X线乳腺摄影的一些概念错误,按在文中出现早晚,一并列于下,供编辑参考:
1、“钼靶X线检查”应称为“X线乳腺摄影(X-ray Mammography”。
2、“丛状微小钙化”应称为“成簇微小钙化”。
3、“乳腺癌的征象主要包括常见征象、特殊征象与合并征象。其中,常见征象包括肿块、钙化和结构扭曲;特殊征象包括非对称性管状结构、单个扩张的导管、乳腺内淋巴结、团状不对称和局灶性不对称;合并征象包括皮肤凹陷、乳头凹陷、皮肤增厚、小梁增粗、皮肤病变投照在乳腺组织中、腋淋巴结肿大等。”应改为“乳腺癌的征象主要包括直接征象、特殊征象与间接征象。其中,直接征象包括肿块、钙化和结构扭曲;特殊征象包括非对称性管状结构、单个扩张的导管、乳腺内淋巴结、团状不对称和局灶性不对称;间接征象包括皮肤凹陷、乳头凹陷、皮肤增厚、小梁增粗、皮肤病变投照在乳腺组织中、腋淋巴结肿大等。”
4、“局部加压摄影”应称为“点压摄影”。如果加上放大摄影,可称为“点压放大摄影”。
5、“密度是以肿块与其周围相同体积的乳腺组织相比,分为高、等、低和脂肪密度四种描述。乳腺癌不含脂肪密度,脂肪密度为良性表现。大多数乳腺癌呈高或等密度,形态不规则,边缘为小分叶、浸润或星芒状的肿块影。”应称为“密度是以肿块与其周围相同体积的乳腺组织相比,分为密度增高、密度中等、密度减低和脂肪密度四种描述。乳腺癌不含脂肪密度,脂肪密度为良性表现。大多数乳腺癌肿块影呈密度增高、密度中等表现,形态不规则,边缘为小分叶、浸润或星芒状。”
6、“铸形钙化”应称作“铸型钙化”。
7、“LeGal’s等则将乳腺癌钙化的表现分为以下5型:①粗颗粒型,钙化点直径在0.5mm左右,形态规则或不规则。②蠕虫样钙化,呈弯曲、直线样或叉样微小钙化,长度约1mm左右。③泥沙型,直径小于0.5mm,呈细沙样。④混合型,以上2种或2种以上类型同时存在。⑤融合型,多个微钙化点相互融合,形成更大的钙化灶。”与我所能看到的文献描述有出入。作者名字应为“Le Gal s等”。并非“将乳腺癌钙化的表现分为以下5型”,而是将227例临床不能扪及肿块的微钙化(根据该论文标题,均为成簇钙化clustered microcalcifications,何注)进行分析,其中99例良性,27例交界性,101例恶性。现评审文中的5个类型的名称只有蠕虫样钙化是对的,其他全错,并且蠕虫样钙化排列序号也错误。
8、钙化的分布包括以下五种方式中,“簇状分布”应称作“成簇分布”(何注:意为成堆的分布,为了将分布和形状的表达有所区别,建议对分布避免用“状”来表达)。
何注:关于钙化,建议作者看看我的文章(何之彦, 陈海曦, 姚戈虹等. 乳线钙化的X线影像评价. 中国医学计算机成像杂志 2007; 13:332-337),特别强调观察钙化着重两方面:(1)钙化的形态和与之关联的密度;(2)钙化的分布特点。我讲的分布把五种分布简化为两种,即(1)散在(Scattered) 或区段(segmental)分布;(2)成簇(Cluster)或局限分布。线样分布较特殊。钙化的形态分成了多种,如铸型(包含条状、分支状、短棒状、线样和蠕虫状)、点状(小于0.5mm直径被称作细点状,大于或等于0.5mm直径则称为圆点状)、新月状、环状、斑点状、双轨状、不定形等。注意,钙化形状中没有“泥沙样”的描述。后附原文摘要。
9、“乳腺影像学检查始于20世纪60年代”,说法是错误的。在1930年代,一位德国医生就开始尝试乳腺摄影。
10、“随着放大摄影、局部压迫摄影、辗平摄影术等新技术的广泛应用”,提法不准确,这些技术已经不是新技术了。
附:
Le Gal M, Chavanne G, Pellier D. Diagnostic value of clustered microcalcifications discovered by mammography (apropos of 227 cases with histological verification and without a palpable breast tumor)[Article in French]. Bull Cancer. 1984;71(1):57-64.
Excisions with histological examination were performed in 227 cases of breast microcalcifications without palpable tumor. 99 benign lesions, 27 borderline lesions and 101 carcinomas, 58 of them in situ, were found. Different radiological parameters were studied in relation to histological results: According to the morphology of the calcifications, a classification of 5 types was made. Type 1: annular: 100 per cent were benign lesions. Type 2: regularly punctiform: 22 per cent were malignant lesions. Type 3: too fine for precizing the shape: 40 per cent were malignant lesions. Type 4: irregularly punctiform: 66 per cent were malignant lesions. Type 5: vermicular: 100 per cent of the lesions were malignant. The number of calcifications was higher in carcinomas and 56 per cent of the lesions with more than 30 calcifications were malignant. Close grouping: when there were more than 10 calcifications within a 5 mm diameter area, 57 per cent of malignant lesions were found. Several clusters: 70 per cent were correlated with malignant lesions. Uneven sizes: no signification. Location: the rare retroareolar location correlated with benign lesions in 64 per cent of the cases. Furthermore, the malignant lesions were rare (24%) in women under 40 years of age. For these young women, the authors suggest to directly excise the most suspicious microcalcifications as based on the factors of suspicion and to simply follow the other cases.
PMID: 6713115 [PubMed - indexed for MEDLINE]