新机遇,对乳腺诊断成像和放射科医生提出了更高要求。尽管有这些新机遇,但乳腺X线摄影仍然是基本检查方法。然而,部分癌症在乳腺X线片上是隐匿的,这部分是致密腺组织的结果,也可能受癌症组织学类型影响。除了降低辐射剂量外,数字乳腺X线摄影还提高了致密乳腺的检查敏感性。断层合成和对比增强乳腺摄影等先进数字检查方法提高了检查准确性。超声乳腺摄影是乳腺X线摄影最重要的补充方法。在超声乳腺摄影的新应用中,可以突出基于不同组织弹性的超声弹性成像以及自动三维超声。此外,在提供功能或代谢数据的成像方法中,磁共振乳腺成像对于检测恶性肿瘤和进行结构检查而言是最合适的非侵入性、非电离方法。磁共振乳腺成像是检测乳腺癌最敏感的方法,在20%至30%的病例中会导致治疗方案改变,并且在致密乳腺检查中也很有效。高水平证据证明磁共振乳腺成像在筛查乳腺癌高危女性方面非常有用。有前景的结果证明磁共振乳腺成像将在评估治疗效果中发挥更重要的作用。扩散加权磁共振成像基于组织水的不同扩散,可以进行定性分析和定量评估。动态对比增强磁共振成像检查对比剂随时间的增强情况,这主要有助于对灌注变化进行定性和定量评估,而灌注变化可能表明对肿瘤治疗的生物学反应。磁共振波谱(MRSI)生化分析增强了病变的特征描述。多模态成像技术提供了更准确的分析,越来越多的证据证实了这一点,但没有一种成像方法具有足够的特异性来提供组织学诊断。然而,成像引导活检能够实现精确的组织学或细胞学确诊。技术发展、新的成像方法以及经验丰富放射科医生和多学科合作提高了诊断准确性和个性化治疗效果。