Traditional Culture Encyclopedia - Photography and portraiture - Clinical application and limitation of mammography

Clinical application and limitation of mammography

Imaging examination is the most important examination method for breast cancer, which can find early breast cancer with negative clinical palpation; For patients with clinical symptoms, imaging examination can be used to understand the characteristics of lesions and distinguish between benign and malignant; Accurate staging of patients diagnosed with breast cancer and follow-up after treatment; It can also show the biological behavior of the tumor by comparing the imaging findings with other clinical indicators. The commonly used examination methods are mammography and ultrasound, and the clinical application of breast MRI is becoming more and more extensive. Mammography is mainly used for screening and diagnosis of breast cancer, and it is the most basic and preferred imaging method for breast diseases. It can detect early breast cancer with negative clinical palpation, especially in detecting breast cancer with calcification as the main manifestation, which has irreplaceable advantages. For patients with clinical symptoms, mammography can understand the characteristics of lesions and distinguish benign from malignant. Mammography is mainly used in two aspects: screening mammography and diagnostic mammography.

(1) mammography is a routine imaging examination for asymptomatic people with the aim of early detection of breast cancer. If anything suspicious is found, further examination or treatment should be suggested.

Breast cancer can be found early through organized breast cancer screening, and effective screening can reduce the mortality rate of breast cancer. In many countries, X-ray photography has been widely used in breast cancer screening for women over 40 years old, and it is the only screening method that has been proved to reduce breast cancer mortality. In China, asymptomatic women over 40 years old are generally advised to have mammography screening. Screening of general population can be based on clinical palpation and ultrasound, and mammography can be performed every 1~2 years, and mammography can be performed every year for high-risk population.

(2) Diagnostic mammography: mammography is performed on patients with abnormal changes or symptoms and signs of breast diseases found by screening, so as to provide more clinical information. The main indications include ① breast mass, sclerosis, abnormal nipple discharge, abnormal skin, local pain or swelling; ② Abnormal changes found by screening; ③ Short-term follow-up of benign findings; ④ Guiding interventional surgery; ⑤ Patients after breast repair and reconstruction; ⑥ Follow-up after treatment of breast tumor; ⑦ Other patients who need radiology examination or consultation.

Mammography is simple, relatively cheap and has high diagnostic accuracy. If you master the correct projection technology and diagnostic skills, you can make an early diagnosis of breast cancer. Refers to a space occupying lesion that can be seen in two different projection positions. The characteristic analysis of the mass includes three aspects: shape (round, oval, lobulated and irregular), edge (clear, fuzzy, slightly lobulated, infiltrated and burr-like) and density (high density, equal density, low density and fat density). The edge of the mass is the most important to diagnose the nature of the lesion, and tiny lobulation, infiltration and burr-like edge are malignant signs. Benign masses usually have clear edges. Most breast cancers show high or equal density, and a few breast cancers can show low density; Breast cancer does not contain fat density, and a lump with fat density must be benign.

Figure 1 Oblique radiograph of the medial side of the right breast shows lobulated high-density nodules in the upper quadrant of the right breast with burrs at the edge, suggesting highly suspicious malignant lesions. Postoperative pathology: breast cancer. The characteristics of calcification were analyzed from two aspects: morphology and distribution.

Morphology: It can be divided into three types: typical benign calcification, moderate calcification (suspected calcification) and high malignant calcification. (1) Typical benign calcification: including skin calcification, vascular calcification, rough or popcorn calcification, thick rod calcification, round and punctate calcification, "ring" or "eggshell calcification", milk-like calcification, suture calcification and hollow malnutrition calcification. (2) Intermediate calcification (suspected calcification): including amorphous or fuzzy calcification and rough uneven calcification. (3) Highly malignant possible calcification: including tiny pleomorphic calcification, linear or fine-line branching calcification (mold calcification). Fine-line branch calcification is thin, irregular and linear, often discontinuous, and its diameter is less than 0.5 mm These signs suggest that calcification is formed by the catheter lumen invaded by breast cancer.

Distribution: including dispersed or dispersed distribution, regional distribution, aggregated distribution, linear distribution and segmented distribution. Among them, linear and segmental distribution often suggests that the lesions come from breast ducts, mostly malignant calcification, but a few benign calcification are distributed along the ducts. Benign and malignant calcification can be clustered, which should be considered in combination with calcification morphology. Locally distributed calcification means that calcification is distributed in a large range, not according to the catheter, and the possibility of malignancy is relatively small, but it also needs to be considered comprehensively in combination with calcification morphology. Diffuse or sporadic calcification is the lowest possibility of malignancy, especially the punctate and amorphous calcification of this distribution, which is often benign and often bilateral.

Fig. 2 irregular nodules in the upper quadrant of the right breast can be seen in the medial oblique position and lateral oblique position of the right breast, and small pleomorphic calcification clusters distributed in and around them suggest highly suspicious malignant lesions. Postoperative pathology: breast cancer. Often combined with mass or calcification signs, or change alone, no other abnormal signs. Including: skin depression, nipple depression, skin thickening, trabecular thickening, skin lesions projected on breast tissue, axillary lymph node enlargement and so on.