Zhou X H, Gordon R
Department of Electrical Engineering, University of Manitoba, Winnipeg, Canada.
Crit Rev Biomed Eng. 1989;17(3):203-55.
Detection and treatment of breast cancer at an early stage is the only method with proven potential for lowering the death rate from this disease. Detection of early breast cancer is promoted by the American Cancer Society, American College of Radiology, and Canadian Association of Radiologists by encouraging the regular use of three types of screening: breast self-examination, clinical breast examination, and mammography. When all factors are considered, it has been convincingly demonstrated that the potential benefits of mammography far outweigh the minimal, clinically undetected radiation risk incurred by the examination. New technologies, such as computed tomography, magnetic resonance imaging, transillumination diaphanography, ultrasound, thermography, and digital subtraction angiography might offer a wide selection for patient examination. However, none of these procedures, in its present form, is expected to replace mammography as the first-line imaging technique for the detection and diagnosis of benign and malignant breast lesions. Breast cancer is detected now, in most cases, via casual or informed breast self-examination. This first-line of detection is not sufficient, since most tumors may metastasize before they reach a palpable size. Mammography generally shows up tumors no smaller than 1-cm diameter, which in many cases have already metastasized. The more advanced imaging modalities in their current forms suffer from a number of drawbacks that give them a lower overall detection rate than mammography. Understandably, improving breast imaging modalities is a great challenge to diagnostic radiology. The purpose of this article is to provide a comprehensive overview of the detection of early breast cancer. It briefly discusses the understanding of breast cancer, its incidence, and the mortality and survival of patients with breast cancer, as well as screening programs for breast cancer. We review the developments in mammography and other breast imaging modalities over the last several years. Prospects for digital mammography, digital image enhancement, and three-dimensional digital subtraction mammography, which may someday supplant film mammography, are also discussed.
早期发现和治疗乳腺癌是唯一已被证实有可能降低该病死亡率的方法。美国癌症协会、美国放射学会和加拿大放射学家协会通过鼓励定期进行三种筛查来推动早期乳腺癌的检测：乳房自我检查、临床乳房检查和乳房X线摄影。综合考虑所有因素后，有令人信服的证据表明，乳房X线摄影的潜在益处远远超过该检查所带来的极小的、临床上难以察觉的辐射风险。计算机断层扫描、磁共振成像、透照式乳腺造影、超声、热成像和数字减影血管造影等新技术可能为患者检查提供多种选择。然而，就目前的形式而言，这些检查方法都预计无法取代乳房X线摄影，成为检测和诊断乳腺良恶性病变的一线成像技术。目前，大多数乳腺癌病例是通过偶然或有针对性的乳房自我检查发现的。这种一线检测方法并不充分，因为大多数肿瘤在达到可触及大小之前可能已经发生转移。乳房X线摄影通常能显示直径不小于1厘米的肿瘤，而在许多情况下，这些肿瘤已经发生转移。目前形式的更先进的成像方式存在许多缺点，导致它们的总体检测率低于乳房X线摄影。可以理解的是，改进乳腺成像方式对诊断放射学来说是一项巨大的挑战。本文的目的是全面概述早期乳腺癌的检测。它简要讨论了对乳腺癌的认识、其发病率、乳腺癌患者的死亡率和生存率，以及乳腺癌筛查项目。我们回顾了过去几年乳房X线摄影和其他乳腺成像方式的发展。还讨论了数字乳房X线摄影、数字图像增强和三维数字减影乳房X线摄影的前景，这些技术有朝一日可能会取代胶片乳房X线摄影。
