常用影像學檢查方法在乳腺癌診斷中的應用及進展

孫哲 李艷翠

[摘要] 乳腺癌是女性最常見的惡性腫瘤之一。早發現、早診斷是乳腺癌治療的關鍵。影像學檢查在乳腺癌早期診斷及療效評估中起重要作用，常用的影像學檢查方法包括乳腺鉬靶X線攝影、超聲、磁共振成像。近年來，數字化乳腺斷層X線檢查、超聲彈性成像、超聲造影及乳腺磁共振波譜成像、灌注成像、擴散峰度成像等新技術、新方法逐步應用于臨床工作中。同時，分子影像學及基于機器學習的計算機輔助診斷技術飛速發展及應用，影像組學逐漸應用于乳腺癌診斷中，使乳腺疾病影像檢查方法的診斷效率顯著提高，一定程度上提高了乳腺癌早期診斷的敏感度和特異度。本文對目前乳腺疾病常用的影像學檢查方法及最新進展進行綜述。

[關鍵詞] 乳腺癌;數字化乳腺斷層X線檢查;超聲;磁共振成像;影像組學

[中圖分類號] R737.9? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-9701（2022）05-0192-05

[Abstract] Breast cancer is one of the most common malignant tumors in women. Early detection and early diagnosis is the key to the treatment of breast cancer.Imaging examination plays an important role in the early diagnosis and efficacy evaluation of breast cancer. The commonly used imaging examination methods include mammography， ultrasound and magnetic resonance imaging（MRI）.In recent years， digital tomographic mammography， ultrasound elastography， contrast-enhanced ultrasound and magnetic resonance spectroscopy imaging， perfusion imaging， diffusion kurtosis imaging and other new technologies and methods have been gradually applied in clinical work. At the same time， with the rapid development and application of molecular imaging and computer aided diagnosis technology based on machine learning， radiomics is gradually applied to the diagnosis of breast cancer， which significantly improves the diagnostic efficiency of breast disease imaging examination methods， and to some extent improves the sensitivity and specificity of early diagnosis of breast cancer. In this paper， the common imaging examination methods and the latest progress of breast diseases were reviewed.

[Key words] Breast cancer; Digital tomographic mammography; Ultrasound; Magnetic resonance imaging; Radiomics

近年來，乳腺癌發病率及死亡率呈上升趨勢，且患病人群逐漸年輕化，引起世界范圍內廣泛關注。2020年全球乳腺癌新增病例約230萬例，成為女性發病率最高的惡性腫瘤[1]，嚴重威脅女性生命健康。早期乳腺癌治愈率達90%以上，早發現、早診斷對乳腺癌的預后極為重要。影像學檢查是乳腺癌早期診斷的主要手段，常用的方法有鉬靶X線攝影、多普勒超聲、磁共振成像檢查。隨著乳腺癌診療要求的提高及醫學影像技術的進步，數字化斷層X線檢查、超聲彈性成像、超聲造影、磁共振波譜成像等新技術逐步應用于臨床工作中。……