Huynh P T, Jarolimek A M, Daye S
Department of Radiology, University of Texas Health Science Center, Houston 77030, USA.
Radiographics. 1998 Sep-Oct;18(5):1137-54; quiz 1243-4. doi: 10.1148/radiographics.18.5.9747612.
In general, failure to detect or correctly characterize breast cancer can be attributed to one of four main factors: inherent limitations of screen-film mammography, inadequate radiographic technique, subtle or unusual lesion characteristics, and interpretation error. The restricted latitude and display contrast of screen-film mammography are among the significant factors that result in decreased visualization of breast tumors and microcalcifications in patients with dense fibroglandular tissue. Unlike the inherent limitations of screen-film mammography, a poor radiographic technique can be improved on and should be eliminated. Crucial components of a well-performed mammographic examination are correct positioning, adequate compression, and proper image exposure. Lesion characteristics that may lead to a false-negative mammogram include small size, a site where visualization is difficult, visualization on only one view, a benign or probably benign appearance, lack of a desmoplastic reaction, and slow or no apparent growth. Causes of interpretation error include suboptimal viewing conditions, outside distractions, lack of a systematic approach, oversight of a subtle lesion because of an obvious finding, lack of knowledge of clinical findings, imprecise correlation with results of other studies, and nonbelief. Recognition of these various factors should help decrease the rate of false-negative mammograms.
一般来说，未能检测到乳腺癌或对其进行正确的特征描述可归因于四个主要因素之一：屏-片乳腺摄影的固有局限性、放射技术不足、病变特征细微或不寻常以及解读错误。屏-片乳腺摄影有限的宽容度和显示对比度是导致致密纤维腺组织患者乳腺肿瘤和微钙化显示减少的重要因素。与屏-片乳腺摄影的固有局限性不同，不良的放射技术是可以改进并应消除的。一次良好的乳腺摄影检查的关键要素是正确的体位、足够的压迫和适当的图像曝光。可能导致乳腺摄影假阴性的病变特征包括尺寸小、难以显示的部位、仅在一个投照位上显示、良性或可能为良性的外观、缺乏促纤维增生反应以及生长缓慢或无明显生长。解读错误的原因包括观察条件不佳、外界干扰、缺乏系统方法、因明显发现而忽略细微病变、对临床发现缺乏了解、与其他检查结果的相关性不准确以及不相信等。认识到这些不同因素应有助于降低乳腺摄影假阴性率。
